Lumbar Spinal Stenosis - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim's educational animated video illustrates spine concept associated with disc herniation.
The disc is an elastic soft cushion between the vertebrae of the spine.
It can herniate in several ways:
- Posterolateral: L4- L5 herniation you compress L5 nerve root (because it compresses towards the lateral central canal), but if it was foraminal disc herniation then it will compress L4 nerve root.
- Central disc herniation: you get cauda equina: it is the tail of the horse: don’t mess with the horses tail, it is a central dis herniation that will give you back pain, bladder and bowel symptoms, saddle anesthesia and fnumb perineum, you need to get an MRI and do surgery within 48 hours, because this will improve the bladder and motor function recovery.
- Disc herniation that affects the L5- S1 nerve root will cause sciatica.

Conditions with confusing names:
- Spondylolysis: this is an anatomical defect or break of the pars interarticularis that occurs usually in the 5th lumbar vertebra in about 5% of the population & hyperextension makes it worse, on oblique x-ray: you see “scotty dog sign”
- Spondylolisthesis: this is a slippage of the vertebral body over the other, occurs usually at L5-S1 in the pediatric population, L4- L5 in female adults, if there is a large slip it will continue to slip, & if you have a dysplastic slip it will continue to progress.
- Spondylitis: it is an inflammation of the vertebrae, like ankylosing spondylitis or TB.
- Spondylosis: is vertebral arthritis, it narrows the neural foramen, pinch the nerve roots and causes radiculopathy, in the cervical spine, compression of the spinal cord from arthritis can lead to myelopathy which means gait disturbance broad base shuffling gait, upper extremity clumsiness and weakness, upper neuron signs may be present such as Huffman’s sign and Babinski reflex.
Coexisting cervical myelopathy can occur in lumbar stenosis.

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