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Severe degenerative spinal stenosis at the
L4–L5 level in a 70–year–old with a history of intermittent
claudication and occasional radicular leg pain. The central and
lateral stenosis is most pronounced at this motion segment level and
is almost exclusively caused by soft tissues. Anteriorly, the
circumferentially "ballooning" disc narrows the thecal sac
anteriorly and also completely obliterates the retrodiscal portion
of the root canals (neuroforamina). The facet joints, especially the
superior articular processes are moderately hypertrophied, rendering
the joints a ball–and–socket configuration of the facet joints. Note
the effusion posteriorly of the left facet joint and the sclerotic
meniscoid tag posteriorly into the right facet joint. The thecal sac
is severely compressed posterolaterally by the thick ligamentum
flavum and assumes a triangular slit–shaped configuration in which
the roots of the cauda equina are tightly packed without any
cerebrospinal fluid surrounding them. The two ligamenta flava are
continuous posteriorly with the thick and degenerated interspinous
ligament. |
©2000 Wolfgang Rauschning, M.D., Ph.D.
Professor of Clinical Anatomy
Academic
University Hospital
Department of Orthopaedic Surgery
Uppsala, Sweden
Reproduction without permission is prohibited
http://www.akademiska.se/
