Questions and Answers

Lateral spinal stenosis generally results in symptoms that are directly related to compression of the nerve roots at the level of the stenosis. Both pain and muscular weakness may result from hypertrophy of the facet joints, spondylosis deformity, bulging of the disc annulus, or herniation of the nucleus pulposus. Although large central disc herniations occur, […] Read More

Central spinal stenosis of the cervical or thoracic regions may result in neurosensory changes at the level of the spinal stenosis or may further compress the spinal cord, resulting in myelopathy. The effects of central spinal canal stenosis may result in lower extremity weakness and gait disturbance. Read More

In the patient with spinal canal stenosis, flexion or marked hyperextension may result in further compromise of the spinal canal in the absence of a fracture. Anterior compression of the cord may result in a central spinal cord syndrome, and dorsal compression may result in a partial dorsal column syndrome. Read More

Spinal stenosis can result in significant morbidity. Severe disability and death may result from the association of cervical stenosis with even minor trauma resulting in central cord syndrome. Both upper (cervical) and lower (lumbar) spinal stenosis may result in motor weakness and chronic pain. Severe lumbar stenosis is associated with cauda equina syndrome. Read More

Secondary (acquired) stenosis arises from degenerative changes, iatrogenic causes, systemic processes, and trauma. Degenerative changes include central canal and lateral recess stenosis from posterior disk protrusion, zygapophyseal joint and ligamentum flavum hypertrophy, and spondylolisthesis. Iatrogenic changes happen after following surgical procedures such as laminectomy, fusion, and discectomy. Systemic processes that may be involved in secondary […] Read More

Primary stenosis is uncommon, occurring in only 9% of cases. Congenital malformations include the following: Incomplete vertebral arch closure (spinal dysraphism); Segmentation failure; Achondroplasia; Osteopetrosis. Read More

Dynamic foraminal stenosis implies intermittent lumbar extension-provoked nerve root impingement, osteophytosis, and vertebral body slippage. Such dynamic stenosis with associated intermittent position-dependent symptoms may not manifest on imaging studies, thereby confounding diagnosis. Other factors promoting the development of LSS include shortened gestational age and synovial facet joint cysts with resulting radicular compression. Adult degenerative scoliosis, […] Read More

Treatment of spinal stenosis can be conservative or surgical. The modes of conservative therapy include rest, physical therapy with strengthening exercises for paraspinal musculature, bracing, use of optimal postural biomechanics, non-steroidal anti-inflammatory medications, analgesics, and antispasmodics. Surgical decompression is indicated in persons who experience incapacitating pain, claudication, neurologic deficit, or myelopathy. Concomitant stabilization is reserved […] Read More

The goal of spinal imaging is to localize the site and level of disease. It also is used to help differentiate conditions for which patients require surgery and conditions for which patients can recover with conservative treatment. Imaging studies used in LSS include standard radiography, magnetic resonance imaging (MRI), computed tomography (CT) scanning, nuclear imaging, […] Read More

Useful neuronal studies include the following: Needle electromyography, which can help diagnose lumbosacral radiculopathy with axonal loss. Nerve conduction studies, which can help differentiate lumbar spinal stenosis (LSS) from other confounding neuropathic conditions (e.g., lumbosacral plexopathy, generalized peripheral neuropathy, tarsal tunnel syndrome, other mononeuropathies); Somatosensory evoked potentials, which are useful in the diagnosis of central […] Read More