### Date : 2024-06-19 23:18 ### Topic : Spinal Stenosis #medicine #orthopedic #neurology ---- ### Spinal Stenosis Overview **Spinal stenosis** (척추관협착증) is a condition where the spinal canal narrows, compressing the spinal cord and nerves. This narrowing can lead to pain, numbness, and weakness, especially in the lower back and legs. It most commonly occurs in the cervical (neck) and lumbar (lower back) regions.  <Photo from: https://www.mountsinai.org/health-library/diseases-conditions/spinal-stenosis> ### Pathophysiology The spinal canal can narrow due to various factors: 1. **Degenerative Changes:** Age-related changes like osteoarthritis can lead to the formation of bone spurs (osteophytes), thickened ligaments (ligamentum flavum), and bulging discs, all contributing to the narrowing of the spinal canal. 2. **Congenital Conditions:** Some individuals are born with a naturally narrow spinal canal. 3. **Trauma:** Injuries to the spine can lead to swelling and scar tissue, which can narrow the spinal canal. 4. **Herniated Discs:** Discs that protrude or rupture can compress the spinal cord or nerves. 5. **Tumors:** Growths within the spinal canal can cause compression. ### Clinical Features **Common Symptoms:** - **Lower Back Pain:** Chronic or intermittent pain, especially with activity. - **Leg Pain and Sciatica:** Pain that radiates down the legs, often described as burning or tingling. - **Numbness and Weakness:** In the legs or feet, leading to difficulty walking or standing for long periods. - **Neurogenic Claudication:** Pain and cramping in the legs that worsens with standing or walking and improves with sitting or bending forward. - **Balance and Coordination Problems:** Difficulty maintaining balance, particularly in severe cases. ### Diagnosis Diagnosis of spinal stenosis involves a combination of clinical evaluation, imaging studies, and sometimes neurophysiological tests: 1. **Clinical Evaluation:** - **Medical History:** Detailed assessment of symptoms, their onset, and progression. - **Physical Examination:** Checking for signs of nerve compression, including muscle strength, reflexes, and sensory function. 2. **Imaging Studies:** - **X-rays:** To identify structural abnormalities and degenerative changes. - **MRI:** Provides detailed images of the soft tissues, including discs, ligaments, and nerve roots, and is the preferred imaging modality for diagnosing spinal stenosis. - **CT Scan:** Useful for visualizing bone structures and detecting spinal canal narrowing. - **Myelogram(척수조영술):** An X-ray or CT scan combined with a contrast dye to highlight the spinal cord and nerves. 3. **Neurophysiological Tests:** - **Electromyography (EMG) and Nerve Conduction Studies (NCS):** To assess the function of the muscles and nerves and confirm nerve compression. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 58 - **Occupation:** Retired Teacher **Medical History:** - **Symptoms:** Chronic lower back pain, numbness, and tingling in both legs, worsening with standing and walking, relieved by sitting or leaning forward. **Clinical Evaluation:** - **Physical Examination:** Reduced strength in the lower extremities, diminished reflexes, and positive straight leg raise test. **Imaging Studies:** - **MRI:** Reveals significant narrowing of the lumbar spinal canal at L4-L5, with disc bulging and thickened ligamentum flavum compressing the nerve roots. **Diagnosis:** Based on the clinical presentation and MRI findings, Jee Hoon Ju is diagnosed with lumbar spinal stenosis. ### Management 1. **Conservative Treatments:** - **Physical Therapy:** Exercises to strengthen the back and abdominal muscles, improve flexibility, and reduce pain. - **Medications:** NSAIDs for pain relief, muscle relaxants, and sometimes corticosteroid injections to reduce inflammation. - **Activity Modification:** Avoiding activities that exacerbate symptoms, using supportive devices like a brace or cane. 2. **Minimally Invasive Procedures:** - **Epidural Steroid Injections:** To reduce inflammation and provide temporary pain relief. - **Nerve Blocks:** To alleviate pain by blocking nerve signals. 3. **Surgical Treatments:** - **Decompression Surgery (Laminectomy):** Removal of part of the vertebrae (lamina) to relieve pressure on the spinal cord or nerves. - **Spinal Fusion:** Stabilizing the spine by fusing two or more vertebrae together, often performed along with decompression surgery. - **Microdiscectomy:** Removal of part of a herniated disc to relieve nerve compression. 4. **Postoperative Care and Rehabilitation:** - **Physical Therapy:** To regain strength and mobility. - **Pain Management:** Ongoing pain relief and management strategies. - **Lifestyle Modifications:** Maintaining a healthy weight, regular exercise, and avoiding activities that strain the back. ### Prognosis - **Conservative Management:** Many patients experience significant symptom relief with non-surgical treatments. - **Surgical Outcomes:** Surgery is generally successful in relieving symptoms, especially leg pain, though recovery can vary based on the patient's overall health and severity of the stenosis. - **Long-Term Management:** Regular follow-up and a proactive approach to back health are crucial for preventing recurrence and managing chronic symptoms. ### Conclusion Spinal stenosis is a common condition, particularly in older adults, characterized by the narrowing of the spinal canal and compression of the spinal cord and nerves. Early diagnosis and a combination of conservative and, if necessary, surgical treatments can effectively manage symptoms and improve quality of life. Regular follow-up and lifestyle modifications are essential to maintain spinal health and prevent complications.