Spinal stenosis, lumbar and cervical osteophytes
Stenosis of the vertebral canal as an independent disease most commonly seen on the lumbar spine level. However, there are spinal stenosis and cervical and thoracic spinal level. Spinal stenosis is associated usually with congenital or acquired anatomical changes in the vertebrae themselves (in the bone formations), as well as cartilage and ligament entities involved in the formation of the spinal canal.
The narrowing of the cross-sectional spinal canal may or consequence of an increase in the amount of bone formation: arch, articular processes, expansion rear surfaces of the vertebral bodies, or as a result of flattening of vertebrae and their displacement in the lumen of the spinal canal.
Spinal stenosis with compression of spinal cord with hypertrophy posterior longitudinal and yellow ligaments.
Also, a narrowing of the spinal canal cause hypertrophy of the yellow and posterior longitudinal ligaments, increasing the thickness of articular capsule of intervertebral joints, displacement of intervertebral discs and annulus involved in the formation of the spinal canal.
Spinal stenosis can be uniform on all sides, but more common spinal stenosis from front to back. Also, spinal stenosis can occur at the level of all or several of the lumbar vertebrae, but occurs at the level of one vertebra.
Narrowing of the spinal canal in the anteroposterior direction may be due to its secondary stenosis, hypertrophy of the posterior longitudinal and yellow ligaments, spondylolisthesis. To determine spinal canal stenosis is necessary to measure the channel in the sagittal plane. Absolute stenosis is considered to be reducing the channel diameter of 10 mm or less. The value of 10-15 mm corresponds to a partial stenosis. The thickness of the posterior longitudinal ligament in the rate should not exceed 2 mm, yellow ligament - 3 mm.
Spinal stenosis with spondylosis and compression of the spinal cord at the cervical spine level with hypertrophy of the posterior longitudinal and yellow ligaments.
Compression of the L3 spinal nerve in the intervertebral foramen in case of extraforaminal stenosis (narrowing).
When the diagnosis of stenosis of the spinal canal on plain film spine (spondylograms) can be seen in the increased size of articular processes, thickened roots handles, reduce the height of the vertebral bodies, sites of ligaments and osteophytes sclerosis. On the positive myelogram shows a uniform, or in the form of constrictions narrowing of the spinal canal at multiple levels. In terms of differential diagnosis is very important to obtain transverse slices at different levels of CT scan of the spine at the level of detection of stenosis of the spinal canal.
The clinical picture in stenosis of the spinal canal can occur monoradikulyarnye symptoms (with protrusions and herniations of intervertebral discs, an increase in the size of adjacent articular processes, which leads to a decrease in cross-section of the intervertebral foramen), or symptoms of compression-ischemic mieloradikulopatii, or even a syndrome of transverse spinal cord lesions.
Spinal stenosis with compression of the spinal cord at the level of the lumbar spine with hypertrophy of the posterior longitudinal and yellow ligaments.
It all starts with neurological and orthopedic examination in a doctor. According to its results may be appointed in addition the following diagnostic procedures:
- X-ray of lumbosacral spine with functional tests
- CT of the lumbosacral spine
- MRI of the lumbosacral spine
However, the main symptoms of the true spinal canal stenosis is a continuous pain in the lumbar spine, without any "party" and without irradiation in the course of the nerve roots. Back pain may be permanent in nature and do not change with a change of body position in space (sometimes in the supine position, the pain even amplified). As the progression of the disease associated flattening of the lumbar lordosis, appears scoliosis, muscle contractures and antalgick spinal deformity.
Narrowing of the spinal canal with compression of the spinal cord on MRI of the thoracic spine tumor.
In the treatment of stenosis of the spinal canal, depending on the severity of clinical manifestations and causes of the spinal canal stenosis, the patient may experience the following actions aimed at improving the condition of the patient:
- drug therapy (NSAIDs, analgesics, hormones)
- therapeutic blockade - the injection of drugs into the cavity of the channel
- manual therapy (muscle, joint and radicular technique)
- physiotherapy (UHF, SMC, etc.)
- spinal traction (contraindicated in the acute stage)
- medical gymnastics and swimming (after primary treatment)
- surgical treatment
In determining the indications for surgery in case of diagnosis of stenosis of the spinal canal should take into account the prevalence of the process. In operations on one or two levels of vertebrae and unilateral symptoms of root compression can be used interlaminotomiya or hemilaminectomy.
When bilateral symptoms neurovascular compression of the spinal canal and entities on several levels, can be performed with bilateral hemilaminectomy preserving spinous processes and interspinous ligament, incising hypertrophied yellow ligament and osteophytes. It is advisable in stenosis of the spinal canal parallel conduct foraminotomii. In some cases, spinal canal stenosis, it is necessary to stabilize the spine using metal.
Operation hemilaminectomy in stenosis of the spinal canal with compression of the spinal cord at the level of the cervical spine with hypertrophy of the posterior longitudinal and yellow ligaments.
Sometimes when the spinal canal stenosis is advisable to divide the operation into two stages. The first step is decompression of the most affected spinal roots, carried out an intensive and neyrostimuliruyuschey vasoactive therapy. And, if not achieved improving and facilitating the patient's condition, we propose the second phase of the operation - a wider decompression (bilateral hemilaminectomy) and the creation of additional reserve spaces in stenosis of the spinal canal.
If you have any questions about the diagnosis or treatment of spinal canal stenosis, you can specify them with our neurosurgeon or neurologist by phone: +7 (926) 988-14-23
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