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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Lumbar spinal stenosis is a condition of polyetiologic origin. It is defined as narrowing of the spinal canal, the nerve root canals or the intervertebral canals. For clinical, diagnostic and therapeutic reasons it may be divided into two main types: central and lateral stenosis with obstruction of the lateral recesses. Plain radiographs may be suggestive in central or generalized narrowing only. Diagnosis is confirmed by additional investigations, i.e. myelography and CT. Lumbar myelography allows definitive diagnosis of central spinal stenosis. However, validity regarding visualization of the lateral recesses is limited and a decision on the nature of the obstruction, bony or soft tissue, cannot be made. In contrast, CT does support information on the bony outline of the lateral recess as related to the facet and soft tissue structures in particular. Treatment of choice should be conservative-supportive if clinical symptoms permit. Surgery is indicated when there is intolerable pain, progressive muscle weakness or sphincter dysfunction. Surgery seeks to attain complete decompression of neural elements, if instability is present or imminent spinal fusion has to be considered. Shape, size and configuration of the spinal canal have to be determined prior to any surgical approach. CT fulfills these requirements most admirably.
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PMID:[Lumbar spinal stenosis]. 717 70

Lumbar spinal stenosis is a clinical-anatomic syndrome. Radiographic evidence of cauda equina compression is necessary but not sufficient to establish the diagnosis. Patients must have a clinical syndrome consisting of back and lower extremity discomfort exacerbated by lumbar extension or relieved by flexion, or evidence of lower extremity neurologic deficits. Symptomatic lumbar spinal stenosis may arise from a variety of specific etiologies and frequently coexists with other pain syndromes.
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PMID:Diagnosis of lumbar spinal stenosis. 801 21

Lumbar spinal stenosis, the results of congenital and degenerative constriction of the neural canal and foramina leading to lumbosacral nerve root or cauda equina compression, is a common cause of disability in middle-aged and elderly patients. Advanced neuroradiologic imaging techniques have improved our ability to localize the site of nerve root entrapment in patients presenting with neurogenic claudication or painful radiculopathy. Although conservative medical management may be successful initially, surgical decompression by wide laminectomy or an intralaminar approach should be done in patients with serious or progressive pain or neurologic dysfunction. Because the early diagnosis and treatment of lumbar spinal stenosis may prevent intractable pain and the permanent neurologic sequelae of chronic nerve root entrapment, all physicians should be aware of the different neurologic presentations and the treatment options for patients with spinal stenosis.
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PMID:Lumbar spinal stenosis. 843 69

Lumbar spinal stenosis and lumbar disc herniation are usually regarded as two pathogenetically different conditions, but in the literature lumbar disc herniation in patients with developmental spinal stenosis has been rarely documented. In a clinical retrospective study, 42 lumbar disc herniations with developmental spinal stenosis were reported and analyzed. Discectomy was performed after laminotomy. The patients were followed-up for an average of 4.4 years (range 2-7 years). The preoperative symptoms disappeared completely in 28 patients, in 13 patients some degree of backache remained although their nerve root pain had been relieved, and in 1 patient intermittent claudication reappeared after 6 years resolution of their preoperative pain. We conclude that when developmental spinal stenosis is combined with disc herniation, discectomy through laminotomy rather than laminectomy is usually sufficient for decompression.
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PMID:Lumbar disc herniation in patients with developmental spinal stenosis. 891 35

A 57-year-old man with severe gouty arthritis for over 20 years was admitted because of persistent back and leg pain and neurogenic claudication. Lumbar spinal stenosis from the L4 to L5 level was diagnosed after admission and decompressive laminectomy was done. However, about 10 months later, another surgery with laminectomy of L2 and L3 and postero-lateral fusion was performed due to post-laminectomy instability with recurrence of stenosis. The pathology of the resected ligmentum flava had tophi deposition. At the one-year follow-up examination after the second operation, the patient was pain free and had resumed daily activity.
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PMID:Recurrent spinal stenosis caused by tophaceous gout: a case report and review of literature. 892 48

Lumbar spinal stenosis is a painful condition that often leads to irreversible neurologic damage and functional disability. Thus, early diagnosis and management are important. Conservative therapy, which is appropriate for many patients, minimizes invasive intervention and decreases the risks of morbidity. As more people live to older ages, the incidence of lumbar spinal stenosis will likely increase. If results of a thorough history and physical examination suggest the disorder, a course of appropriate physical therapy should be started promptly; more expensive tests and treatments are reserved for patients whose pain is refractory to early conservative intervention. However, if pain is severe, if the origin is not clear, or if neurologic deficits quickly become worse, immediate neuroradiologic studies should be considered, including timely EMG. Strong guidance by the primary care physician is of paramount importance because the therapeutic program is lengthy. Additional help from a physiatrist, neurologist, or orthopedic surgeon may be indicated as treatment progresses.
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PMID:Conservative management of lumbar spinal stenosis. Identifying patients likely to do well without surgery. 955 88

Lumbar spinal stenosis is a condition that may cause significant pain and associated disability, especially in older patients. It is being recognized with increasing frequency as the population continues to age, and is the most common diagnosis associated with lumbar spine surgery in patients older than 65 years of age. The natural history of lumbar spinal stenosis is not necessarily one of progressive deterioration. Conservative treatment is advocated in patients with mild to moderate symptoms of lumbar spinal stenosis, and may include therapeutic exercise. The therapeutic exercise program must be prescribed with a thorough understanding of the contributing pathoanatomic and pathophysiologic factors, and should be tailored to each patient based on his or her history and physical examination. Components of the program are described in detail and include specific stretching and strengthening exercises, general conditioning exercises, and education in proper posture and body mechanics. Randomized controlled studies are needed to help clarify the indications for conservative versus surgical treatment, to determine which components of the therapeutic exercise program are the most beneficial, and to compare outcomes after conservative or surgical measures.
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PMID:Therapeutic exercise in the treatment of patients with lumbar spinal stenosis. 1124 59

Lumbar spinal stenosis is well defined in patho-anatomical terms but its clinical features are heterogeneous. We carried out a comprehensive retrospective review of the clinical features, radiological changes and outcome of 75 patients with radiologically diagnosed lumbar spinal stenosis in order to define its clinical spectrum. The presenting complaints were of weakness, numbness/tingling, radicular pain and neurogenic claudication in almost equal proportions. The commonest symptom was numbness or tingling of the legs. Neurogenic claudication eventually occurred in only 61%. Ninety-three per cent showed abnormalities on neurological examination, but these were generally mild with reduced ankle jerks being commonest. Imaging of the lumbar spine showed that moderate to severe central spinal stenosis correlated with complaints of weakness and abnormal motor power on clinical examination. Patients were reviewed at a mean of 4 years after diagnosis and 65% had undergone surgical decompression; this was not a prospective comparison of different treatment modalities. Overall, a third of patients felt that their symptoms had improved while a quarter felt that they had worsened. More than half had satisfactory neurological function at the time of review. Thirty-nine per cent of those treated surgically, and 25% of those managed conservatively, reported improved symptoms. A poorer functional status at review correlated with complaints of motor weakness and associated comorbid disease. Degenerative lumbar stenosis is a clinically heterogeneous neurological disorder of the lower limbs in the elderly with variable longer-term outcome. A high index of suspicion is required and neuroimaging should be obtained to confirm the diagnosis.
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PMID:The clinical syndrome associated with lumbar spinal stenosis. 1558 58

Stenosis is the narrowing of a hollow tube, in this case the central lumbar spinal canal, lateral recess, or foramen. Clinically, this narrowing produces neurovascular compression that may lead to pain. Lumbar spinal stenosis may be classified by etiology (for example, congenital or acquired) or by symptom complex (radiculopathy, neurogenic claudication, or mechanical back pain). Stenosis can also be classified radiographically, by the location of the stenosis (for example, central canal, lateral recess, or intervertebral foramen) or by the presence of deformity such as spondylolisthesis or scoliosis. Overlap occurs in these schemes of classification in that central stenosis with thecal sac compression typically leads to neurogenic claudication, whereas lateral recess compression is associated with compression of an individual nerve root and, therefore, radiculopathy. Because radiographic changes associated with stenosis are very common with aging, understanding the pathophysiology of lumbar spinal stenosis is critical in the assessment and management of related symptom complexes. Although symptoms may arise from narrowing of the spinal canal, not all patients with narrowing develop symptoms. The reason why some patients develop symptomatic stenosis and others do not is still unknown. Therefore, the term lumbar spinal stenosis refers not to the pathoanatomic finding of spinal canal narrowing, but rather to a clinical syndrome of lower extremity pain caused by mechanical compression on the neural elements or their blood supply.
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PMID:Spinal stenosis: pathophysiology, clinical and radiologic classification. 1594 57

Lumbar spinal stenosis is a common condition seen in patients presenting to physicians who specialize in pain management or perform spine surgery. The designation of "spinal stenosis" without other qualifiers is vague and as such holds little practical value. Classifications have been created in order to more specifically describe the various etiologies as well as the site(s) of narrowing. For this purpose, diagnostic imaging studies are vital. These include myelography, computed tomography (CT), and magnetic resonance imaging (MRI). Each imaging modality has its own inherent advantages and limitations in demonstrating anatomical structures and how they may contribute to the stenotic process. Since proper treatment follows accurate identification of the pathology, it is important for physicians to have a sound understanding of normal and abnormal spinal elements as they are depicted on various imaging studies.
Pain Physician 2004 Jan
PMID:Imaging in lumbar spinal stenosis. 1686 27


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