Spinal stenosis overview: Difference between revisions
No edit summary |
|||
| Line 2: | Line 2: | ||
{{Spinal stenosis}} | {{Spinal stenosis}} | ||
{{CMG}}; {{AE}}{{MMJ}} | {{CMG}}; {{AE}}{{MMJ}} | ||
==Classification== | ==Classification== | ||
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. | |||
==Pathophysiology== | ==Pathophysiology== | ||
Spinal stenosis is the narrowing of the vertebral canal tube. This narrowing produces [[Neurovascular bundle|neurovascular]] compression that may lead to pain and other neurology manifestations of spinal stenosis. Radiographic changes associated with stenosis are very common with aging. Although symptoms may arise from narrowing of the [[spinal canal]], not all patients with narrowing develop symptoms. The [[spinal cord]] extends from the [[foramen magnum]] down to the level of the first and second [[lumbar vertebrae]]. At L2 level [[spinal cord]] transforms into spinal roots and forms a cone-shaped structure called [[Conus medullaris|conus medullaris.]] The cord is protected by the [[vertebral column]], which is mobile and allows for movement of the spine. It is enclosed by the [[dura mater]] and the vessels supplying it. The cord floats in the [[cerebrospinal fluid]] which acts as a buffer to movement and early degrees of compression. The cord substance contains a [[Grey matter|gray area]] centrally and is surrounded by [[white matter]] communication tracts, both ascending and descending. The spinal stenosis may result from any condition that narrows the spinal canal and compresses nerve roots. The most common cause of spinal stenosis is degenerative joint disease. The [[spinal cord]] and [[Nerve root|nerve roots]] depend on a constant blood supply to perform axonal signaling. Conditions that interfere, either directly or indirectly, with the blood supply will cause malfunction of the transmission pathway. It initiates a cascade of events in the [[Grey matter|gray matte]]<nowiki/>r and [[white matter]] and results in [[hypoperfusion]]. The following results in [[autonomic dysfunction]] leading to [[neurogenic shock]] ( triad of [[hypotension]], [[bradycardia]] and peripheral vasodilation) and eventually [[Necrosis|hemorrhagic necrosis.]] The extent of [[necrosis]] depends on the severity of the compression, and blood flow. The tissue responses by [[gliosis]], [[demyelination]], and axonal loss. This results in injury to the [[White matter|white matte]]<nowiki/>r (myelinated tracts) and the [[Grey matter|gray matter]] (cell bodies) in the cord with loss of [[Reflexes|sensory reflexes]] (pinprick, joint position sense, vibration, hot/cold, pressure) and [[Motor Control|motor function]]. | |||
==Causes== | ==Causes== | ||
The most common cause of spinal stenosis is [[degenerative joint disease]]. Other common causes of spinal stenosis include: [[Spinal disc herniation|Spinal disc herniation,]] thickness of the Ligamentum Flavum, [[trauma]], [[Spinal tumor|tumor]] (primary or secondary), [[scoliosis]], [[Compression fracture|vertebral compression fractures]], [[epidural abscess]], [[epidural hematoma]] and [[ligamentum flavum]] cyst. | |||
==Differentiating Xyz from Other Diseases== | ==Differentiating Xyz from Other Diseases== | ||
Revision as of 14:02, 27 July 2018
|
Spinal stenosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Spinal stenosis overview On the Web |
|
American Roentgen Ray Society Images of Spinal stenosis overview |
|
Risk calculators and risk factors for Spinal stenosis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Classification
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.
Pathophysiology
Spinal stenosis is the narrowing of the vertebral canal tube. This narrowing produces neurovascular compression that may lead to pain and other neurology manifestations of spinal stenosis. Radiographic changes associated with stenosis are very common with aging. Although symptoms may arise from narrowing of the spinal canal, not all patients with narrowing develop symptoms. The spinal cord extends from the foramen magnum down to the level of the first and second lumbar vertebrae. At L2 level spinal cord transforms into spinal roots and forms a cone-shaped structure called conus medullaris. The cord is protected by the vertebral column, which is mobile and allows for movement of the spine. It is enclosed by the dura mater and the vessels supplying it. The cord floats in the cerebrospinal fluid which acts as a buffer to movement and early degrees of compression. The cord substance contains a gray area centrally and is surrounded by white matter communication tracts, both ascending and descending. The spinal stenosis may result from any condition that narrows the spinal canal and compresses nerve roots. The most common cause of spinal stenosis is degenerative joint disease. The spinal cord and nerve roots depend on a constant blood supply to perform axonal signaling. Conditions that interfere, either directly or indirectly, with the blood supply will cause malfunction of the transmission pathway. It initiates a cascade of events in the gray matter and white matter and results in hypoperfusion. The following results in autonomic dysfunction leading to neurogenic shock ( triad of hypotension, bradycardia and peripheral vasodilation) and eventually hemorrhagic necrosis. The extent of necrosis depends on the severity of the compression, and blood flow. The tissue responses by gliosis, demyelination, and axonal loss. This results in injury to the white matter (myelinated tracts) and the gray matter (cell bodies) in the cord with loss of sensory reflexes (pinprick, joint position sense, vibration, hot/cold, pressure) and motor function.
Causes
The most common cause of spinal stenosis is degenerative joint disease. Other common causes of spinal stenosis include: Spinal disc herniation, thickness of the Ligamentum Flavum, trauma, tumor (primary or secondary), scoliosis, vertebral compression fractures, epidural abscess, epidural hematoma and ligamentum flavum cyst.