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Spinal stenosis is a term used to describe the condition in which the spinal canal dimensions are decreased. This may be a primary canal stenosis ( space available for spinal cord and thecal sac is less since birth) or may be a secondary canal stenosis due to space occupying lesions such as hypertrophied ligamentum flavum, ossified yellow ligament, facetal hypertrophy and ossified posterior longitudinal ligament.
1.Lumbar Canal stenosis – it is the most common type of spinal stenosis encountered in clinics and most commonly presents with neurogenic claudication ( patient may experience pain/numbness in thigh and calves or sense of heaviness/giving way of legs) after walking for some time. These symptoms are relived by sitting or lying down and reappear on standing or walking.
2.Dorsal Canal stenosis – Rarest form of Canal stenosis. Often such symptoms are a result of ossified ligamentum flavum and typically present with dorsal myelopathy – patients usually complain of tightness in legs and difficulty in walking.
3.Cervical Canal stenosis –Commonly cervical canal stenosis is caused by an ossified posterior longitudinal ligament. It most commonly presents with symptoms of cervical myelopathy i.e. numbness in hands with difficulty in doing fine motor activity, walking difficulties and urinary issues. Rarely patient may present with only arm pains as in cervical radiculopathy.
4.Tandem stenosis – when spinal stenosis is present at more than one level in spine ( cervical plus lumbar/dorsal plus lumbar) then the clinical presentation can be a mix up cause of both levels and should always be considered in patients in order to avoid a missed stenosis.
No weakness and quality of life not affected by symptoms – Careful observation, Medicines, and physiothjerapy, pain management injections.
If patient has developed weakness / quality of life is severely affected then surgical options are indicated.
1.Lumbar Decompression +/- Fixation
2.Cervical Decompression +/- Fixation
3.Dorsal Decompression +/- Fixation