Stenosis of the spinal canal

Vertebral stenosis is a narrowing of the spinal canal, which causes compression of the spinal roots (sometimes the spinal cord) before their exit from the intervertebral foramen, positionally dependent back pain and compression symptoms of the nerve roots.

Vertebral stenosis can be congenital or acquired. It can be in the cervical and lumbar regions. Acquired stenosis of the lumbar vertebral canal is a common cause of sciatica in middle-aged patients. Most often it is caused by degenerative processes, such as osteoarthritis, disc pathology, facet joint arthropathy, thickening and deformation of ligaments, spondylolisthesis with horse tail compression. Other causes include Paget's disease, rheumatoid arthritis and ankylosing spondylitis. All these provoking factors tend to deteriorate with age.

Symptoms of spinal stenosis

Usually stenosis of the spinal canal is clinically manifested by pain and weakness in the legs during walking. Such a neuropathic pain is called "pseudo-intermittent claudication" or neurogenic intermittent claudication. Also, patients with stenosis of the spinal canal can have paresis, sensory disorders and decreased reflexes.

Patients suffering from narrowing of the spinal canal complain that they have pain in the shin and leg and weakness while walking, standing, lying on their back, pain in the buttock, thigh or lower leg when walking, running, climbing stairs or even standing. The pain does not decrease with quiet standing. These symptoms disappear if patients kyphosis in the lumbar region or take a sitting position. Walking on an inclined up is less painful than down, because the back is slightly bent. Often patients with spinal stenosis take an anesthetized posture with a forward torso bent forward, slightly bent knees when walking to reduce the symptoms of pseudo-intermittent claudication. Extension of the spine can cause symptoms. Also, patients complain of pain, numbness, tingling, paresthesia in the innervation zone of the affected root or roots. There may be weakness and impaired coordination in the affected limb. Often there is a positive test for flexion with stenosis of the spinal canal. Along with the pain radiating into the trapezoidal and interscapular area, muscle spasms and pain in the back are observed. During physical examination, a decrease in sensitivity, weakness, and change in reflexes are revealed.

Sometimes in patients with spinal stenosis, compression of the lumbar roots and horse tail occurs, leading to lumbar myelopathy and horse tail syndrome. This is manifested by weakness of various degrees in the lower limbs and symptoms of bladder and bowel dysfunction, which is an urgent neurosurgical situation, the onset of these symptoms is often unexpected.

Examination

MRI gives the most complete information about the lumbar spine and its contents, it should be performed by all patients with suspicion of spinal stenosis. MRI is highly informative and can identify a pathology that exposes the patient to the risk of developing lumbar myelopathy. The smallest sagittal size of the lumbar vertebral canal is 10.5 mm. For patients who can not pass an MRI (presence of pacemakers), CT and myelography are a reasonable alternative. If a fracture or bone pathology is suspected, such as a metastatic disease, a radionuclide bone scan or an overview radiograph is indicated.

While MPT, KT and myelography provide useful neuroanatomical information, electromyography and study of nerve conduction velocity - neurophysiological data on the actual state of each nerve root and lumbar plexus. Also, electromyography can distinguish between plexopathy and radiculopathy and identify the concurrent tunneling neuropathy that can complicate the diagnosis. If the diagnosis is uncertain, a laboratory examination should be performed, which includes a general blood test. ESR. Determination of antinuclear antibodies, HLA B-27 antigen and blood biochemistry for elucidating other causes of pain.

Differential diagnosis

Stenosis of the spinal canal is a clinical diagnosis based on anamnesis, physical examination, radiography, MRI. Pain syndromes capable of simulating the stenosis of the spinal canal include myogenic pain, lumbar bursitis, lumbar fibromyositis, inflammatory arthritis, and lumbar spine, rootlet, plexus and nerve damage, such as diabetic femoral neuropathy.

Treatment of spinal stenosis

In the treatment of stenosis of the spinal canal, a multicomponent approach is most effective. Physiotherapy consisting of thermal procedures, and a deep relaxing massage in combination with NSAIDs (for example, diclofenac, loronoxicam) and muscle relaxants (tizanidine) are justified to begin treatment. If necessary, you can add caudal or lumbar epilural block; blockade with local anesthetics and steroids are highly effective in treating stenosis of the spinal canal. Sleep disorders in depression are best treated with tricyclic antidepressants, such as amitriptyline, which can be started with 12.5 mg once a day before bedtime.

Complications and Diagnostic Errors

Untimely diagnosis of spinal stenosis can expose the patient to the risk of developing lumbar myelopathy, which, if untreated, may progress to paraparesis or paraplegia.

Stenosis of the spinal canal is a common cause of pain in the back and lower limb, and the detection of pseudo-intermittent claudication should guide the physician to this diagnosis. It should be remembered that this syndrome tends to deteriorate with age. The onset of lumbar myelopathy or cauda equina syndrome may not be noticeable, so a thorough survey and physical examination are necessary in order not to miss the symptoms of these complications.