79. The Effect of Lumbar Flexion and Extension on the Central Canal with Dynamic MRI
Feng WeiSoon-Woo HongJun ZouBenjamin TowMasashi MiyazakiYuichiro MorishitaAhmet AlanayJean-Jaques AbitbolJeffrey Wang
6
Citation
0
Reference
10
Related Paper
Citation Trend
Keywords:
Spinal canal stenosis
Cadaveric spasm
Lateral recess
Background: Determining the prevalence of degenerative changes by MRI in patients with low back pain (LBP) and lumbar canal stenosis is valuable for better understanding of important LSS issue. Objective: This study was designed to determine the prevalence of disc degeneration changes through MRI images obtained from patients with low back pain and lumbar spinal stenosis. Methods: This was a cross sectional study in which 53 patients (selected through examining 200 MRI images from patients seeking medical care because of low back pain (LBP) and referred to our MRI imaging center) with MRI findings compatible with lumbar canal stenosis (LSS), were investigated between June 2003 to September 2004. Intervertebral disc conditions such as normal status, bulging, and herniation were evaluated in patient’s MRI images. Findings: In 53 patients with lumbar canal stenosis, 34% were women and 66% men (P<0.005). Degenerative disc disorders (especially herniation) were found in 51% of our patients and 49% shown to have isolated bony canal stenosis occasionally with bulging discs. The isolated or combined anteroposterior (AP) diameter narrowing between patients with LBP was 94.35% in the current study compared to the previous estimation in our imaging center (80%) found in 1998. There was 5.65% isolated LR narrowing and 7.5% AP and LR narrowing in our study. Conclusion: Based on our results, 51% of patients had degenerative disc disorder in the form of disc herniation associated with spinal canal stenosis; 24.5% with no disc pathology, and 24.5% with bulging discs. Disc degeneration was more prevalent in stenotic group compared to non-stenotic group (51% versus 34%; p<0.03).
Spinal canal stenosis
Lateral recess
Disc protrusion
Intervertebral Disc
Degeneration (medical)
Back Pain
Cite
Citations (0)
Cite
Citations (15)
Question 2: A back problem and intractible lower extremity symptoms and signs may not have a disc protrusion as main pathology. Can you pinpoint clinical and investigative differences between the following conditions: Disc protrusion, lateral bony entrapment, spinal stenosis, degenerative spondylolisthesis, and instability?
Disc protrusion
Spinal canal stenosis
Degenerative Disc Disease
Cite
Citations (1)
Objective. To analyze the results of differentiated surgical treatment of elderly and senile patients with lateral stenosis of the lumbar spinal canal. Material and Methods . A total of 95 patients with nerve root compression and back pain were operated on. The analysis and complex evaluation of treatment results were carried out in two groups: Group 1 included 79 (84.15 %) patients with nerve root compression associated with lateral spinal canal stenosis without instability of the spinal motion segment; Group 2 – 16 (15.85 %) patients with clinically significant lateral lumbar spinal canal stenosis with one root compression and severe back pain syndrome caused by the spinal motion segment instability. The clinical and neurological status of patients was evaluated using VAS, ODI, and SF-36 questionnaires. Changes in the angle and depth of the lateral radicular recess and the instability of the spinal motion segment were assessed using CT and functional radiographic findings. Results . Lateral stenosis in elderly and senile patients is presented as a combination of compressing factors in 47.2 % of cases. The increase in the angle of the lateral radicular recess up to 30–40° and in its depth up to 5 mm resulted in reduction of the pain syndrome in the leg and back, and improvement of the quality of life. Conclusion . The use of differentiated surgical treatment tactics based on identification of the dominant clinical neurological syndrome provides good and excellent results in patients of the older age group in 83 % of cases.
Spinal canal stenosis
Lateral recess
Cite
Citations (2)
Spinal canal stenosis
Supine position
Disc protrusion
Lateral recess
Intervertebral Disc
Intervertebral foramen
Spinal nerve
Cite
Citations (116)
Neuroradiology
Back Pain
Cite
Citations (6)
The concept of lumbar stenosis is defined and a classification of the diverse types is proposed. This is based on a correlation of the findings at operation with those of radiographs and axial tomography in patients with spinal stenosis or with disc hernia in a narrow spinal canal. The spinal canal can only be considered stenosed if the osseous canal is narrowed to the point at which it causes compression of the dural sac with or without nerve root involvement. Lumbar spinal stenosis can be divided into: Stenosis of the spinal canal, stenosis of the root canal, and stenosis of the intervertebral foramen.
Intervertebral foramen
Lateral recess
Spinal canal stenosis
Foramen
Cite
Citations (21)
Twenty-two patients with clinical symptoms suggesting lumbar spinal canal stenosis underwent myelography, computed tomography (CT), and magnetic resonance imaging (MRI). Patients were divided into two groups according to myelographic findings. Group I included 19 cases in which myelograms showed spinal canal stenosis, and group II consisted of 3 patients with myelograms negative for this condition. MRI showed uniform narrowing of the dural sac, indentations on the posterior aspect, or interruption of the outline of the sac in the sagittal scans and reduced area of the sac in the transverse scans. In group I patients, the diagnostic accuracy of MRI was greater than that of CT and myelography. In Group II patients, all of whom had moderate or severe lumbar scoliosis, MRI suggested spinal canal stenosis in contrast with myelography. In spinal canal stenosis surgery may be planned on the basis of MRI findings alone, except in scoliotic patients.
Lateral recess
Spinal canal stenosis
Cite
Citations (22)
Stenosis of the central and lateral lumbar vertebral canal can be congenital or acquired; the latter is most often caused by a degenerative process. The associated neurogenic claudication and/or radiculopathic symptom complexes are thought to result from compression of the cauda equina and lumbosacral nerve roots by hypertrophy of or encroachment by any combination of the following: canal walls, ligamenta flava, intervertebral discs, posterior longitudinal ligament, or epidural fat. The authors' technique for the treatment of lumbar stenosis involves extensive unilateral decompression with undercutting of the spinous process and obviates the need for instrumentation by using a contralateral autologous bone fusion. The results in a series of 29 patients in whom the procedure was performed suggest that this decompression method safely and successfully treats not only the radicular symptoms caused by lateral stenosis but also the neurogenic claudication symptoms associated with central stenosis. In addition, the procedure can preserve spinal stability without instrumentation by using contralateral autologous bone fusion along the laminae and spinous processes.
Cauda equina
Neurogenic claudication
Lateral recess
Spinal canal stenosis
Intermittent claudication
Claudication
Posterior longitudinal ligament
Lumbosacral joint
Cite
Citations (4)
With the advent of computed tomography of the lumbar spine, the theories of a small number of pioneering physicians regarding the pathologic sequela of degenerative disc disease and the entities of central and lateral spinal stenosis have been translated into objective determinations which can now be observed by all. CT scanning has provided clinicians with a better appreciation of the diagnostic limitations of myelography and of the pathologic sequela of hemilaminectomy, dorsal-lateral fusion, and discectomy itself. Since the identification by CT scanning of the loss of disc volume, leading to lateral nerve entrapment and nerve compression resulting from fusion overgrowth, it has become clear that our present modes of therapy require comprehensive reevaluation. Because of the findings of CT scanning, dorsal-lateral fusion now appears to have a much reduced role in the treatment of degenerative disc disease and spinal stenosis. In an era in which unnecessary surgery is a matter of concern, CT scanning is an important means of ensuring that surgery will be undertaken only after thorough analysis of the patient's condition and that surgery will not induce additional pathologic conditions.
Rachis
Cite
Citations (26)