Spinal stenosis Classification and external resources
ICD-10	M48.0
ICD-9	723-724

Spinal stenosis is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings M00-M99 - Diseases of the Musculoskeletal system and Connective tissue (M00-M25 Arthropathies (M00-M03 Infectious arthropathies The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the The spinal canal (or vertebral canal or spinal cavity) is the space in Vertebrae through which the Spinal cord passes The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected A nerve is an enclosed cable-like bundle of peripheral Axons (the long slender projections of Neurons. This is usually due to the natural process of spinal degeneration that occurs with aging. It can also sometimes be caused by spinal disc herniation, osteoporosis, or a tumour. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic Spinal stenosis may affect the cervical spine, the lumbar spine or both. In Vertebrates cervical vertebrae (singular vertebra) are those vertebrae immediately behind (posterior to the Skull. The lumbar vertebrae are the largest segments of the movable part of the Vertebral column, and are characterized by the absence of the Foramen transversarium within Lumbar spinal stenosis results in low back pain as well as pain or abnormal sensations in the legs, thighs, feet, or buttocks, or loss of bladder and bowel control. Back pain (also known " dorsalgia " is Pain felt in the back that usually originates from the Muscles Nerves Bones Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm A leg is a limb on an Animal 's Body that supports the rest of the animal above the ground between the Ankle and the Hip and is used for In humans the thigh is the area between the Pelvis and the Knee. The buttocks (singular buttock) are rounded portions of the anatomy located on the posterior of the Pelvic region of the Apes including Humans ^[1]

Contents 1 Cervical spinal stenosis 1.1 Diagnosis 1.2 Treatment 2 Lumbar spinal stenosis 2.1 Diagnosis 2.2 Treatment 2.2.1 Surgical laminectomy 2.2.2 New surgical developments 3 External links 4 References

Cervical spinal stenosis

The main causes of cervical spinal stenosis (CSS) include cervical spondylosis, diffuse idiopathic skeletal hyperostosis (DISH), or calcification of the posterior longitudinal ligament. Not to be confused with Spondylitis, Spondylolysis or Spondylolisthesis. Calcium (ˈkælsiəm is the Chemical element with the symbol Ca and Atomic number 20

CSS is more common in males than females, and is mainly found in the 40-60 year age group. Male (♂ refers to the sex of an organism or part of an organism which produces small mobile Gametes called spermatozoa. Female (♀ is the Sex of an Organism, or a part of an organism which produces ova (egg cells

Signs of CSS 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. A Sign is an indication of some fact or quality and a medical sign is an objective indication of some medical fact or quality that is detected by a Physician Radicular Pain, or Radiculitis, is pain "radiated" along the dermatome (sensory distribution of a Nerve due to inflammation or other irritation In Human anatomy, the upper limb (also upper extremity) refers to what in common English is known as the arm, that is the region of the shoulder Muscle atrophy is defined as a decrease in the mass of the muscle it can be a partial or complete wasting away of muscle A reflex action, also known as a reflex, is an involuntary and almost instant movement in response to stimulus.

Diagnosis

The best diagnostic and investigative tool is magnetic resonance imaging (MRI), while computed tomograghy (CT) is somewhat useful if MRI is unavailable. Computed tomography (CT is a Medical imaging method employing Tomography. However, spinal stenosis can be found in asymptomatic patients. ^[2][3][4]

Treatment

If the problem is mild, treatment may be as simple as physical therapy and the use of a cervical collar. A cervical collar (also neck brace) is an Orthopedic piece of Medical equipment used to support a patient's Spinal cord and head If severe, treatments include laminectomy, hemilaminectomy, or decompression. Laminectomy is a spine operation to remove the portion of the vertebral bone called the lamina. A laminotomy is a neurosurgical procedure that removes part of a Lamina of the vertebral arch in order to decompress the corresponding Spinal cord and/or

Lumbar spinal stenosis

The main causes of lumbar spinal stenosis (LSS) include hypertrophy of the facet joints or osteoarthritis; spondylolisthesis; diffuse idiopathic skeletal hyperostosis (DISH); and degenerative disc disease. Hypertrophy is the increase of the size of an organ or in a select area of the tissue A zygapophysial joint ( zygapophyseal, or facet joint) is a Synovial joint between the superior articular process of one Vertebra and Osteoarthritis ( OA, also known as degenerative Arthritis, degenerative joint disease) is a clinical syndrome in which low-grade inflammation Spondylolisthesis describes the anterior displacement of a Vertebra or the vertebral column in relation to the vertebrae below Degeneration of the Intervertebral disc, which is often called " degenerative disc disease " (DDD of the spine, is a condition that can be painful and can

Usually, this condition occurs after the age of 50, and both genders are equally affected.

Signs of LSS include neurogenic intermittent claudication that causes leg pain, weakness, tingling and loss of deep tendon reflexes. Claudication, literally ' Limping ( Latin) is used as a Medical term in various contexts A reflex action, also known as a reflex, is an involuntary and almost instant movement in response to stimulus. Many of these leg symptoms are referred to as sciatica. Sciatica is a set of symptoms including Pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the Sciatic nerve Low back pain may or may not be present. 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, such as walking while leaning on a shopping cart. On the other hand, pain is worse with extension of the back at the hips, which is why patients prefer to lean forward or to sit down, as these actions flex the body at the hip. This is also why patients complain of increased pain walking downhill as opposed to uphill.

Diagnosis

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

Treatment

Treatment includes weight loss, and activity modification, such as using a walker to promote a certain posture. Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid A walker or walking frame is a Tool for Disabled or elderly people who need additional support to maintain balance or stability while Walking Posture or posturing may refer toIn humans Neutral spine or good posture Human position Abnormal posturing Epidural steroid injections may also help relieve the leg pain. The term epidural is often short for epidural anesthesia, a form of Regional anesthesia involving injection of drugs through a Catheter placed into the

If the symptoms are more severe, a laminectomy or foraminotomy may be indicated to take pressure off the spinal nerve. Laminectomy is a spine operation to remove the portion of the vertebral bone called the lamina. Foraminotomy is a medical operation used to relieve pressure on Nerves that are being compressed by the Intervertebral foramina, the passages through the bones of the

Surgical laminectomy

Regarding indications for laminectomy, a complicated, nonrandomized analysis of a randomized controlled trial of laminectomy^[5], in patients with:

"neurogenic claudication or radicular leg pain with associated neurologic signs, spinal stenosis shown on cross-sectional imaging, and degenerative spondylolisthesis shown on lateral radiographs obtained with the patient in a standing position. Laminectomy is a spine operation to remove the portion of the vertebral bone called the lamina. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare The patients had had persistent symptoms for at least 12 weeks and had been confirmed as surgical candidates by their physicians. Patients with adjacent levels of stenosis were eligible; patients with spondylolysis and isthmic spondylolisthesis were not. "

found that patients:

"treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically. "

New surgical developments

Recent developments include several new implants used in surgery to treat the symptoms of spinal stenosis, while preserving as much normal motion in the spine as possible. The only FDA approved non-fusion treatment is the X STOP, by St. Francis Medical Techologies, Inc. which works via indirect decompression, called Interspinous Process Decompression [1](IPD) Some other IPD technologies that are still being studied include the Wallis implant, by Aboott Spine , the DIAM by Medtronic and the Coflex by Paradigm Spine, . ^[6] Other implant systems being studied include the Dynesys by Zimmer, the Stabilimax by Applied Spine, the TFAS by Archus Orthopedics and the Anatomic Facet Replacement System, by Facet Solutions.

One recent implant system that was being studied in the US reportedly has problems that ended its enrollment, the TOPS implant by Impliant. This was reported [2]by an investor in Impliant, Elron Ltd.

Also recently, Medtronic's non-fusion implant was recalled officially in the United Kingdom [3], though in the US the device has been withdrawn from surgeons but MDT has not issued a recall, probably due to the way inventory is handled rather than a difference in the product sold in the US vs. the UK.

External links

• Spinal Stenosis.org
• Spinal Stenosis - Information for Patients
• Lumbar Spinal Stenosis
• Cervical Disorders - Spinal Stenosis and Disc Herniation

References

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