tailieunhanh - Chapter 016. Back and Neck Pain (Part 8)

Degenerative Conditions Lumbar spinal stenosis describes a narrowed lumbar spinal canal. Neurogenic claudication is the usual symptom, consisting of back and buttock or leg pain induced by walking or standing and relieved by sitting. Symptoms in the legs are usually bilateral. Lumbar stenosis, by itself, is frequently asymptomatic, and the correlation between the severity of symptoms and degree of stenosis of the spinal canal is poor. Unlike vascular claudication, symptoms are often provoked by standing without walking. Unlike lumbar disk disease, symptoms are usually relieved by sitting. Focal weakness, sensory loss, or reflex changes may occur when spinal stenosis is. | Chapter 016. Back and Neck Pain Part 8 Degenerative Conditions Lumbar spinal stenosis describes a narrowed lumbar spinal canal. Neurogenic claudication is the usual symptom consisting of back and buttock or leg pain induced by walking or standing and relieved by sitting. Symptoms in the legs are usually bilateral. Lumbar stenosis by itself is frequently asymptomatic and the correlation between the severity of symptoms and degree of stenosis of the spinal canal is poor. Unlike vascular claudication symptoms are often provoked by standing without walking. Unlike lumbar disk disease symptoms are usually relieved by sitting. Focal weakness sensory loss or reflex changes may occur when spinal stenosis is associated with radiculopathy. Severe neurologic deficits including paralysis and urinary incontinence occur rarely. Spinal stenosis can be acquired 75 congenital or due to a combination of these factors. Congenital forms achondroplasia idiopathic are characterized by short thick pedicles that produce both spinal canal and lateral recess stenosis. Acquired factors that contribute to spinal stenosis include degenerative diseases spondylosis spondylolisthesis scoliosis trauma spine surgery metabolic or endocrine disorders epidural lipomatosis osteoporosis acromegaly renal osteodystrophy hypoparathyroidism and Paget s disease. MRI provides the best definition of the abnormal anatomy Fig. 16-5 . Figure 16-5 Sourc iauci A . Karpar ÖL. Braunvald Haul SL Longo t L. Jarnuon JL Lojcalco Ji rtawsoj s d J rtcr uf WarAcv 17th Edition1 http Copyright o Tti MoCrav-HiS Ccmpanl tnc. Ali .mJ. Spinal stenosis. Sagittal T2 fast spin echo magnetic resonance imaging of a normal left and stenotic right lumbar spine revealing multifocal narrowing arrows of the cerebrospinal fluid spaces surrounding the nerve roots within the thecal sac. Conservative treatment of symptomatic spinal stenosis includes nonsteroidal anti-inflammatory drugs NSAIDs exercise programs and .