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Spinal stenosis - spinal claudication
Spinal and/or lateral recessus stenosis can cause symptoms.
Mostly this happens in combination with other degenerative processes.
A symptomatic spinal stenosis has a typical history and clinical image.
Spinal stenosis - spinal claudication
Spinal stenosis could be :
ongenital or acquired
segmental or general
spinal or lateral foraminal.
If the stenosis is in the complete spinal canal, then the symptoms will be bilaterally in several dermatomes.
Absolute stenosis : a sagittal diameter of less than 10 mm can provoke symptoms as a singular pathology.
Relative stenosis : a sagittal diameter between 10-12 mm can only provoke symptoms in the presence of another pathology.
A study on 443 patients showed that only 6% had a relative stenosis and no one had an absolute stenosis. The lateral stenosis is the more frequent one. The symptoms generally appear/start between the age of 30-40 years.
There can be pressure on dura, nerve roots, venous and arterial vessels, resulting in symptoms.
Symptoms
The patient describes an ill-defined "lumbo-sciatica", a numb feeling and weakness.
The image of spinal claudication (neurogenic cause) is quite different from the image of intermittent claudication (vascular cause).
Spinal claudication :
* the symptoms are felt bilaterally in the legs and the back
* pins and needles
* walking makes it worse
* standing has no effect
* flexion makes it better
* cycling has no effect
* prone lying worse.
Intermittent claudication :
* the symptoms are mostly felt in the calf
* no pins and needles
* walking makes it worse
* standing makes it better
* flexion has no effect
* cycling makes it worse
* prone lying has no effect.
Signs
The clinical signs are mostly minimal : lumbar flexion is negative or even makes the symptoms disappear ; prolonged extension is positive. Usually there is no neurological deficit.
(See part I, p210-212) |
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