About
- Spinal stenosis is a condition where the spinal canal becomes narrowed, which may be asymptomatic or lead to compression of the cauda equina, potentially causing neurological symptoms.
Aetiology
- A narrowed spinal canal can compress neural structures, leading to back, buttock, and leg pain.
- Those with developmental stenosis are at risk of additional compression from disc protrusion or degeneration later in life.
- The condition is most common at the cervical and lumbosacral spine levels.
- Neurogenic claudication, a hallmark of spinal stenosis, results from venous congestion and arterial hypertension around nerve roots, leading to oedema.
Associations
- Congenital spinal stenosis, including with achondroplasia and idiopathic forms.
- Degenerative causes of stenosis.
- Spondylolisthesis or spondylolysis-related stenosis.
- Iatrogenic causes, such as post-laminectomy stenosis.
- Post-traumatic and metabolic conditions, such as Paget disease, leading to stenosis.
Clinical Features
- More common in women than men.
- Symptoms include back and buttock pain, leg pain with walking, progressive numbness in the legs, claudication, and falls.
Investigations
- MRI: Non-invasive and effective in assessing lumbar stenosis.
- CT: Useful alternative imaging modality.
- Myelography with CT: Water-soluble myelography followed by CT can also aid in evaluating the extent of stenosis.
Differential Diagnosis
- Vascular claudication.
- Hip joint disorders.
- Peripheral neuropathy.
- Note: Some patients may present with both vascular claudication and spinal stenosis.
Management
- Non-operative management is often effective, including:
- Bed rest and NSAIDs or paracetamol/acetaminophen for pain management.
- Structured exercise programs for aerobic fitness and symptom relief.
- Epidural steroid injections may be considered for symptom control.
- Surgical decompression may be considered if conservative measures fail.