Lumbar spinal stenosis

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The etiology or causes of lumbar spinal stenosis can vary, and it is often a result of degenerative changes associated with aging.

Common etiological factors include:

Degenerative Changes: see Degenerative lumbar spinal stenosis

Herniated Discs: Disc herniation occurs when the soft inner material of a spinal disc protrudes through the tough outer layer. A herniated disc can impinge on the spinal canal, causing stenosis and putting pressure on the nerves.

Osteoarthritis: Degeneration of the facet joints due to osteoarthritis can result in the growth of bone spurs (osteophytes). These bone spurs can encroach upon the spinal canal and contribute to stenosis.

Thickened Ligaments: The ligaments that support the spine can thicken over time, especially the ligamentum flavum. Thickening of these ligaments can reduce the space within the spinal canal.

Congenital Factors: In some cases, individuals may have a genetic predisposition to spinal stenosis. Congenital conditions or abnormalities in the structure of the spine can contribute to the development of stenosis.

Traumatic Injuries: see Thoracolumbar spine fracture

Tumors: While less common, tumors within the spinal canal or along the spinal column can cause stenosis by exerting pressure on the nerves and spinal cord.

Inflammatory Conditions: Certain inflammatory conditions, such as rheumatoid arthritis, can affect the spine and contribute to the development of spinal stenosis.

While lumbar spinal stenosis is commonly associated with degenerative changes, it can also occur as a secondary consequence of spine fractures.

Here's how a spine fracture can contribute to lumbar spinal stenosis:

1. Compression Fractures: If a vertebra in the lumbar spine experiences a compression fracture, where the front part of the vertebral body collapses, it can result in a reduction of the overall height of the spine. This reduction in height can lead to a narrowing of the spinal canal, causing or contributing to spinal stenosis.

2. Instability and Misalignment: Fractures can cause instability in the spine. When the normal alignment of the vertebrae is disrupted due to a fracture, it may result in abnormal loading and stress on surrounding structures. This can contribute to the development of spinal stenosis as the bones and soft tissues attempt to compensate for the instability.

3. Bone Spurs: Fractures can trigger the formation of bone spurs or osteophytes. These bony outgrowths can encroach upon the spinal canal, narrowing its diameter and causing compression of the spinal nerves.

4. Scar Tissue Formation: The healing process following a spine fracture can involve the formation of scar tissue. Excessive scar tissue may contribute to the narrowing of the spinal canal, leading to stenosis.

5. Post-Traumatic Changes: In the aftermath of a spine fracture, the surrounding tissues, including ligaments and intervertebral discs, may undergo changes that contribute to spinal stenosis. These changes could involve thickening of ligaments or disc degeneration.

The diagnosis of lumbar spinal stenosis secondary to a spine fracture involves a thorough examination of clinical history, imaging studies (such as X-rays, CT scans, or MRI), and possibly other diagnostic tests. Treatment options may include:

Conservative Measures: Pain management, physical therapy, and lifestyle modifications may be recommended to alleviate symptoms.

Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) or pain relievers may be prescribed to manage pain and inflammation.

Bracing: In some cases, a brace may be used to provide support and stability to the spine during the healing process.

Surgical Intervention: Severe cases or those unresponsive to conservative measures may require surgical intervention, such as spinal fusion or decompression procedures, to address the spinal stenosis.

The specific treatment approach will depend on the severity of the fracture, the extent of spinal stenosis, and the overall health of the individual. It's essential for individuals with lumbar spinal stenosis secondary to a spine fracture to consult with healthcare professionals for a comprehensive evaluation and tailored treatment plan.

Lumbar spinal fusion for Lumbar Canal Stenosis Secondary to Vertebral Fracture in a 70-Year-Old Woman

Clinical Presentation: Hypertension, Type 2 Diabetes Mellitus (DM), lumbar hernias, compression fracture of L3 (A2), traumatic brain injury with a history of fall.

Current Medications: Candesartan, Ebastine, Alprazolam, Diazepam, Zolpidem, Xeristar, Omeprazole, Metformin, Pregabalin.

History: The patient presented with a history of hypertension, type 2 diabetes, and lumbar hernias. She sustained a traumatic brain injury, leading to suspicion of pharmacological hypertension. A computed tomography (CT) scan showed no significant findings. Additionally, the patient had undergone an appendectomy and had a cyst in her right knee.

The patient was diagnosed with a compression fracture of L3 (A2), characterized by severe reduction of vertebral height (70% in the central portion; 30% in the posterior wall) and associated with slight displacement causing a reduction in the anteroposterior diameter of the spinal canal. Signs of disc vacuum and degenerative facet changes were identified in adjacent spaces. There were also degenerative changes in the L4/5 and L5/S1 spaces.

Treatment: Considering the patient's clinical history and radiological findings, she was scheduled for Lumbar spinal fusion to address lumbar canal stenosis secondary to the vertebral fracture of L3.

Procedure: The patient underwent lumbar arthrodesis to stabilize the affected vertebrae and alleviate symptoms associated with lumbar canal stenosis. The surgical intervention aimed to achieve fusion in the lumbar spine, preventing further deterioration and providing stability.

Follow-up: The patient will be closely monitored postoperatively for the resolution of symptoms and the progression of the fusion process. Rehabilitation measures and physiotherapy will be implemented to optimize the patient's functional recovery.

Conclusion: This case highlights the complexity of managing lumbar canal stenosis secondary to vertebral fractures in elderly patients with comorbidities. Lumbar arthrodesis emerges as a viable solution to address instability and alleviate symptoms associated with lumbar canal stenosis, promoting a better quality of life for the patient.