Lumbar Spinal Stenosis

ISBN-13: 9783709190234 / Angielski / Miękka / 2012 / 230 str.

Franco Postacchini; Attilio Mancini; Lamberto Perugia

Opis

Up until two decades ago, clinical interest in the etiopathogenetic interpretation of lumbo-radicular syndromes was prevalently concentrated on the pathology of the inter vertebral disc. This vision gradually changed and grew as a result of the affirmation of the concept of pathological narrowing of the osteoligamentous vertebral canal as a cause of compression of the lumbar nervous structures. Finally, in the last ten years, lumbar stenosis has become more and more a subject of current interest not only as a result of problems related to nosography, diagnosis, and therapy, but also as a result of the increasing frequency with which vertebral canal or nerve root canal stenosis syndromes are recognized and treated. At the same time there was a tendency to include in stenotic pathology other pathological conditions responsible for lumbo-radicular syndromes. This led to dilation of the concept of stenosis, which perhaps no longer responded to reality, and which was not useful from a practical point of view. The need to define stenotic pathology and to correctly locate it within the vast field of lumbar pathology inspired the writing of this volume. This monograph gathers many diagnostic and therapeutic concepts matured at our In stitution over the years. Some of these concepts have already been defined in scientific meet ings or in publications."

Spis treści

I Historical Review.- II Anatomy of the Vertebral Canal and the Neural Structures in the Lumbar Spine.- Vertebral foramen.- Morphology.- Dimensions.- Width of the lateral recesses.- Vertebral canal.- Nerve root canal.- Intervertebral foramen.- Neural structures in the vertebral canal.- Spinal cord and cauda equina.- Extradural course of the spinal nerver roots.- Functional changes of the vertebral canal and nerve roots.- Blood supply.- Vascular pattern of the spinal cord and cauda equina.- Intrinsic vasculature of the caudal nerve roots.- III Definition and Classification.- Stenosis and pseudostenosis.- Previous definitions of lumbar stenosis.- The concept of stenosis.- Pseudostenosis.- Classification.- Spinal canal stenosis.- Primary stenosis.- Secondary stenosis.- Combined stenosis.- Mixed stenosis.- Isolated stenosis of the nerve root canal.- Stenosis of the intervertebral foramen.- IV Epidemiology.- Incidence.- Sex.- Age.- Physical characteristics.- Occupation.- Familiarity.- Cases observed by the author.- Case reports.- Conclusions.- V Aetiopathogenesis.- Aetiopathogenetic factors.- Achondroplasia.- Developmental narrowing of the spinal canal.- Spondylotic changes.- Intervertebral disc.- Facet joints.- Vertebral body.- Degenerative spondylolisthesis.- Traumas.- Pathogenetic mechanisms.- Primary forms of stenosis.- Degenerative stenosis.- VI Pathomorphology.- Vertebral canal and intervertebral foramen.- Primary stenosis.- Degenerative stenosis.- Disc degeneration and osteophytosis of the vertebral body.- Osteoarthrotic changes of the facet joints.- Thickening of the laminae.- Changes of the ligamenta flava.- Dynamic stenosis.- Degenerative spondylolisthesis.- Epidural tissue.- Spinal nervous structures.- Durai sac.- Spinal nerve roots in the intrathecal course.- Spinal nerve roots in the extrathecal course.- VII Clinical Features.- Clinical syndromes.- Continuous radicular syndrome.- Intermittent radicular syndrome.- Combined radicular syndrome.- Illustrative case reports.- Incidence of the different types of syndrome.- Differential diagnosis with disc prolapse.- Lumbo-radicular intermittent claudication.- Pathogenesis.- Differential diagnosis with other types of claudication and pseudoclaudication.- Medullary intermittent claudication.- Vascular intermittent claudication.- Pseudoclaudication due to joint disorders in the lower limb.- VIII Diagnostic Investigations.- Plain radiography.- Anteroposterior projection.- Length of the laminae and interlaminar angle.- Interapophysolaminar space.- Articular space of facet joints.- Degenerative changes of the facet joints.- Lateral projection.- Length of the pedicles.- Vertebral bodies.- Intervertebral foramina.- Oblique projections.- Measurements of vertebral canal dimensions.- Interpedicular distance.- Midsagittal diameter.- Jones and Thomson’s spinal index.- Conventional tomography.- Electrodiagnostic investigations.- Electromyography.- H reflex.- Somatosensory evoked potentials.- Ultrasonography.- Myelography.- Technical details.- Elementary signs of stenosis.- Uniform narrowing of the durai sac.- Deformations of the durai sac.- Indentations.- Hour-glass deformations.- Block images.- Intrasaccular abnormalities.- Translucencies of the caudal nerve roots in the intrathecal course.- Dyshomogenous distribution of the contrast medium.- Redundancy of spinal nerve roots.- Abnormalities of the nerve root sheaths.- Longitudinal extension of stenosis.- Single level stenosis.- Multilevel stenosis.- Functional myelography.- Myelographic patterns in the various types of stenosis.- Spinal canal stenosis.- Nerve root canal stenosis.- Stenosis of the intervertebral foramen.- Discography.- Computerized tomography.- Spinal canal stenosis.- Vertebral canal.- Midsagittal diameter.- Articular processes.- Intervertebral disc and vertebral body osteophytes.- Ligamenta flava.- Dural sac.- Midsagittal and transverse dimensions.- Area.- Morphology.- Nerve root canal stenosis.- Stenosis of the intervertebral foramen.- Diagnostic accuracy of CT scan.- Myelo-CT.- Magnetic resonance imaging.- IX Treatment.- Conservative treatment.- Drug therapy.- Physiotherapy.- Bracing.- Surgical treatment.- Indications and contraindications.- Planning of surgery.- Spinal canal stenosis.- Number of levels to decompress.- Mono- or bilateral decompression.- Type of decompression.- Longitudinal and transverse extent of decompression.- Vertebral fusion.- Effects of laminectomy on vertebral stability.- Indications to fusion.- Planning of surgery in degenerative spondylolisthesis.- Isolated stenosis of the nerve root canal.- Anaesthesia.- Hypotensive anaesthesia.- Patient positioning.- Preoperative identification of spinal levels.- Surgical technique.- Bilateral laminectomy.- Skin incision and superficial haemostasis.- Disinsertion of paraspinal muscles.- Opening of spinal canal.- Exploration of intervertebral discs and spinal nerve roots.- Excision of posterior osteophytes of the vertebral body.- Control of deep haemorrhage.- Opening of durai sac.- Prevention of epidural scar formation.- Wound closure.- Spinal fusion.- Laminotomy.- Microsurgery.- Postoperative treatment.- Complications.- Vertebral complications.- Extravertebral complications.- X Results of Treatment.- Natural history.- Conservative treatment.- Surgical treatment.- Review of the literature.- Spinal canal stenosis.- Degenerative spondylolisthesis.- Nerve root canal stenosis.- Author’s series.- Material.- Evaluation of the results.- Spinal canal stenosis.- Overall results.- Analytical results.- Nerve root canal stenosis.- Overall results.- Analytical results.- Isolated stenosis of the intervertebral foramen.- Clinical symptoms and signs after surgery.- Spinal canal stenosis.- Nerve root canal stenosis.- Conclusions.