Estenosis lumbar degenerativa: conceptos básicos, evaluación clínica y manejo / Degenerative lumbar spinal stenosis: basic concepts, clinical evaluation, treatment

La estenorraquis lumbar es la disminución del volumen del canal raquídeo en la columna. Es la causa más frecuente de dolor lumbociático y lumbocrural en población mayor de 60 años. Existen múltiples causas. La más común es la degenerativa que consiste en una disminución del canal secundario a varios factores como protrusión del disco intervertebral, hipertrofia y abombamiento del ligamento amarillo, engrosamiento de la capsula articular y por osteofitos. Los síntomas principales son el dolor lumbar irradiado a extremidades inferiores tipo lumbociática o lumbocruralgia y la claudicación neural intermitente. Generalmente no hay déficit motor ni sensitivo. La resonancia magnética es el estudio de elección para el diagnóstico, pero debe complementarse con radiografías y con frecuencia con tac para una mejor valoración de la patología. El tratamiento inicial siempre es conservador, que incluye uso de antiinflamatorios, analgésicos, relajantes musculares, kinesioterapia e infiltraciones de columna (epidurales o radiculares). La mayoría de los pacientes responden satisfactoriamente a este manejo. El tratamiento quirúrgico está indicado a los pacientes que presentan un dolor intenso, que afecta su calidad de vida y que no mejora con el tratamiento conservador. Consiste en la descompresión quirúrgica de las raíces lumbares a través de laminectomía. En ocasiones se recomienda complementar la descompresión con artrodesis específicamente cuando la estenorraquis se asocia a otras condiciones como espondilolistesis degenerativa, escoliosis, desbalance sagital o coronal, inestabilidad segmentaria y en enfermedad del segmento adyacente.

Spinal lumbar stenosis is a narrowing of the spinal canal in the lumbar spine. Is the most frequent cause of sciatic pain or cruralgia in the elderly population over 60 years old. Exist many etiologies. The most common is degenerative caused by many factors including bulging disc, hypertrophy of flavum ligament as well as facet capsule thickening and by osteophytes formation. The main symptoms of spinal stenosis are radicular pain and neurogenic claudication. Lumbar flexion usually improves the symptom and deambulation often worsens the pain. Most of the time neurologic examination is normal. The gold standard study is mri but is necessary to complement with x rays and ct to obtain a better evaluation. Initial treatment is always conservative and consists in nsaid's, muscle relaxants, physical therapy and steroid spinal injections. Most of the patients respond well to this treatment. Surgical treatment is indicated when the patient has a severe pain, quality of life is miserable and conservative treatment fails. Decompression is the gold standard surgical treatment. The addition of an arthrodesis or spinal fusion is recommended in degenerative spondylolisthesis, scoliosis, sagital or coronal imbalance, deformity correction, recurrent spinal stenosis and in cases of adjacent level disease problem.

Uso da inteligência articial como armamento no diagnóstico e condução clínica da estenose de canal lombar / Use of Articial Intelligence in Diagnosis and Clinical Conduct of Lumbar Spinal Stenosis

A estenose do canal vertebral lombar (ECL) é uma patologia complexa, com alta incidência entre pessoas acima de 65 anos de idade. No entanto, o diagnóstico correto é, por vezes, difícil de ser confirmado. O uso de modelos de Inteligência Articial (IA) na medicina é, em geral, desconhecida para a maioria da comunidade médica, mas tem sido usada há décadas na assistência em UTI, os métodos de imagem e dispositivos de diagnóstico eletrônico (ECG). Através de uma revisão sistemática da literatura, com foco nos achados clínicos e radiológicos, juntamente com todas as modalidades de tratamento, foi possível identicar o ambiente completo de pacientes LSS, para responder a quatro questões: (a) "Com base no quadro clínico, o paciente tem um, cenário moderado ou grave?"; (b) "Com base nos dados radiológicos, o paciente pode ser classicado com um cenário leve,moderada ou grave?"; (c) "Qual é a probabilidade, com base na anamnese, do paciente ter ECL?"; (d) "Qual é o melhor tratamento a ser oferecido?".þ. Como auxílio de um software usando Sistema Especialista (Expert Sinta), uma linguagem de IA, alocamos todas as variáveis e seus valores para orientar o software responder às quatro perguntas. Foi possível identicar 657 artigos cientícos, no entanto apenas 63 poderia mencionar não apenas as variáveis, mas a sua probabilidade de ocorrência ou teve disponibilidade texto completo. Foi possível classicar a intensidade do quadro clínico e radiológico, criar um índice de probabilidade para LSS e oferecer o melhor tratamento. Recomendamos o uso, sob supervisão médica, em de Neurocirurgia ou clínicas ortopédicas como um conselheiro para os pacientes com ELA.

The lumbar spinal stenosis (LSS) is a complex pathology with high incidence among people above 65 years old. However, the correct diagnose is sometimes difcult to perform. The use of Articial Intelligence (AI) models in medicine is, in general, unfamiliar for the majority of medical community, but has been used for decades in assistance in ICUs, image methods and electronic diagnostic devices (EKG). Through a systematic literature review focused in the clinical and radiological ndings, in addition to all treatmentmodalities, we identied the complete environment of LSS patients, to answer four questions. (a) "Based on the clinical presentation, the patient has a mild, moderate or severe scenario?", (b) "Based on the radiological data, the patient can be classied having a mild, moderate or severe scenario?", (c) "What is the probability, based on the anamneses, the patient has LSS?", and (d) "What is the best treatment to be offered?".With the aid of a software using Expert System (Expert Sinta), a language of AI, we allocate all the variables and their values to orient the software to answer the four questions. It was possible to identify 657 scientic articles, however only 63 could mention not only the variables, but their occurrence probability or had full text availability. It was possible to classify the intensity the clinical and radiological scenario, create a probability index for LSS and offer the best treatment. We recommend the use, under medical supervision, in neurosurgery or orthopedic clinics as an adviser for patients with LSS.

Tratamiento quirúrgico de la estenosis lumbar degenerativa en octogenarios / Surgical treatment of degenerative lumbar stenosis in octogenarians

INTRODUCCIÓN: el diagnóstico de estenosis lumbar degenerativa se ha incrementado en años recientes y representa una parte importante de las actividades diarias de los cirujanos espinales. Los pacientes mayores de 80 años presentan características y comorbilidades que incrementan los riesgos perioperatorios y pueden ocasionar malos resultados. OBJETIVO: mostrar resultados en el tratamiento quirúrgico, mediante descompresión, de los pacientes mayores de 80 años con diagnóstico de estenosis lumbar degenerativa. MÉTODOS: estudio de intervención longitudinal prospectivo con 13 pacientes mayores de 80 años de edad, siete hombres y seis mujeres, diagnosticados e intervenidos por estenosis lumbar degenerativa entre el 1ro. de enero de 2005 y el 31 de octubre de 2011, en el Centro de Investigaciones en Longevidad, Envejecimiento y Salud, y evaluados dos años después. RESULTADOS: predominó la afectación de cuatro o más espacios intervertebrales, con más de dos años de padecer fundamentalmente del síntoma de claudicación de origen neurógeno, las comorbilidades de causas cardiovasculares y ocurrieron cinco complicaciones perioperatorias. La disminución del dolor y del nivel de discapacidad fue significativa, con predominio de resultados bueno y regular. CONCLUSIONES: el tratamiento quirúrgico de la estenosis lumbar degenerativa, en pacientes mayores de 80 años de edad, según nuestros resultados, produce efectos beneficiosos, con disminución de dolor y discapacidad y baja ocurrencia de complicaciones.

INTRODUCTION: the diagnosis of degenerative lumbar stenosis has increased in recent years and it represents an important part of the daily activities of spinal surgeons. Patients older than 80 have characteristics and comorbidities that increase the perioperative risk causing bad results. OBJECTIVe: show results in the surgical treatment by decompression of patients older than 80 years diagnosed with degenerative lumbar stenosis. METHODS: a prospective longitudinal intervention study was conducted in 13 patients older than 80 years of age, seven men and six women diagnosed and treated for degenerative lumbar stenosis, from January 1, 2005 to October 31, 2011, at the Center for Research in Longevity, Aging and Health, and they were evaluated two years later. RESULTS: predominant involvement of four or more intervertebral spaces, more than two years of suffering primarily symptom of neurogenic claudication, comorbidities and cardiovascular causes occurred five perioperative complications. Reducing pain and disability was significant, with a predominance of good and fair results. CONCLUSIONS: surgical treatment of degenerative lumbar stenosis, in patients older than 80 years, according to our results, produces beneficial effects, with reduced pain and disability and low occurrence of complications.

Clinical and Radiological Predictive Factors to be Related with the Degree of Lumbar Back Muscle Degeneration: Difference by Gender

BACKGROUND: The prediction of lumbar back muscle degeneration is important because chronic low back pain and spino-pelvic imbalance have been known to be related to it. However, gender difference should be considered because there are different quality and volume of muscles between genders. The purpose of this study was to search for clinical and radiological factors to predict the degree of lumbar back muscle degeneration according to gender difference. METHODS: We reviewed 112 patients (44 men and 68 women) with spinal stenosis who underwent a decompressive surgery between 1 January 2009 and 31 December 2011. Degrees of lumbar back muscle degeneration were classified into three categories by the fatty infiltration at each L3-4 disc level on the axial view of T1 magnetic resonance imaging (MRI). Age, sex, bone marrow density score, and body mass index (BMI) were obtained from chart reviews. Lumbar lordosis, sacral slope, pelvic tilt (PT), and pelvic incidence were calculated with lumbar spine standing lateral radiographs. The degrees of spinal stenosis and facet arthropathy were checked with MRI. Student t-test, chi-square test, or Fisher exact test were used to compare clinical and radiological parameters between genders. Analysis of variance (ANOVA) and linear regression analysis were used to search for a relationship between lumbar back muscle degeneration and possible predictive factors in each gender group. RESULTS: Many clinical and radiological parameters were different according to gender. The age, BMI, and PT in the female group (p = 0.013, 0.001, and 0.019, respectively) and the PT in the men group (p = 0.018) were predictive factors to be correlated with lumbar back muscle degeneration. CONCLUSIONS: The PT was the important predictive factor for lumbar back muscle degeneration in both, the male and the female group. However, age and BMI were predictive factors in the female group only.

Differentiation between Symptomatic and Asymptomatic Extraforaminal Stenosis in Lumbosacral Transitional Vertebra: Role of Three-Dimensional Magnetic Resonance Lumbosacral Radiculography

OBJECTIVE: To investigate the role of lumbosacral radiculography using 3-dimentional (3D) magnetic resonance (MR) rendering for diagnostic information of symptomatic extraforaminal stenosis in lumbosacral transitional vertebra. MATERIALS AND METHODS: The study population consisted of 18 patients with symptomatic (n = 10) and asymptomatic extraforaminal stenosis (n = 8) in lumbosacral transitional vertebra. Each patient underwent 3D coronal fast-field echo sequences with selective water excitation using the principles of the selective excitation technique (Proset imaging). Morphologic changes of the L5 nerve roots at the symptomatic and asymptomatic extraforaminal stenosis were evaluated on 3D MR rendered images of the lumbosacral spine. RESULTS: Ten cases with symptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. On 3D MR lumbosacral radiculography, indentation of the L5 nerve roots was found in two cases, while swelling of the nerve roots was seen in eight cases at the exiting nerve root. Eight cases with asymptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. Based on 3D MR lumbosacral radiculography, indentation or swelling of the L5 nerve roots was not found in any cases with asymptomatic extraforaminal stenosis. CONCLUSION: Results from 3D MR lumbosacral radiculography Indicate the indentation or swelling of the L5 nerve root in symptomatic extraforaminal stenosis. Based on these findings, 3D MR radiculography may be helpful in the diagnosis of the symptomatic extraforaminal stenosis with lumbosacral transitional vertebra.

Actualización en estenorraquis lumbar: diagnóstico, tratamiento y controversias / Spinal lumbar stenosis: An update

Spinal lumbar stenosis is a disease that occurs mainly between the 5th and 7th decade of life and can be congenital or acquired. The latter has many etiologies, but a degenerative cause is the most common. Stenosis is a narrowing of the spinal canal diameter caused by many factors such as bulging discs, hypertrophy of flavum ligament, facet capsule thickening and osteophyte formation. The classical symptom of the disease is sciatic pain, that improves with lumbar flexion and worsens with ambulation. Neurological examination is often normal and the most useful imaging test is magnetic resonance imaging (MRI). Conservative management consists in non-steroidal anti-inflammatory drugs, muscle relaxants, physical therapy and epidural - radicular infiltrations. Spinal infiltrations have a proven efficacy for pain management. A good result of this therapy predicts a favorable outcome after surgery. Surgical treatment consists in decompression with or without lumbar fusion. The addition of an arthrodesis is recommended for degenerative spondylolisthesis, correction of deformities, recurrent spinal stenosis with instability, sagittal or coronal imbalance and adjacent segment disease.

Estabilización dinámica con ligamentoplastia interespinosa en discopatía degenerativa de columna vertebral lumbar / Dynamic stabilization with interspinous ligamentoplasty in degenerative discopaty of lumbar spine

El tratamiento de la Discopatía Degenerativa lumbar, mediante dispositivo suave de estabilización dinámica, con el uso de ligamento para reforzamiento interespinoso, altera favorablemente el movimiento y la transmisión de carga de un segmento vertebral, proporcionando estabilidad y previniendo la enfermedad del segmento adyacente. Por lo tanto se realiza un estudio prospectivo, longitudinal con 25 pacientes con edades comprendidas entre 15 y 58 años, con diagnóstico de Discopatia degenerativa lumbar; con estudios de imágenes previos con radiografias en proyección AP, lateral y laterales dinámicas además de Resonancia Magnética, con los cuales se confirmo el diagnóstico, al igual que control radiológico postoperatorio, a los que se les practico semihemilaminectomia mas discectomíamas foraminectomía mas ligamentoplastia interespinosa del segmento afectado y adyacentes. Se obtuvo como resultado mejoría clínica inmediata en la mayoría de los pacientes y con pronto reintegro a sus actividades habituales luego de la cirugía.

The treatment of lumbar degenerative discopaty, by means of a soft dynamic stabilization device, with the use of ligament for interspinous reinforcement, alter favorably the movement and load transmission of a vertebral segment, providing stability and preventing the disease of the adjacent segment. Therefore a prospectivelongitudinal study is carried out on 25 patients with ages ranging from 15 to 58 years, with a lumbar degenerative disease diagnosis; previous radiographicstudies in AP, lateral and dynamic-laterals projectionsand also Magnetic Resonance Imaging confirm the diagnosis, along with postoperative radiological controls. The patients received semi-hemilaminectomy plus discectomy plus foraminectomy plus interspinous ligamentoplasty of affected and adjacent segments. As result, inmediate clinical improvement in most patients was obtained and a soon return to their usual activities after the surgery.

Types and Prevalence of Coexisting Spine Lesions on Whole Spine Sagittal MR Images in Surgical Degenerative Spinal Diseases

PURPOSE: We investigated types and prevalence of coexisting lesions found on whole spine sagittal T2-weighted images (WSST2I) acquired from magnetic resonance imaging (MRI) and evaluated their clinical significance in surgical degenerative spinal diseases. MATERIALS AND METHODS: Coexisting spinal lesions were investigated using WSST2I from 306 consecutive patients with surgical degenerative spinal diseases. Severity of coexisting lesions was classified into four grades (0-3). Lesions of grade 2 and 3 were defined as "meaningful coexisting spine lesions" (MCSL). Degenerative spinal diseases were classified into three pathologies: simple disc herniation, degenerative spinal stenosis, and ligament ossification disease. The relationships between MCSL, gender, age, and primary spine lesions were analyzed. RESULTS: MCSL were found in 95 patients: a prevalence of 31.1%. Five out of 95 MCSL were surgically managed. The most common types of MCSL were disc herniation with 13.1% prevalence, followed by degenerative stenosis (9.5%) and ligament ossification diseases (6.8%). Older patients (age > or = 40) showed a significantly higher prevalence of MCSL than younger patients. There was no significant difference between male and female patients. The prevalence of MCSL was significantly higher (52.4%) in ligament ossification diseases than in disc herniation or spinal stenosis. CONCLUSION: Degenerative spinal diseases showed a high prevalence of MCSL, especially in old ages and ligament ossification diseases. WSST2I is useful for diagnosing coexisting spinal diseases and to avoid missing a significant cord-compressing lesion.

Degenerative lumbar stenosis: update / Estenose lombar degenerativa: atualização

We present a literature review of the diagnosis and treatment of acquired lumbar spinal stenosis (LS), with a brief description of new surgical techniques. LS is the most common cause of spinal surgery in individuals older than 65 years of age. Neurogenic claudication and radiculopathy result from compression of the cauda equina and lumbosacral nerve roots by degenerated spinal elements. Surgical decompression is a well established treatment for patients with refractory, or moderate to severe clinical symptoms. However, the variety of surgical options is vast. New techniques have been developed with the goal of increasing long term functional outcomes. In this article we review lumbar decompression and fusion as treatment options for LS but also present other recent developments. Prospective long term studies are necessary to know which procedures would result in optimal patient outcome.

Apresentamos uma revisão de literatura do diagnóstico e tratamento da estenose lombar (EL) adquirida, enfatizando as novas técnicas de manejo cirúrgico. A EL é a causa mais comum de cirurgia na coluna de pacientes com mais de 65 anos de idade. Claudicação neurogênica e radiculopatias são sintomas resultantes da compressão das raízes lombossacrais pelos elementos degenerados. A descompressão cirúrgica é um procedimento bem estabelecido para pacientes com sintomas severos ou refratários ao tratamento clínico. Contudo, as opções cirúrgicas são amplas. Novas técnicas de fusão e artrodese são úteis para melhorar os resultados funcionais. Neste artigo, varias alternativas cirúrgicas são apresentadas, incluindo as novas tecnologias na área. Evidências científicas mais contundentes com seguimento longo são necessárias para a incorporação destas práticas na atividade médica de rotina.

Lumber spinal canal stenosis: our experience

Lumber spinal canal stenosis is an important cause of lower backache and /or sciatica, which result in significant disability. The aim of this paper is to report our experience with the different patterns of clinical presentation of degenerative lumbar spinal canal stenosis [DLSS] and the correlation of MRI finding with the clinical presentation. During the period from January 2004 to January 2008, a total of 100 patients were observed at the Neurosurgical Hospital of Baghdad, who were complaining of lower backache and/or sciatica. The pattern of clinical presentation was analyzed to determine the possible correlations with the different MRI findings. Age ranged between 22-71 years, the highest proportion of patients was between 50-59 years age with predominance of male sex [56 male and 44 women]. The most common clinical presentation was intermittent neurogenic claudication [in 52% of our patients] and more common among elderly patients or patients having multilevel stenosis, while radiculopathy symptom was more common among young patients or patients having single level stenosis. Chronic cauda equine syndrome was uncommon pattern of presentation with bladder function most seriously affected function. L4-5 was the most frequently involved level followed by L3-4 and then L5-S1. Multilevel stenosis with involvement of central canal and lateral recess at the same time was the most common MRI pattern. The cause of stenosis in majority of our patients was combination of disc degeneration, facet and ligaments hypertrophy, osteophytes and in some patients was spondylolisthesis

Estenorraquis lumbar: ¿tratamiento médico, pequeña o gran cirugía? / Lumbar Estenorraquis: medical treatment, small or great surgery?

Lumbar spinal stenosis is a disease that is not always symptomatic, with increasing incidence on the population as it ages. Initial treatment must be conservative, based on medicine, physiokinesiotherapy, while compensating general illnesses. A second stage would include the use of steroid injections, as in the epidural or foraminal space, or in the facet joints. If these treatments were to fail, it is possible to realize surgical treatment, previously analizing the most suitable surgery for each patient, with laminectomy at the forefront. It is necessary to keep in mind that "minimally invasive surgery" is usually best. Arthrodesis must always be performed during surgery, which must to be realized in case of previous or intra operative instability, degenerative scoliosis, or flat back, while its use in degenerative espondilolisthesis is still in discussion.

Estenose do canal lombar / Stenosis of the lumbar canal

Os autores fazem uma revisão bibliográfica sobre a estenose do canal raquídeo lombar com o objetivo de difundir para o médico generalista as principais manifestações clínicas, etiopatogenia, diagnóstico e respectivo tratamento desta patologia tão freqüente na prática médica.

Sistema de normalización mecánica: un nuevo concepto en ligamentoplastia: primer año de seguimiento / Mechanical standardization system: a new concept in ligamentoplastia: first year of follow-up

Evaluar la discapacidad clínica luego de usar el sistema de normalización mecánica. El disco intervertebral no cicatriza en condiciones normales, lo cual puede deberse a un ambiente mecánico desfavorable, si esto se soluciona entonces podría ocurrir la cicatrización discal. Para resolver esta situación se plantea la ligamentoplastia, la cual está basada en el principio de que el proceso degenerativo implica una pérdida de la rigidez del segmento, la cual puede ser incrementada mediante fijación ligamentaria, normalizando las demandas mecánicas y ayudando a la regeneración discal. Basado en estos principios se desarrolló en sistema de normalización mecánica el cual es un espaciador interespinoso realizado en PEEK (polieteretercetona) con dos ligamentos, el cual reduce el rango de motilidad del segmento, la zona neutral y la traslación discal. Se desarrolla un estudio prospectivo que forma parte de un estudio multicéntrico internacional en el cual se evaluaron 75 pacientes, intervenidos quirúrgicamente entre Enero 2002 y Julio 2003 en las siguentes instituciones: Hospital Ortopédico Infantil y Centro de Clínicas y Urología en la ciudad de Caracas y en el Hospital Coromoto de Maracaibo,(todos en Venezuela), con los diagnósticos de discopatía degenerativa, hernia discal y estenosis de canal lumbar. Todos los pacientes fueron evaluados clínica y radiológicamente. Se administraron el test de discapacidad de Oswertry, el JOA test (Japanese Orthopedie Association), la escala analogo visual y el SF-36, en el pre- operatorio y en los controles subsiguientes a los 3,6 y 12 meses post- operatorios. Igualmente en los controles post-operatorios y al control anual realizándose solo radiología simple y dinámicas en los controles previos. Se evaluaron 75 pacientes. 48 por ciento femeninos y 52 por ciento masculinos: con un promedio de edad de 49 años, con los diagnósticos de: discopatía degenerativa (27,4 por ciento), hernia discal (37,3 por ciento).

Comparison of the Predictive Value of Myelography, Computed Tomography and MRI on the Treadmill Test in Lumbar Spinal Stenosis

To date, there have been no prospective, objective studies comparing the accuracy of the MRI, myelo-CT and myelography. The purpose of this study is to compare the diagnostic and predictive values of MRIs, myelo-CTs, and myelographies. Myelographies with dynamic motion views, myelo-CTs, MRIs and exercise treadmill tests were performed in 35 cases. The narrowest AP diameter of the dural sac was measured by myelography. At the pathologic level, dural cross-sectional area (D-CSA) was calculated in the MRI and Myelo-CT. The time to the first symptoms (TAF) and the total ambulation time (TAT) were measured during the exercise treadmill test and used as the standard in the comparison of correlation between radiographic parameters and walking capacity. The mean D-CSA by CT was 58.3 mm2 and 47.6 mm2 by MRI. All radiographic parameters such as AP diameters and D-CSA have no correlation to TAF or TAT (p > 0.05). Our data showed no statistically significant differences in the correlation of the patients' walking capacity to the severity of stenosis as assessed by myelography, myelo-CT and MRI.

Lumbar spinal stenosis: Evaluation of surgical Results in 100 cases

Although lumbur spinal stenosis syndrome is extremely common, considerable controversy continues to surround its classification, diagnosis and treatment. The aim of this study is evaluation of results of surgical therapy for lumbar spinal stenosis in 100 patients. In this article, we retrospectively analyzed the clinical, radiologicaLand surgical results of 100 patients operated in our neurosurgical clinics with the diagnosis of lumbar spinal stenosis. Surgical therapy and outcome are discussed with respect to the known facts. After clinical and radiological evaluation, 100 patients were diagnosed with lumbar spinal stenosis. All patients underwent laminectomy and bilateral foraminotomy at the stenotic level. Surgical outcomes were evaluated as very good, good,same, and poor according to the clinical findings. Fifty- three of the patients were males and forty-seven were females.More than half were between the ages of 40 and 60.The most frequently operated level was L4-L5. Ninety two percent of the surgically treated patients demonstrated very good and good outcomes. Our conclusion in lumbar spinal stenosis diagnosed by objective clinical and radiological findings is that decompressive laminectomy and extensive foraminotomy without instrumentation allow a good outcome

High cervical and lumbar canal stenosis of varied etiology: a case report.

Developmental stenosis without any significant spondylotic changes frequently occurs at C3 vertebra or below, and typically extends to C6-C7. However, high cervical focal canal stenosis is unusual. A case of cervical canal segmental stenosis at C2-3 level in addition to a developmental stenosis of the lumbar region, in a 45 year old male, has been presented in this article. The dynamics of the spinal canal in relation to the likely pathology of such conditions are reviewed. We speculate that focal segmental stenosis in the high cervical region may be due to a possible premature fusion of the neurocentral synchondrosis of the cartilage, or due to an abnormal rotary biomechanics which can result in facetal hypertrophy.

Correlation between cortical somatosensory evoked potentials and MRI in patients with lumbosacral radiculopathy

MRI and somatosensory evoked potentials [SEP] have been used in evaluation of different aspects of radiculopathies. Investigators have been interested in comparative values of these tests. To determine the clinical value of truncular and dermatomal SEP in diagnosis, localization and prognosis of lumbosacral radiculopathy and its sensitivity relative to MRI. The lower extremity SEP studies were done in 34 patients with definite clinical and MRI findings of lumbosacral radiculopathy. The findings were compared with those obtained from the control group which consisted of 35 healthy individuals. Among 33 patients with abnormal MRI, 29 had abnormal SEPs [87.8%]. The concordance of SEP with MRI regarding the level and side of affected roots was 65.5%. MRI overestimates disc bulge in some patients. As a low-cost and sensitive tool, SEP is recommended to be used in addition to MRI in evaluation of lumbosacral radiculopathy

Unilateral thoracic canal stenosis.

Two unusual cases of thoracic spinal canal stenosis are reported. The cord compression was a result of unilateral hypertrophy of the lamina and facet joint. Bony decompression resulted in rapid neurological recovery.

Calcificación del ligamento transverso del atlas en condrocalcinosis / Chondrocalcinosis: calcification of the transverse ligament of the atlas

A fin de evaluar la frecuencia de calcificación del ligamento transverso del atlas en pacientes con condrocalcinosis y describir las características de dicha calcificación se estudiaron 8 pacientes con condrocalcinosis y 8 de un grupo control, con artrosis pero sin evidencia de condrocalcinosis, encontrando una elevada frecuencia de calcificación del ligamento transverso del atlas en condrocalcinosis, muchas veces asintomática, sin correlación con síntomas cervicales agudos