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{{Spinal stenosis}}
{{Spinal stenosis}}
{{CMG}}


{{CMG}}; {{AE}} {{MMJ}}
==Overview==
==Overview==
Spinal stenosis may be classified according to where on the [[spine]] the condition occurs, into three groups: Cervical spinal stenosis, thoracic spinal stenosis and lumbar spinal stenosis. Spinal stenosis occurs most often in the lower back and in the neck.
==Classification==
==Classification==
==Cervical spinal stenosis==
The main causes of '''cervical spinal stenosis (CSS)''' include cervical [[spondylosis]], diffuse idiopathic skeletal hyperostosis (DISH), or [[calcium|calcification]] of the posterior longitudinal ligament.
CSS is more common in [[male]]s than [[female]]s, and is mainly found in the 40-60 year age group.
[[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.
===Diagnosis===
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>
===Treatment===
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.
==Lumbar spinal stenosis==
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]].
Usually, this condition occurs after the age of 50, and both genders are equally affected.
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.


===Diagnosis===
*Spinal stenosis may be classified according to where on the [[spine]] the condition occurs, into three groups:<ref name="pmid20227646">{{cite journal| author=Genevay S, Atlas SJ| title=Lumbar spinal stenosis. | journal=Best Pract Res Clin Rheumatol | year= 2010 | volume= 24 | issue= 2 | pages= 253-65 | pmid=20227646 | doi=10.1016/j.berh.2009.11.001 | pmc=2841052 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20227646  }} </ref><ref name="pmid21113592">{{cite journal| author=Morishita Y, Naito M, Wang JC| title=Cervical spinal canal stenosis: the differences between stenosis at the lower cervical and multiple segment levels. | journal=Int Orthop | year= 2011 | volume= 35 | issue= 10 | pages= 1517-22 | pmid=21113592 | doi=10.1007/s00264-010-1169-3 | pmc=3174302 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21113592  }} </ref><ref name="pmid3819827">{{cite journal| author=Barnett GH, Hardy RW, Little JR, Bay JW, Sypert GW| title=Thoracic spinal canal stenosis. | journal=J Neurosurg | year= 1987 | volume= 66 | issue= 3 | pages= 338-44 | pmid=3819827 | doi=10.3171/jns.1987.66.3.0338 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3819827  }} </ref>
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.
**Cervical spinal stenosis
**Thoracic spinal stenosis
**Lumbar spinal stenosis
*Spinal stenosis occurs most often in the lower back and in the neck.


===Treatment===
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.


If the symptoms are more severe, a [[laminectomy]] or [[foraminotomy]] may be indicated to take pressure off the spinal nerve.
==References==
==References==
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{{Reflist|2}}
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[[Category:Skeletal disorders]]
[[Category: (name of the system)]]
[[Category:Rheumatology]]
[[Category:Orthopedics]]
[[Category:Needs Overview]]

Latest revision as of 13:52, 19 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Spinal stenosis may be classified according to where on the spine the condition occurs, into three groups: Cervical spinal stenosis, thoracic spinal stenosis and lumbar spinal stenosis. Spinal stenosis occurs most often in the lower back and in the neck.

Classification

  • Spinal stenosis may be classified according to where on the spine the condition occurs, into three groups:[1][2][3]
    • Cervical spinal stenosis
    • Thoracic spinal stenosis
    • Lumbar spinal stenosis
  • Spinal stenosis occurs most often in the lower back and in the neck.


References

  1. ↑ Genevay S, Atlas SJ (2010). "Lumbar spinal stenosis". Best Pract Res Clin Rheumatol. 24 (2): 253–65. doi:10.1016/j.berh.2009.11.001. PMC 2841052. PMID 20227646.
  2. ↑ Morishita Y, Naito M, Wang JC (2011). "Cervical spinal canal stenosis: the differences between stenosis at the lower cervical and multiple segment levels". Int Orthop. 35 (10): 1517–22. doi:10.1007/s00264-010-1169-3. PMC 3174302. PMID 21113592.
  3. ↑ Barnett GH, Hardy RW, Little JR, Bay JW, Sypert GW (1987). "Thoracic spinal canal stenosis". J Neurosurg. 66 (3): 338–44. doi:10.3171/jns.1987.66.3.0338. PMID 3819827.

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