How Do You Get Lumbar Spinal Stenosis?

Lumbar Spinal Stenosis: Part 2

	Richard G. Fessler, MD, PhD Professor of Neurological Surgery Northwestern University Chicago, IL, USA
	Kristine M. Khoo, RN, MSN, NP Acute Care Nurse Practitioner Chicago Institute of Neurosurgery and Neuroresearch Chicago, IL, USA
	Larry T. Khoo, MD CoDirector UCLA Comprehensive Spine Center Los Angeles, CA, USA

Though we don't know why some people develop symptoms of spinal stenosis and others do not, we do know that some people are born with the predisposition towards it. In normal development, the spinal canal reaches adult size by about age four. If the canal does not reach adequate size by this age, then it will never "catch up" and spinal stenosis results and occurs uniformly throughout the spine (Figure 2a).

discs, normal and abnormal

Figure 2a

With this type of stenosis, you may remain symptom free until other conditions further compromise the canal space. Such conditions include formation of extra bony growths (osteophytes), trauma, or intervertebral disc problems. Others may develop stenosis without this predisposition but can instead "acquire" it through trauma, degenerative changes (osteophytes), bulging of the large connective "band" (ligamentum flavum), and most commonly by spondylosis.

As we age our body begins to dehydrate. This process causes our intervertebral discs to dry out thus decreasing the area of cushioning between each vertebra. Normally our discs separate each vertebra, act as shock absorbers during regular activity, and allow our spine to move freely. A decrease in the area of cushioning leads to trauma of our vertebrae and formation of osteophytes. This condition is referred to as Spondylosis. Several of these changes are demonstrated in Figure 2b.

Figure 2b

Figure 2c demonstrates changes from the normal anatomy to those found in lumbar and foraminal; stenosis.

Figure 2c

The vertebrae are connected in the back by the bony facets and intervening pars interarticularis. These structures in combination with the intervertebral disc help to interlock each level of the spine. Degeneration, spondylosis, and some congenital conditions can cause these joints to progressively fail. Eventually, a vertebra can slip forward and compromise either the central canal space and/or the opening through which the nerve root exits the spinal canal (foramina). This condition is called spondylolisthesis (Figure 3). It is more prominent in groups of people with who place a lot of stress on their backs including manual laborers, heavy machine operators, and professional athletes.

x-ray, thinning disc

Figure 3

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Article written 11/13/2000
Published online 10/30/2000
Last updated 09/15/2009

This study gives an excellent overview of what is a very common spinal condition. The etiology, manifestations and management of spinal stenosis are covered very well. A few comments need to be made. Myelography is rarely used as a primary investigative tool with the widespread availability of MR scanning. Minimally-invasive laminectomy is certainly not standard of care in the management of spinal stenosis and most surgeons perform open laminectomies very successfully. In all but experienced hands, complication rates from minimally-invasive laminectomy may be higher than open laminectomy. All patients who are considering surgical intervention or suffer from spinal stenosis should read this thorough and thoughtful review. Fessler et al provide a comprehensive and complete guide to this condition and its management.

Lali Sekhon, MD, PhD, FRACS, FICS

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