Lumbar Spinal Canal Stenosis, lowback pain - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the anatomy of the lumber spinal canal and it stenosis.
The lumbar spine is made up of five vertebral bodies in the lower back. Nerves travel through the spinal canal and exit through the openings on the sides of the vertebrae called foramen.
Lumbar canal stenosis is a narrowing of the spinal canal, which may cause nerve impingement and it can occur in the central canal, the lateral recess, or at the foramen. It is a common cause of back pain.
Normal lumbar spinal canal more than 150 mm.
Degeneration of the spinal canal: absolute stenosis = spinal canal less than 100 mm2. Degenerative changes involving the thecal sac, facet joint and ligament flavum.
•Narrowing and compression between the sac and medial pedicle wall. superior facet, facet capsule, disc.
•Lateral to medial pedicle affecting the exiting nerve root. Facet enlargement, overriding or disc.
Diagnosis
•Back pain
•Leg and buttock pain: from proximal to distal. Patient may complain of neurogenic claudication.
•Patient is usually neurologically intact.
•MRI or CT myelogram: absolute stenosis = spinal canal diameter less than 10 mm.
Differential diagnosis
•Hip disease
•Vascular disease:
a)pain is distal to proximal
b)the pain starts in the calf
c)relief when patient stops walking
d)pulses could be affected.
Neurological vs vascular claudication
Neurological claudication
•Vague pain beginning in the lower back
•Proximal to distal radiation
•Worse with extension, standing, rare with bicycling.
•Uphill walking less painful than downhill walking.
Vascular claudication
•Tightness/ cramping in the calf.
•Calf pain
•Worse with walking, bicycling, better when stopping the activity.
•Uphill or downhill walking is painful.
Check pulses for both claudications.
Forminal area decreases by 20% during extension and increases by 12% during flexion.
Bicycle test
•Patient rides and walks a fixed distance.
•The patient with spinal stenosis generally shows symptoms with walking but not while riding the bicycle.
•Due to flexed posture of riding a bicycle there is less pain present.
•Patient with vascular claudication will have pain while both walking and riding the bicycle.
Treatment
•NSAIDS
•Physiotherapy
•Brace
•Epidural Injections
•Surgery
Surgery is done for persistent pain not improved by conservative treatment.
Laminectomy and partial facetectomy with or without fusion.
Fusion is done for instability and for degenerative spondylolisthesis.

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