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Handbook of Clinical Neurology 2014Narrowing of the spinal canal or foramina is a common finding in spine imaging of the elderly. Only when symptoms of neurogenic claudication and/or cervical myelopathy... (Review)
Review
Narrowing of the spinal canal or foramina is a common finding in spine imaging of the elderly. Only when symptoms of neurogenic claudication and/or cervical myelopathy are present is a spinal stenosis diagnosis made, either of the lumbar spine, cervical spine or both (only very rarely is the thoracic spine involved). Epidemiological data suggest an incidence of 1 case per 100 000 for cervical spine stenosis and 5 cases per 100 000 for lumbar spine stenosis. Cervical myelopathy in patients over 50 years of age is most commonly due to cervical spine stenosis. Symptomatic spinal narrowing can be congenital, or, more frequently, acquired. The latter may be the result of systemic illneses, namely endocrinopathies (such as Cushing disease or acromegaly), calcium metabolism disorders (including hyporarthyroidism and Paget disease), inflammatory diseases (such as rheumathoid arthritis) and infectious diseases. Physical examination is more often abnormal in cervical spondylotic myeloptahy whereas in lumbar spinal stenosis it is typically normal. Therefore spinal stenosis diagnosis relies on the clinical picture corresponding to conspicuous causative changes identified by imaging techniques, most importantly CT and MRI. Other ancillary diagnostic tests are more likely to be yielding for establishing a differential diagnosis, namely vascular claudication. Most patients have a progressive presentation and are offered non operative management as first treatment strategy. Surgery is indicated for progressive intolerable symptoms or, more rarely, for the neurologically catastrophic initial presentations. Surgical strategy consists mainly of decompression (depending on the anatomical level and type of narrowing: laminectomy, foraminotomy, discectomy, corporectomy) with additional instrumentation should spinal stability and sagittal balance be at risk. For cervical spine stenosis the main objective of surgery is to halt disease progression. There is class 1b evidence that surgery is of benefit for lumbar stenosis at least in the short term.
Topics: Diagnosis, Differential; History, 20th Century; Humans; Magnetic Resonance Imaging; Spinal Stenosis
PubMed: 24365318
DOI: 10.1016/B978-0-7020-4086-3.00035-7 -
Der Orthopade Oct 2019Lumbar spinal stenosis is caused by various pathological conditions. With the diagnostic tools available, a precise classification of the condition should be made,... (Review)
Review
BACKGROUND
Lumbar spinal stenosis is caused by various pathological conditions. With the diagnostic tools available, a precise classification of the condition should be made, which enables a consistent and appropriate therapeutic approach.
OBJECTIVES
In the present article, the currently used classifications of lumbar spinal stenosis are discussed and the diagnostic tools are presented, focussing on the imaging descriptions of morphological changes.
MATERIALS AND METHODS
This article is based on a PubMed literature search of the past 60 years and our own experiences.
RESULTS
Lumbar spinal stenosis is caused mainly by degenerative changes to the spine. MR tomographic imaging can result in precise anatomical illustration and classification of the stenosis.
CONCLUSIONS
Although modern imaging procedures deliver a very precise illustration of lumbar spinal stenosis, clinical symptoms make a considerable contribution to therapeutic decision-making. With the anatomical classification, differentiated surgical decompression of the spinal canal can be planned.
Topics: Decompression, Surgical; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Spinal Canal; Spinal Stenosis
PubMed: 31101963
DOI: 10.1007/s00132-019-03746-1 -
European Spine Journal : Official... Sep 2020To systematically evaluate any consensus for the etiology, definition, presentation and outcomes of developmental lumbar spinal stenosis (DLSS). (Review)
Review
PURPOSE
To systematically evaluate any consensus for the etiology, definition, presentation and outcomes of developmental lumbar spinal stenosis (DLSS).
METHODS
A comprehensive literature search was undertaken by 2 independent reviewers with PubMed, Ovid, and Web of Science to identify all published knowledge on DLSS. Search terms included "developmental spinal stenosis" or "congenital spinal stenosis" and "lumbar". The inclusion criteria were English clinical studies with sample size larger than 8, articles examining the etiology, diagnostic criteria, surgical outcomes of DLSS, and its association with other spinal pathologies. Articles that did not specify a developmental component were excluded. The GRADE approach was used to assess their quality of evidence.
RESULTS
The initial database review found 404 articles. Twenty articles with moderate to very low quality met the inclusion criteria for analysis. The bony canal diameter was significantly shorter in patients with DLSS than normal subjects. In addition, the risk of re-operation on adjacent levels (21.7%) was high which could be explained by multi-level stenosis. However, there was a lack of consensus on the methodology of diagnosing DLSS and on its specific surgical techniques.
CONCLUSION
Multi-level stenosis and re-operation at adjacent levels are especially common with DLSS. Identification of these individuals provides better prognostication after surgery. However, current literature provides few consensus on its definition and the required surgical approach. Besides, there are limited reports of its etiology and association with other spinal pathologies. Due to these limitations, standardizing the definition of DLSS and investigating its etiology and expected clinical course are necessary.
Topics: Humans; Lumbar Vertebrae; Lumbosacral Region; Reoperation; Spinal Stenosis
PubMed: 32623513
DOI: 10.1007/s00586-020-06524-2 -
A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis.Pain Medicine (Malden, Mass.) Dec 2019Lumbar spinal stenosis (LSS) is a degenerative spinal condition affecting nearly 50% of patients presenting with lower back pain. The goal of this review is to present... (Review)
Review
OBJECTIVE
Lumbar spinal stenosis (LSS) is a degenerative spinal condition affecting nearly 50% of patients presenting with lower back pain. The goal of this review is to present and summarize the current data on how LSS presents in various populations, how it is diagnosed, and current therapeutic strategies. Properly understanding the prevalence, presentation, and treatment options for individuals suffering from LSS is critical to providing patients the best possible care.
RESULTS
The occurrence of LSS is associated with advanced age. In elderly patients, LSS can be challenging to identify due to the wide variety of presentation subtleties and common comorbidities such as degenerative disc disease. Recent developments in imaging techniques can be useful in accurately identifying the precise location of the spinal compression. Treatment options can range from conservative to surgical, with the latter being reserved for when patients have neurological compromise or conservative measures have failed. Once warranted, there are several surgical techniques at the physician's disposal to best treat each individual case.
Topics: Back Pain; Decompression, Surgical; Humans; Intermittent Claudication; Low Back Pain; Lumbar Vertebrae; Spinal Stenosis
PubMed: 31808530
DOI: 10.1093/pm/pnz161 -
Instructional Course Lectures 2013Lumbar spinal stenosis affects many patients and is one of the most common reasons for spinal surgery in the elderly population. New research and surgical innovations... (Review)
Review
Lumbar spinal stenosis affects many patients and is one of the most common reasons for spinal surgery in the elderly population. New research and surgical innovations have resulted in a better understanding of the disease and its diagnosis and treatment. To select the optimal treatment approach for each patient, it is helpful to review patient presentations, diagnostic workups, surgical and nonsurgical treatment options, evidence-based outcomes, and the pathophysiology of lumbar spinal stenosis.
Topics: Decompression, Surgical; Humans; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Minimally Invasive Surgical Procedures; Orthopedic Procedures; Scoliosis; Spinal Fusion; Spinal Stenosis; Spondylolisthesis; Tomography, X-Ray Computed
PubMed: 23395043
DOI: No ID Found -
BMJ Open Jan 2022Neurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the...
OBJECTIVES
Neurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment of LSS with neurogenic claudication.
DESIGN
A systematic review.
DATA SOURCES
CENTRAL, MEDLINE, EMBASE, CINAHL and Index to Chiropractic Literature databases were searched and updated up to 22 July 2020.
ELIGIBILITY CRITERIA
We only included randomised controlled trials published in English where at least one arm provided data on non-operative treatment and included participants diagnosed with neurogenic claudication with imaging confirmed LSS.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers extracted data and assessed risk of bias using the Cochrane Risk of Bias Tool 1. Grading of Recommendations Assessment, Development and Evaluation was used for evidence synthesis.
RESULTS
Of 15 200 citations screened, 156 were assessed and 23 new trials were identified. There is moderate-quality evidence from three trials that: Manual therapy and exercise provides superior and clinically important short-term improvement in symptoms and function compared with medical care or community-based group exercise; manual therapy, education and exercise delivered using a cognitive-behavioural approach demonstrates superior and clinically important improvements in walking distance in the immediate to long term compared with self-directed home exercises and glucocorticoid plus lidocaine injection is more effective than lidocaine alone in improving statistical, but not clinically important improvements in pain and function in the short term. The remaining 20 new trials demonstrated low-quality or very low-quality evidence for all comparisons and outcomes, like the findings of our original review.
CONCLUSIONS
There is moderate-quality evidence that a multimodal approach which includes manual therapy and exercise, with or without education, is an effective treatment and that epidural steroids are not effective for the management of LSS with neurogenic claudication. All other non-operative interventions provided insufficient quality evidence to make conclusions on their effectiveness.
PROSPERO REGISTRATION NUMBER
CRD42020191860.
Topics: Aged; Back Pain; Exercise Therapy; Humans; Leg; Musculoskeletal Manipulations; Spinal Stenosis
PubMed: 35046008
DOI: 10.1136/bmjopen-2021-057724 -
The Spine Journal : Official Journal of... Jul 2013The evidence-based clinical guideline on the diagnosis and treatment of degenerative lumbar spinal stenosis by the North American Spine Society (NASS) provides... (Review)
Review
BACKGROUND CONTEXT
The evidence-based clinical guideline on the diagnosis and treatment of degenerative lumbar spinal stenosis by the North American Spine Society (NASS) provides evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of degenerative lumbar spinal stenosis. The guideline is intended to reflect contemporary treatment concepts for symptomatic degenerative lumbar spinal stenosis as reflected in the highest quality clinical literature available on this subject as of July 2010. The goals of the guideline recommendations are to assist in delivering optimum efficacious treatment and functional recovery from this spinal disorder.
PURPOSE
Provide an evidence-based educational tool to assist spine care providers in improving quality and efficiency of care delivered to patients with degenerative lumbar spinal stenosis.
STUDY DESIGN
Systematic review and evidence-based clinical guideline.
METHODS
This report is from the Degenerative Lumbar Spinal Stenosis Work Group of the NASS's Evidence-Based Clinical Guideline Development Committee. The work group consisted of multidisciplinary spine care specialists trained in the principles of evidence-based analysis. The original guideline, published in 2006, was carefully reviewed. A literature search addressing each question and using a specific search protocol was performed on English language references found in MEDLINE, EMBASE (Drugs and Pharmacology), and four additional, evidence-based, databases to identify articles published since the search performed for the original guideline. The relevant literature was then independently rated by a minimum of three physician reviewers using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final recommendations to answer each clinical question were arrived at via work group discussion, and grades were assigned to the recommendations using standardized grades of recommendation. In the absence of Levels I to IV evidence, work group consensus statements have been developed using a modified nominal group technique, and these statements are clearly identified as such in the guideline.
RESULTS
Sixteen key clinical questions were assessed, addressing issues of natural history, diagnosis, and treatment of degenerative lumbar spinal stenosis. The answers are summarized in this document. The respective recommendations were graded by the strength of the supporting literature that was stratified by levels of evidence.
CONCLUSIONS
A clinical guideline for degenerative lumbar spinal stenosis has been updated using the techniques of evidence-based medicine and using the best available clinical evidence to aid both practitioners and patients involved with the care of this condition. The entire guideline document, including the evidentiary tables, suggestions for future research, and all references, will be available electronically at the NASS Web site (www.spine.org) and will remain updated on a timely schedule.
Topics: Evidence-Based Medicine; Humans; Lumbar Vertebrae; Spinal Stenosis; Treatment Outcome
PubMed: 23830297
DOI: 10.1016/j.spinee.2012.11.059 -
South Dakota Medicine : the Journal of... Mar 2006Spinal stenosis can be generally described as the narrowing of the spinal canal causing compression of the spinal cord. This compression most often occurs in the lumbar... (Review)
Review
Spinal stenosis can be generally described as the narrowing of the spinal canal causing compression of the spinal cord. This compression most often occurs in the lumbar portion of the spine and has a clinical presentation of pain and numbness in the low back, legs and buttocks after walking or extension of the lumbar spine. The symptoms associated with lumbar spinal stenosis are usually relieved with flexion of the lower back. In addition, compression at the cervical spine has occasionally been seen in combination with lumbar spinal stenosis, with thoracic spinal stenosis occurring only rarely. Therefore, because spinal stenosis is the most prevalent preoperative diagnosis for spine surgery and affects nearly 5 of every 1000 Americans older than 50 years old, it is imperative to understand the role of spinal stenosis in generating back and leg pain. In this article an overview of the etiology, treatment, and outcomes will be presented to give a better understanding of this condition.
Topics: Aged; Diagnostic Imaging; Humans; Low Back Pain; Lumbar Vertebrae; Middle Aged; Quality of Life; Spinal Stenosis
PubMed: 16566302
DOI: No ID Found -
JBJS Reviews Sep 2017Tandem spinal stenosis refers to spinal canal diameter narrowing in at least 2 distinct regions of the spine, most commonly the lumbar and cervical regions. This entity... (Review)
Review
BACKGROUND
Tandem spinal stenosis refers to spinal canal diameter narrowing in at least 2 distinct regions of the spine, most commonly the lumbar and cervical regions. This entity can be an asymptomatic radiographic finding, or it can present with severe myelopathy and lower-extremity symptoms. Tandem spinal stenosis may impact surgeon decision-making when planning either cervical or lumbar spine surgery, and there is currently no consensus in the literature regarding the treatment algorithm for operative intervention.
METHODS
A MEDLINE literature search was performed using PubMed, the Cochrane Database of Systematic Reviews, and Embase from January 1980 to February 2015 using Medical Subject Heading queries for the terms "tandem spinal stenosis," "cervical stenosis AND lumbar stenosis," and "concomitant spinal stenosis." We included studies involving adult patients, tandem spinal stenosis of the cervical and lumbar regions, and a minimum of 5 patients. Articles that did not discuss spinal disorders or only explored disorders at a single spinal region were excluded.
RESULTS
The initial database review resulted in 234 articles. After abstracts were reviewed, only 17 articles that met inclusion criteria were identified: 2 cadaveric studies, 5 clinical studies of patients with radiographic tandem spinal stenosis, and 10 clinical studies of patients with symptomatic tandem spinal stenosis.
CONCLUSIONS
Tandem spinal stenosis is a common condition present in up to 60% of patients with spinal stenosis. This disorder, however, is often overlooked, which can lead to serious complications. Identification of tandem spinal stenosis is paramount as a first step in management and, although there is still no preferred intervention, both staged and simultaneous procedures have been shown to be effective. Surgeons may utilize a single, staged, or combined approach to decompression, always addressing cervical myelopathy as a priority.
Topics: Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Clinical Decision-Making; Decompression, Surgical; Diagnosis, Differential; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Neurosurgical Procedures; Spinal Cord Diseases; Spinal Stenosis; Treatment Outcome
PubMed: 28872572
DOI: 10.2106/JBJS.RVW.17.00007 -
Seminars in Neurology Jun 2002Lumbar spinal stenosis refers to a diversity of conditions that decrease the total area of the spinal canal, lateral recesses, or neural foramina. Lumbar stenosis is a... (Review)
Review
Lumbar spinal stenosis refers to a diversity of conditions that decrease the total area of the spinal canal, lateral recesses, or neural foramina. Lumbar stenosis is a common disorder that may be present in isolation, with or without associated disk bulge or herniation, or can be associated with degenerative spondylolisthesis or scoliosis. Symptomatic lumbar spinal stenosis is characterized by neurogenic claudication and/or lumbar or sacral radiculopathy. Sixty percent to 85% of properly selected patients have a satisfactory symptomatic improvement with surgical treatment.
Topics: Cauda Equina; Decompression, Surgical; Humans; Intermittent Claudication; Nerve Compression Syndromes; Orthopedic Procedures; Radiculopathy; Spinal Stenosis; Treatment Outcome
PubMed: 12524561
DOI: 10.1055/s-2002-36539