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| {{DiseaseDisorder infobox |
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| Name = Spinal stenosis |
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| ICD10 = {{ICD10|M|48|0|m|45}} |
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| ICD9 = {{ICD9|723}}-{{ICD9|724}} |
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| {{Search infobox}}
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| {{CMG}}
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| __NOTOC__ | | __NOTOC__ |
| '''Associate Editor-In-Chief:''' {{CZ}}
| | {{Spinal stenosis}} |
| | | For patient information click [[Spinal stenosis (patient information)|here]] |
| {{EJ}}
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| ==Overview==
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| '''Spinal stenosis''' is a [[medicine|medical]] condition in which the [[spinal canal]] narrows and compresses the [[spinal cord]] and [[nerves]]. This is usually due to the natural process of spinal degeneration that occurs with aging. It can also sometimes be caused by [[spinal disc herniation]], [[osteoporosis]], or a [[tumour]].
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| Spinal stenosis may affect the [[cervical vertebrae|cervical spine]], the [[lumbar vertebrae|lumbar spine]] or both. Lumbar spinal stenosis results in low [[back pain]] as well as [[Pain and nociception|pain]] or abnormal sensations in the [[leg]]s.
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| ==Cervical spinal stenosis==
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| The main causes of '''cervical spinal stenosis (CSS)''' include cervical [[spondylosis]], diffuse idiopathic skeletal hyperostosis (DISH), or [[calcium|calcification]] of the posterior longitudinal ligament.
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| CSS is more common in [[male]]s than [[female]]s, and is mainly found in the 40-60 year age group.
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| [[Sign (medicine)|Sign]]s of CSS include spastic gait; upper extremity numbness; upper extremity, lower extremity weakness or both; [[radicular pain]] in the [[upper limb]]; sphincter disturbances; muscle wasting; sensory deficits; and [[reflex]] abnormalities.
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| ===Diagnosis===
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| The best diagnostic and investigative tool is [[magnetic resonance imaging]] (MRI), while computed tomograghy (CT) is somewhat useful if MRI is unavailable. However, spinal stenosis can be found in asymptomatic patients.<ref name="pmid3588931">{{cite journal |author=Teresi LM, Lufkin RB, Reicher MA, ''et al'' |title=Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging |journal=Radiology |volume=164 |issue=1 |pages=83-8 |year=1987 |pmid=3588931 |doi=}}</ref><ref name="pmid2398088">{{cite journal |author=Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S |title=Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation |journal=The Journal of bone and joint surgery. American volume |volume=72 |issue=8 |pages=1178-84 |year=1990 |pmid=2398088 |doi=}}</ref><ref name="pmid16129249">{{cite journal |author=Ernst CW, Stadnik TW, Peeters E, Breucq C, Osteaux MJ |title=Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers |journal=European journal of radiology |volume=55 |issue=3 |pages=409-14 |year=2005 |pmid=16129249 |doi=10.1016/j.ejrad.2004.11.003}}</ref>
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| ===Treatment===
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| If the problem is mild, treatment may be as simple as [[physical therapy]] and the use of a [[cervical collar]]. If severe, treatments include [[laminectomy]], [[hemilaminectomy]], or decompression.
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| ==Lumbar spinal stenosis==
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| The main causes of '''lumbar spinal stenosis (LSS)''' include [[Organ hypertrophy|hypertrophy]] of the facet joints or [[osteoarthritis]]; [[spondylolisthesis]]; diffuse idiopathic skeletal hyperostosis (DISH); and [[degenerative disc disease]].
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| Usually, this condition occurs after the age of 50, and both genders are equally affected.
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| Signs of LSS include neurogenic intermittent [[claudication]] that causes leg pain, weakness, tingling and loss of deep tendon reflexes. Many of these leg symptoms are referred to as [[sciatica]]. Low back pain may or may not be present. With lumbar spinal stenosis, the patient's pain usually is worse while walking and will feel better after sitting down. The patient is usually more comfortable while leaning forward, such as walking while leaning on a shopping cart. On the other hand, pain is worse with extension of the back at the hips, which is why patients prefer to lean forward or to sit down, as these actions flex the body at the hip. This is also why patient complain of increased pain walking downhill as opposed to uphill.
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| ===Diagnosis===
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| As with CSS, [[MRI]] is the best imaging procedure, though unlike with CSS, [[CT]] may be somewhat useful, and can be used if [[MRI]] is unavailable.
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| ===Treatment=== | | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} |
| Treatment includes [[weight loss]], and activity modification, such as using a walker to promote a certain posture. [[Epidural]] steroid injections may also help relieve the leg pain.
| | ==[[Spinal stenosis overview|Overview]]== |
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| If the symptoms are more severe, a [[laminectomy]] or [[foraminotomy]] may be indicated to take pressure off the spinal nerve.
| | ==[[Spinal stenosis classification|Classification]]== |
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| ====Surgical laminectomy==== | | ==[[Spinal stenosis pathophysiology|Pathophysiology]]== |
| Regarding indications for [[laminectomy]], a complicated, nonrandomized analysis of a [[randomized controlled trial]] of [[laminectomy]]<ref name="pmid17538085">{{cite journal |author=Weinstein JN, Lurie JD, Tosteson TD, ''et al'' |title=Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis |journal=N. Engl. J. Med. |volume=356 |issue=22 |pages=2257-70 |year=2007 |pmid=17538085 |doi=10.1056/NEJMoa070302}}</ref>, in patients with:
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| :"neurogenic claudication or radicular leg pain with associated neurologic signs, spinal stenosis shown on cross-sectional imaging, and degenerative spondylolisthesis shown on lateral radiographs obtained with the patient in a standing position. The patients had had persistent symptoms for at least 12 weeks and had been confirmed as surgical candidates by their physicians. Patients with adjacent levels of stenosis were eligible; patients with spondylolysis and isthmic spondylolisthesis were not."
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| found that patients:
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| :"treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically."
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| ====New surgical developments==== | | ==[[Spinal stenosis causes|Causes]]== |
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| Recent developments include several new implants used in surgery to treat the symptoms of spinal stenosis, while preserving as much normal motion in the spine as possible. The only FDA approved non-fusion treatment is the X STOP, [http://www.sfmt.com/ by St. Francis Medical Techologies, Inc.] which works via indirect decompression, called Interspinous Process Decompression [http://en.wikipedia.org/wiki/Interspinous_Process_Decompression](IPD) Some other IPD technologies that are still being studied include the Wallis implant, [http://us.abbottspine.com/index.php?pid=44 by Aboott Spine] , the DIAM [http://www.medtronic.com/ by Medtronic] and the Coflex by [http://www.paradigm-spine.de/web/wirbelkanal.php Paradigm Spine], .<ref name="Stromquist"> {{cite web| author=B. Stromqvist|year=2006 |title= Lumbar Spinal Stenosis - Striving for Less Invasive Surgery|url=http://www.touchneurology.com/articles.cfm?article_id=5604&level=2}}</ref> Other implant systems being studied include the Dynesys [http://www.zimmer.com/z/ctl/op/global/action/1/id/9163/template/PC/prcat/P6/prod/y by Zimmer], the Stabilimax [http://www.appliedspine.com/ by Applied Spine], the TFAS [http://www.archusorthopedics.com/ by Archus Orthopedics] and the Anatomic Facet Replacement System, [http://www.stenosisrelief.com/pages/aboutafrs.htm by Facet Solutions].
| | ==[[Spinal stenosis differential diagnosis|Differentiating Spinal stenosis from other Diseases]]== |
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| In November 2005 the X-STOP was approved by the [[FDA]] for treatment of lumbar spinal stenosis with moderate symptoms. This procedure is a much less invasive surgery than decompression, but the treatment is still new and effectiveness, indications and potential risks and complications won't be well understood until the procedure has been in use for a longer period.
| | ==[[Spinal stenosis epidemiology and demographics|Epidemiology and Demographics]]== |
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| One recent implant system that was being studied in the US reportedly has problems that ended its enrollment, the TOPS implant [http://www.impliant.com by Impliant.] This was reported [http://www.marketwatch.com/news/story/impliant-deepens-elron-loss/story.aspx?guid=%7BD0A6748D-9F78-4155-90D2-13BD50783D0C%7D ]by an investor in Impliant, [http://www.elron.com/default.asp?PageId=0 Elron Ltd.]
| | ==[[Spinal stenosis risk factors|Risk Factors]]== |
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| Also recently, [http://209.85.173.104/search?q=cache:g71FsSBs9joJ:www.sofamordanek.com/spineline/physician/agileguide.pdf+CD+Agile+spine&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a Medtronic's] non-fusion implant was recalled officially in the United Kingdom [http://209.85.173.104/search?q=cache:mNI1si-aw6QJ:www.mhra.gov.uk/home/idcplg%3FIdcService%3DGET_FILE%26dDocName%3DCON2033507%26RevisionSelectionMethod%3DLatestReleased+Medtronic+Agile+recall&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a], though in the US the device has been withdrawn from surgeons but MDT has not issued a recall, probably due to the way inventory is handled rather than a difference in the product sold in the US vs. the UK.
| | ==[[Spinal stenosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| == External links == | | ==Diagnosis== |
| | [[Spinal stenosis history and symptoms|History and Symptoms]] | [[Spinal stenosis physical examination|Physical Examination]] | [[Spinal stenosis x ray|X Ray]] | [[Spinal stenosis CT|CT]] | [[Spinal stenosis MRI|MRI]] | [[Spinal stenosis other diagnostic studies|Other Diagnostic Studies]] |
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| * [http://www.ascent-oxford.kramesonline.com/HealthSheets/3,S,84755 Spinal Stenosis - Information for Patients]
| | ==Treatment== |
| * [http://www.spine-health.com/stenosis/ Spinal Stenosis for Patient information]
| | [[Spinal stenosis medical therapy|Medical Therapy]] | [[Spinal stenosis surgery|Surgery]] | [[Spinal stenosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Spinal stenosis future or investigational therapies|Future or Investigational Therapies]] |
| * [http://www.spineuniverse.com/displayarticle.php/article244.html Lumbar Spinal Stenosis]
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| * [http://www.spineuniverse.com/displayarticle.php/article334.html Cervical Disorders - Spinal Stenosis and Disc Herniation]
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| ==References== | | ==Case Studies== |
| <div class="references-small" style="-moz-column-count:2; column-count:2;">
| | :[[Spinal stenosis case study one|Case #1]] |
| <references/>
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| </div>
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| {{Diseases of the musculoskeletal system and connective tissue}} | | {{Diseases of the musculoskeletal system and connective tissue}} |
| {{SIB}}
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| [[Category:Skeletal disorders]] | | [[Category:Skeletal disorders]] |