Spinal Stenosis

Lumbar spinal stenosis (or narrowing of the spinal canal) is a clinical syndrome because of pain in the lower back, buttock or leg.  The term “stenosis” means a narrow constriction within a tubular structure.

Sachs and Fraenkel (Fraenkel B and Sachs J, 1900) were among the first to link the symptoms of sciatic nerve compression in the channel. Subsequently, descriptions of the condition report are:  compression bone acquired called “degenerative” and/or constitutional narrowness or “defect” of the spinal canal.

Van Gelderen (C. Van Gelderen, 1948) suggests that the hypertrophy of ligamentum flavum is a possible cause of spinal stenosis by publishing two cases of patients suffering from this condition.  The clinical syndrome of spinal stenosis and their relationship to congenital narrowness are described in detail by the surgeon Holland Verbiest, which is also clearly demonstrated by the mechanical compression of neural elements in myelography (HA Verbiest, 1954).

Kirkaldy-Willis et al. clarify the pathologic anatomy of the spinal canal stenosis and contribute to the good correlation between anatomical lesions and pathological symptoms (Kirkaldy-Willis W, Paine K, Cauchoix J, et al., 1974).

Classification

The etiology of spinal stenosis is most commonly (Arnoldi C, Brodsky A, Cauchoix J, et al., 1976) or congenital, developmental, acquired, degenerative or a combination of all.
Most cases of spinal stenosis are acquired, because the degenerative changes of the complex consists of three joints of the intervertebral disc and two facet joints.

In some cases, these degenerative changes may be superimposed on stenosis.  Variations in form, as in the dimensions of the vertebral canal, may predispose to stenosis of the spinal canal with canal clover more readily associated with lateral recess stenosis, more common in the case of round or oval canal.

Clinical examination
Patients may not suffer from lumbar spinal stenosis, while others may experience very severe pain. If the symptoms most frequently encountered are low back pain and intermittent claudication of the cauda equina, bilateral sciatica is accompanied by paresthesia of the lower limbs occurring after a certain distance of running.

The discomfort of the patient is increased by the accentuation of lordosis of the lumbar spine. The patient’s symptoms decrease spontaneously through their lumbar spine in kyphosis (i.e. leaning forward).  Eventually, the patient has a compression of the cauda equina slowly with saddle anesthesia and sphincter disorders.  There is a form of lateralized lumbar spinal stenosis manifested by symptoms similar to that of a sciatica herniated disc.
Here is a summary list of features suggestive history in a case of lumbar spinal stenosis:
Demographics
Adult middle-aged or older, except “congenital” …
Ratio Male> Male (3 / 1 to 5 / 1)
Leg Pain> bad lower back
Gene in the limb
Projection or root
Pseudoclaudication (called neurogenic claudication)
Caused by standing or walking
Relieved by sitting position above station leaning forward (sign of the cart)
Differential Diagnosis
Peripheral neuropathy (non-physical activity in type dysesthesias burns)
Vascular claudication
Affection of the hip (Hip-column syndrome)
Physical examination
Imaging

Radiology standard
Scanner and lumbar
MRI lumbar spine
Reviews can be stressful, expensive (and very irradiating for some) and should be achieved if the surgeon asks for a surgical indication (not before).
Spontaneous evolution

Medical treatment has a place in the CLE:
Rest, brace restraints
Rest and analgesics (NSAID infiltration of corticosteroids, sometimes rehabilitation).