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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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CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH SPINAL CANAL STENOSIS AND HYPEREXTENSION INJURIES OF THE CERVICAL SPINE
From Journal of Bone and Joint Surgery, 1/1/04 by J, Geraghty T

Study design: Retrospective, descriptive study

Objectives: To describe the characteristics and outcomes of patients with spinal canal stenosis who suffer significant spinal cord injury (SCI) due to hyperextension injury of the cervical spine. To compare their characteristics and outcomes with all patients suffering traumatic cervical SCI and with the total cohort of patients admitted to a Spinal Injuries Unit for rehabilitation.

Setting: Spinal Injuries Unit (SIU). Princess Alexandra Hospital. Brisbane.

Method: Demographic, injury and outcome data were obtained from an existing database and by review of the medical records of 575 patients admitted to and discharged from the SIU between july 1st. 1995 and july 1st 2002. Main outcome measures were: change in American Spinal Injury Association (ASIA) scale category, change in ASIA motor score, discharge Functional Independence Measure (FIM) score and change in FIM score, length of stay (LOS), primary means of mobility at discharge and discharge destination. Standard statistical methods were used to compare groups.

Results: A total of IM (3%) of the 575 patients were found to have cervical canal stenosis and hyperextension injury (the CCS/HI group). This represents 8% of the total group suffering traumatic injury to the cervical spinal cord (the total cervical trauma: TCT group, n = 225). This CCS/HI group was found to have a mean age at injury of 55.1 years compared to 37.1 and 37.S years respectively for the TCT and total groups. Ninety-four percent of patients were found to have a neurological level at admission at C1-3 or C4-5 compared to 75.6% of the TCT group and only 5.6% of patients had an ASIA Impairment Category A lesion at admission compared to 34.7% of the TCT group. Falls (55.6%) was the most common cause of injury in the CCS/HI group with motor vehicle accidents (33.8% ) most common in the TCT group.

The mean change in ASIA motor score between admission and discharge was 34.7 compared to 20.4 for the TCT group. Degree of impairment (measured by a change in ASIA Category) improved in 28% of patients and mean change in total FIM score was 41.3. There was no difference seen with the TCT group. LOS was shorter for these patients (111.1 days vs. 161.6days). The primary means of mobility at discharge was "walking " for 50% of this group (compared to 2H.4% for the TCT group) while the next most common means of mobility was "power wheelchair" at 28% (17% of TCT group). Most patients (55.4%) were discharged to their previous home following rehahilitatiun and 22.3% were discharged to another rehabilitation unit or acute hospital.

Conclusions: Patients with cervical spinal canal stenosis who suffer hyperextension injury constitute a distinct suhgmup with the tutal group of traumatic cervical spinal cord injuries. This study suggests that they are older at the time of injury, have more rostral cervical injuries, are more likely to have incomplete injuries and that falls is the most common cause of injury. They have greater improvement in motor function hut this does not appear to result in greater function at discharge as measured by the FIM. There appears to be a dichotomy with results for mobility at discharge with patients either being able to walk or requiring a power wheelchair. LOS in the SIU is shorter hut a higher percentage are discharged to another hospital or rehabilitation unit.

Geraghty TJ1. West A2, Bellamy N3

1 Director of Rehabilitation (Spinal Injuries), Spinal

Injuries Unit, PAH, Brisbane. 2Research Officer,

Spinal Injuries Unit, PAH, Brisbane. 3Professor of

Rehabilitation Medicine, Director of CONROD,

University of Queensland, Brisbane

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

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