Interventional Pain Procedures by Rajat Mathur MD Michael Sabia MD

Author:Rajat Mathur, MD,Michael Sabia, MD
Language: eng
Format: epub
Publisher: Springer Publishing Company, Inc.
Published: 2018-06-02T00:00:00+00:00

LUMBAR SPINAL STENOSIS

DEFINITION: Lumbar spinal stenosis is defined as narrowing of the central (intraspinal) canal, narrowing of the neural foramen, or narrowing of the lateral recess. Compression of the nerve roots may lead to ischemia and inflammation causing neurogenic claudication. The syndrome causes symptoms characterized as neurogenic claudication, progressive paresthesia, and pain with ambulation. Symptoms are often relieved by sitting or leaning forward.

RISK FACTORS: Spondylosis (degenerative joint disease) is the result of osteoarthritic changes in the spine. It is the most common cause of spinal stenosis and typically affects individuals older than 60 years. Weight gain has also been known to be a contributing factor. Trauma, wear and tear, along with other lifestyle factors lead to loss of disc height, disc protrusion, and loading of the posterior elements of the spine, including the zygapophyseal joints (facet joints). The facet joint arthropathy, ligamentum flavum hypertrophy, and development of osteophytes also occur as the degenerative process progresses. This degenerative process then can infiltrate on the central canal and the neural foramina. Other causes include ankylosing spondylitis, Paget’s disease, diffuse idiopathic skeletal hyperostosis (DISH), rheumatoid arthritis, and congenital malformation such as spina bifida, achondroplasia, and myelomeningocele. Space-occupying lesions such as tumors, synovial cysts, neural cysts, lipomas, and epidural lipomatosis may also cause neuroforaminal stenosis.

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