What is the spinal stenosis, its causes, extent, symptoms, treatment
spinal Stenosis is a dangerous disease that leads to disability. The diagnosis pathology is established on the basis of condylomata (dimension of the lumen of the spine) after performing magnetic resonance imaging (MRI).
The Spinal canal is the container for the spinal cord. When narrowing occurs, the spinal cord compression. Condition is dangerous loss of functionality innervated organs.
Cause and description of disease
spinal Stenosis is diagnosed, when the reduced width zadnepryany division of the canal or dural SAC. The sizes are measured after performing a myelogram (injection of contrast into the subarachnoid space of the spinal cord and performing x-rays).
If the distance between the spinous process of the opposite side of the shackle and its base in the area measure less than 12 mm – can be put the diagnosis of "narrowing of the spinal canal".
What causes stenosis of the spine:
- Intervertebral hernia;
- Deposition of calcium salts in the spinous ligaments (Bekhterev's disease)
- Lipoma (fatty benign education)
- Epidurit (inflammation of the dural SAC and spinal membranes).
When evaluating the lower part of the spinal column at the location of the "horse's tail", a contraction is detected if the minimum size is less than 3 mm at any level. The myelogram in this disease is a contrast agent does not fill the pocket completely radicular. In such a situation, urgently needs an operation.
Symptoms of disease
spinal Stenosis leads to disability due to numerous violations of the function of internal organs.
As there are signs of spinal cord compression:
- Compression first leads to disruption of bone and fibrous tissue surrounding the spinal canal;
- Entrapment of neurovascular formations produces a local swelling at the injury site;
- disruption of the blood supply and innervation of the internal organs leads to changes in the functionality of the abdomen, pelvis, and lower extremities;
- Pathology of liquor circulation creates hypoxia of the brain.
The Above pathogenetic symptoms of stenosis can lead to disability if not carried out timely conservative treatment or surgery. Without timely and proper treatment the symptoms can provoke the death of a person due to pathology of many organs.
spinal Stenosis depending on the localization is divided into:
Central spinal stenosis of the spine characterized by a decrease in the size of the shackle between the base of the spinous process and posterior surface of the vertebra 12 to 10 mm (relative) or less 10 mm (absolute).
Some doctors in assessing the degree of narrowing of the spinal canal calculate the area. If it is less than 100 mm2 – reduction; if less than 75 mm2 – absolute.
Lateral spinal stenosis is diagnosed by the narrowing of the radicular canal is less than 4 mm When it is required urgent surgery for decompression structures.
spinal Stenosis is classified according to etiology in:
- Congenital (idiopathic);
- Combined – the combination of the above types of illness.
What are the signs of congenital stenosis:
- shortening of the arches of the vertebrae;
- an increase in the thickness of arcs;
- reduction in the height of vertebrae;
- Cartilaginous diastematomyelia.
Congenital stenosis of the spine is accompanied by the following anatomical changes:
- calcium Deposits in intervertebral disks;
- spondylarthrosis of the facet joints;
- Stretch yellow ligament;
- Displacement of vertebras;
- the Formation of adhesions.
note that the most common cause of the disease is the deposition in the articular-ligamentous apparatus of calcium salts in the degenerative-dystrophic processes (scoliosis, spondylosis, osteochondrosis).
In degenerative processes of the spinal cord is compressed gradually. With the progression of the disease, local pain and neurological symptoms of pathological innervation of peripheral organs. If no treatment, symptoms rapidly progress.
In the elderly because of numerous pathological processes in the spinal column is formed by the diagnosis – "polysegmental spinal stenosis". The pathology treatment conservative and surgical methods allows only a few to relieve its course. Typically, spinal stenosis in the elderly leads to disability, even if timely surgery for decompression of the spinal cord.
Clinical degree of stenosis of the canal of the spine:
- Narrowing on the background of anomalies: nonunion of the vertebrae, anomalies of the ear, pathology lumbosacral transition, hyperplasia of the spinous processes;
- Dysplastic stenosis: hypochondroplasia, spondylodiscitis, osteopathy, joints and connective tissue, marble bone disease, Paget's disease;
- Degenerative stenosis of the spine: osteochondrosis, hernia of the median, subligamentous disc sequestration, spondylarthrosis, spondylolisthesis;
- constitutional view: by anatomical peculiarities of the spinal column;
- not degenerative Acquired: traumatic injuries, neuromuscular diseases, hormonal disorders, the effects of operations on the spine;
- Combo: a combination of several types simultaneously.
When forming a diagnosis, the doctors set the type of stenosis:
- Spinal canal
- Radicular canal;
depending on localization of stenosis:
depending on the extent of the lesion:
- of Total
The Degree of stenosis of the stages of development:
Gradation of the disease on the basis of the above classification applies not only to domestic but also foreign doctors.
The symptoms of the disease can be divided into the following groups:
Paroxysmal symptoms are formed during exacerbation of the disease or the presence of serious changes of the internal organs.
What syndromes are paroxysmal:
- Punctuating claudication neurogenic etiology;
- Paroxysmal seizure symptom;
- dysesthesia of the extremities
- Uncontrolled defecation and urination
- Temperature dysesthesia;
- Paresis of the limbs (limited mobility).
- Vegetative-vascular dystonia;
- musculo-tonic reduction;
- Cervicalgia, cervical (it leads to stenosis of the cervical spine), thoracalgia (through contraction), sacralgia, lumbodynia, sciatica (lumbar canal stenosis)
- Radicular symptoms: polyradicular, monoarticular, cauda equina syndrome;
- Radicular cardiovascular: radiculomyeloischemia, myelopathy.
depending on the severity of symptoms distinguish the following degrees of severity of the disease:
- 1 degree – punctuating claudication (the appearance of a sharp pain in the calf muscles when walking);
- 2 degree – moderate violation of ' walk with pain syndrome type punctuating lameness;
- 3 degree – pain syndrome pronounced without the aid of movement impossible;
- grade 4 – severe manifestations of punctuating lameness with severe pain.
spinal Stenosis refers to a number of rapidly progressive disease. If the doctors manage to stop an acute attack of the disease, after a while it comes back again.
Treatment of pathology performed in a hospital. Outpatient therapy does not bring positive results due to the limitations of drugs. NSAIDs have side effects on the intestine (provoking an ulcer). Moreover, the majority of patients required decompressive surgery.
What is the relative stenosis of the lumbar and cervical
Relative stenosis (degree of narrowing of the channel from 12 to 10 mm) accompanied by the following neurologic signs:
- Pain syndromes
- movement disorders
- Radiculo cardiovascular changes.
Spinal stenosis is accompanied by punctuating the syndrome of lameness. This symptom may be considered the first sign of the disease. It appears the majority of the patients regardless of the localization of spinal cord compression.
The Pathogenic stage of pathology is considered a transient ischemic attack. When it results in vasoconstriction not only of the spine, and other organs. At transition in vertical position pain worse.
When changing the position of the activated symptoms of venous hypertension and stasis of cerebrospinal fluid. If the patient has edema of the lower extremities, they are enhanced in a vertical position.
Specific neurological symptom is postural dysbasia. It is characterized by the fact that punctuating lameness appears not only when walk but also when standing, when the extension of the spine.
Relative spinal stenosis is characterized by the following neurologic signs:
- Numbness of extremities
- Weakness in the legs;
- loss of coordination due to pathology of nerve impulses
- change the sensitivity of the extremities
- paresthesias in the legs;
- Sensitive disorder without reducing forces in the legs;
- Pelvic disorders and ataxia.
10% of patients symptoms in the initial stages is not expressed. The only marker that allows neurologists to establish a diagnosis of "spinal stenosis", is a thoracic myelopathy.
Whatsuch thoracic myelopathy
Thoracic myelopathy syndrome punctuating the limp combined with pain in the chest, abdomen, hips. Such symptoms may be an early harbinger of absolute stenosis of the spinal canal. If treatment is not applied, the spinal cord over time will be squeezed harder.
Thoracic myelopathy most patients is koudounas – associated with lesions of the cauda equina roots.
Conservative treatment and surgery for lumbar stenosis
spinal Stenosis requires immediate treatment. With a small degree of spinal cord compression can be applied treatment aimed at the elimination of:
- compression of the neurovascular structures;
- tension of muscular-ligamentous apparatus;
- Hypoxia of the nerve root;
- Arterial and venous insufficiency
- Metabolic disorders of metabolism;
- Demyelination of nerves
- Pathologic innervation of bodies;
- Disorders of liquor circulation;
- Instability of the spine.
Alone at home to eliminate the above symptoms it is impossible, therefore, in determining the narrowing of the spinal or radicular canals, the patient required hospitalization.
what is the operation performed when narrowing of the spinal cord
Surgery for the narrowing of the spinal canal is performed to relieve the compression. Prolonged increased pressure in the spinal cord will cause diseases of all internal organs, immobility of the upper and lower limbs.
Surgical treatment of pathology is performed with a small skin incision (about 4-5 cm). After surgical access to an interarch space, is performed to remove the bow with the repair of defects of soft tissues and elimination of protrusions of the intervertebral discs (laminectomy).
In instability of vertebrae surgery is supplemented with transpedicular fixation.
spinal Stenosis is not related to common diseases. It is far more common in the elderly. Because of degenerative changes of the spine are formed severe complications. Eliminate older people can't even operational methods, therefore, in the presence of this pathology, patients present high frequency of disability.