Lumbar spine decompression for spinal stenosis
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Lumbar spinal stenosis is a very common condition affecting up to up to 47% of adults over 60 years old, although only around 9% may be symptomatic. Symptoms often come on with standing or walking and improve with leaning forwards or sitting down. In some instances, patients may also experience a radiculopathy while at rest.
Spinal stenosis can occur at any level of the spine. It is most commonly caused by facet joint hypertrophy, ligamentum flavum hypertrophy, and degenerative broad disc bulges. Since the lumbar spine and cervical spine move more than the thoracic spine, stenotic changes are more common in these mobile sections of the spine. More forces go through the lumbar spine which means stenotic changes are most common in this area.
Spinal stenosis can affect the central canal and lateral recesses but may also cause foraminal stenosis. It can also be associated with spondylolisthesis, retrolisthesis, and lateral listhesis as well as any spinal deformity. There is also a subgroup of patients who have congenital stenosis that predisposes them to becoming symptomatic if they develop degenerative changes later in life.
The condition often presents insidiously with spinal claudication. This manifests itself as paraesthesia or aching, progressing to pain and weakness. Patients typically have spinal claudication effecting both lower limbs but it can present unilaterally. The pain often starts when patients have been standing in one position for more than a few minutes, or if they walk for more than 5-10 minutes. Patients will often complain symptoms are worse if they have to walk slowly around shops. However, leaning forward on a stick, frame, or shopping trolley often alleviate their symptoms since flexion makes the lumbar spinal canal wider. Patients also describe that they need to sit down or lean forwards to allow their symptoms to resolve.
The vast majority of patients can be managed non-operatively and should be encouraged to stay as active as possible, with modification of activities that bring on their symptoms. However, for those who have exhausted non-operative measures, surgery may be beneficial.
Lumbar decompression is one of the most common spinal procedures and doctors managing spinal patients should be familiar with the management options available, including lumbar decompression.
Author:Mr Stephen Morris FRCS (Tr & Orth).
Institution: The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.
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Question 1 of 17
Lumbar spinal stenosis clinically presents with which one of the following options?CorrectIncorrect
Question 2 of 17
Spinal stenosis can be due to which of the following?CorrectIncorrect
Question 3 of 17
Spinal claudication typically improves when a patient does which of the following?CorrectIncorrect
Question 4 of 17
What is the most important examination feature that will help differentiate between spinal stenosis and a differential diagnosis?CorrectIncorrect
Question 5 of 17
Which imaging modalities should you obtain prior to undertaking a lumbar decompression to obtain the most accurate information?CorrectIncorrect
Question 6 of 17
Instrumented fusion should be considered in which one of the following situations?CorrectIncorrect
Question 7 of 17
Nerve root injections should be offered to which one of the following groups of patients with spinal stenosis?CorrectIncorrect
Question 8 of 17
Which one of the following describes why should the abdomen not be compressed when positioning prone for a spinal decompression?CorrectIncorrect
Question 9 of 17
Which one of the following statements is NOT true regarding surface anatomy of the lumbar spine?CorrectIncorrect
Question 10 of 17
During exposure for posterior spinal decompression which one of the following is correct?CorrectIncorrect
Question 11 of 17
The level check should be performed with the marker in which one position?CorrectIncorrect
Question 12 of 17
The burr can be used to do which one of the following?CorrectIncorrect
Question 13 of 17
The ligamentum flavum inserts into which two areas, one answer only is correct ?CorrectIncorrect
Question 14 of 17
Before using the Kerrison rongeur to remove ligament, you should confirm which one of the following?CorrectIncorrect
Question 15 of 17
The medial wall of the caudal pedicle is a useful landmark during lumbar decompression for which one of the following reasons?CorrectIncorrect
Question 16 of 17
Which one answer describes how much of the facet joint can be removed during a medial undercutting facetectomy without resulting in post-operative instability?CorrectIncorrect
Question 17 of 17
At the end of decompression, which one of the following answers describes why any remaining sharp spikes of bone should be removed?CorrectIncorrect