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Definition
This refers to a narrowing
of the spinal canal. Certain individuals may have a narrow
canal from birth, but the majority of individuals develop
narrowing with age. With age, wear and tear arthritic spurs
build up on the facet joints in the posterior part of the
spine. These arthritic spurs then encroach on the spinal
canal and pinch the lumbar nerve roots. This condition can
be worsened as well by narrowing and degeneration of the
disc at that level as the space for exit of the nerve root
(called the foramen) is narrowed further by a degenerated
disc. Spinal stenosis is most common in the last three levels
of the lumbar spine namely L3-4, L4-5 and L5-S1. It is diagnosed
and confirmed by an MRI or CAT scan/myelogram.
Lumbar Spinal Stenosis
Symptomatology
There are various signs and
symptoms of spinal stenosis. A common one is referred to
as spinal claudication. This refers to pain in the legs,
the calves or the buttocks. This pain is associated with
activity. The pain is often relieved by sitting and resting.
It will then often times start up again with activity. A
common complaint is that an individual will be able to walk
several blocks then develops leg pain, is able to get rid
of the leg pain by sitting and resting for five to ten minutes
and then, upon trying to walk another several blocks the
pain will return. The pain may be a radiating pain like
a sciatica or it may be a cramping pain. At times though,
the stenosis may be severe enough that the leg pain is constant
and unremitting. It may at times be indistinguishable from
the kind of pain that occurs with a herniated disc. Spinal
stenosis is uncommon in younger people. It usually occurs
at age 50 or older. Leg pains from spinal pathology are
more common from herniated discs in people under 50. Over
50 it is more common that spinal stenosis will be the problem.
In addition to developmental degenerative spinal stenosis,
entrapped nerve roots may be caused as well by spondylolisthesis
and scotiosis. There is really no conservative treatment
for a spinal stenosis. It will rarely cause paralysis. The
condition will tend to gradually worsen with time and cause
increasing pain however. Patients with congenital spinal
stenosis (such as achondroplastic dwarfs) may develop symptomatic
stenosis as early as age 15 or 20.
Treatment
Spinal stenosis can be relieved
by removing the overgrown portions of the facet joints posteriorly.
At times only parts of the facet joint have to be removed.
In more severe cases most of the facet joints will have
to be removed in order to adequately decompress the nerve
roots. Whether or not a fusion has to be performed at the
same time as a decompression is dependent upon many factors
including the stability of the spine, the age of the patient,
and the amount of bone being removed. The reason for doing
the fusion after the decompression is so that instability
does not develop and forward slippage or spondylolisthesis
does not occur after a decompression.
Postoperative Course
There is a fair amount of
discomfort for about 2 days after the surgery. On the first
postoperative day the individual can sit and dangle off
the side of the bed as well as stand. Over the next couple
of days he/she is able to ambulate fairly comfortably and
is able to walk up and down stairs without too much trouble.
Average hospital stay after a spinal stenosis decompression
is approximately 3 days. Recovery will be quicker if a fusion
is not performed simultaneously. If a fusion is performed
then this adds 2-3 days on to the hospital stay and the
recovery. Generally within 3-4 weeks after the surgery the
patient should feel good enough that he/she can go back
to a desk job. The results with this kind of surgery are
quite good. On the order of 80-90% of patients have relief
of their pain after the surgery.
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