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Spinal stenosis

Spinal stenosis is a medical condition where the spinal canal narrows and pinches the spinal cord and nerves, usually due to disc herniation or a tumour. This may affect the cervical spine, the lumbar spine or both. Lumbar spinal stenosis results in low back pain as well as pain or abnormal sensations in the legs. more...

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Cervical spine stenosis

The main causes of cervical spine (CS) stenosis include cervical spondylosis, diffuse idiopathic skeletal hyperostosis (DISH), or calcification of the posterior longitudinal ligament. CS stenosis is more common in males than females, and is mainly found in the 40-60 year age group.

Signs of CS stenosis include spastic gait; upper extremity numbness; upper extremity, lower extremity weakness or both; radicular pain in the upper limb; sphincter disturbances; muscle wasting; sensory deficits; and reflex abnormalities in reflexes. The best diagnostic and investigative tool is magnetic resonance imaging (MRI), and computed tomograghy (CT) is not useful.

If the problem is mild, treatment may be as simple as physiotherapy and the use of a cervical collar. If severe, treatments include laminectomy or decompression.

Lumbar spine stenosis

The main causes of lumbar spine (LS) stenosis include hypertrophy of the facet joints; spondylolisthesis; diffuse idiopathic skeletal hyperostosis (DISH); and degenerative disc disease. Usually, this condition occurs after the age of 50, and both genders are equally affected.

Signs of LS stenosis include neurogenic claudication that causes leg pain, weakness, and loss of deep tendon reflexes. With lumbar spinal stenosis, the patient's pain usually is worse while walking and will feel better after sitting down. The patient is usually more comfortable while leaning forward.

As with CS stenosis, MRI is the best imaging procedure, though unlike with CS stenosis, CT may be somewhat useful, and can be used if MRI is unavailable.

Treatment includes weight loss, and activity modification, such as using a walker to promote a certain posture. Epidural steroid injections may also help relieve the leg pain. If the symptoms are more severe, a laminectomy or foraminotomy may be indicated.

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AVASCULAR NECROSIS OF THE FEMORAL HEAD AFTER SURGERY FOR LUMBAR SPINAL STENOSIS
From Journal of Bone and Joint Surgery, 1/1/04 by Birch, Nick

Introduction: No previous case of avasculur necrosis (AVN) of the femoral head have been described in the World Literature, to our knowledge.This paper reports the catastrophic failure of the bony integrity of the hip in three patients (five hips) following prolonged hypotension during spinal surgery for spinal stenosis on a Montreal mattress and offers adviee to prevent this complication of spinal surgery. A theory to explain this phenomenon is explored, but we recognize its limitations with such a small sample.

Method: The case notes of all patients undergoing decompressive spinal surgery in our hospitals between March 1997 and December 2001 were examined (168 cases). Three patients had been identified as suffering from AVN following prolonged hypotensive anaesthesia prospectively. No other cases were identified alter the notes review. Clinical notes and pre- and post-operative radiographs were studied in an attempt to identify the factors that caused this complication in these three patients.

Results: Between 1997 and 2001. 168 patients underwent surgery for multi-level symptomatic spinal stenosis in our hospitals. Forty percent of the patients had an instrumented fusion as well as a decompression. During this period, three patients had catastrophic AVN of the femoral head requiring total hip arthroplasty soon after their spinal operation. all had some clinical and radiological evidence of hip arthritis at their pro-surgery visit. all subsequently, presented within symptomatic hip AVN within six months of the index operation. In two. histology confirmed the diagnosis of AVN. and typical changes of AVN were well demonstrated on MRI in the third patient.

Conclusions: The development of avascular necrosis of the femoral heads following surgery for spinal stenosis may be due to a femoral head at risk being exposed to hypotensive anesthesia, prone positioning on a Montreal mattress or a combination of the two. Careful intra-operative positioning may reduce the risk of this occurring after spinal surgery. However, close post-operative surveillance and a high index of suspicion of worsening hip pathology in patients who appear to mobilize poorly after lumbar spinal surgery may be the only method of earh detection of this condition.

Nick Birch, Neil Orpen

BMI Three Shires Hospital. Northampton, UK.

Copyright British Editorial Society of Bone & Joint Surgery 2004
Provided by ProQuest Information and Learning Company. All rights Reserved

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