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Chapter-096 Lumbar Spinal Canal Stenosis

BOOK TITLE: Textbook of Contemporary Neurosurgery (2 Volumes)

Author
1. Mehta Samit S
2. Gil Krzysztof
ISBN
9789350252390
DOI
10.5005/jp/books/11681_96
Edition
1/e
Publishing Year
2012
Pages
12
Author Affiliations
1. Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
2. Medical University of Lublin, Lublin, Poland
Chapter keywords

Abstract

Lumbar spinal canal stenosis (LSCS) may be defined as narrowing of the lumbar canal in its central part, the lateral recess or the intervertebral foramen sufficient to impair one or more roots of the cauda equine, resulting in pain, unilateral or bilateral neurological deficit or neurogenic intermittent claudication. Symptoms predominate over signs; it is essentially a clinical diagnosis supported by imaging studies. Interpedicular distance on X-ray may give a clue. Congenitally stenotic patients present with fewer degenerative changes and multiple levels of involvement; the vertically oriented laminae are short and thick, bringing the facets almost to the midline. Acquired or secondary type is most often caused by a degenerative process. Lateral recess stenosis (nerve-root canal stenosis) is the most common form of degenerative spinal stenosis that occurs either alone or in combination with central stenosis. Early diagnosis and treatment prevent intractable pain and the permanent neurologic sequelae of chronic nerve root entrapment. Low back pain is a common complaint for a long time before radicular compression occurs. Usually the pain neuro-claudication type and is bilateral; pain is relieved by sitting or forward flexion unlike discogenic pain. Lumbar spinal stenosis can coexist with cervical canal stenosis. Treatment usually requires a decompressive procedure; the greater the degree of compression the better the chance of a satisfactory result provided that the motor deficit is not very severe and long-standing. L1 to L5 laminectomy is widely practiced although minimized decompressive procedures have evolved with good results; a subgroup of high-risk patients in whom the spine is unstable preoperatively will benefit from an initial fusion procedure. Limited operative decompression, with retention of the stabilizing elements and innovative motion preserving devices await further evaluation. An individualized program of back care exercises and activity modification should follow to arrest further degenerative process.

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