spinal stenosis

脊柱管狭窄症

WordNet

1. work natural fibers into a thread; "spin silk"
2. prolong or extend; "spin out a visit" (同)spin out
3. the act of rotating rapidly; "he gave the crank a spin"; "it broke off after much twisting" (同)twirl, twist, twisting, whirl
4. a distinctive interpretation (especially as used by politicians to sway public opinion); "the campaign put a favorable spin on the story"
5. a short drive in a car; "he took the new car for a spin"
6. a swift whirling motion (usually of a missile)
7. revolve quickly and repeatedly around ones own axis; "The dervishes whirl around and around without getting dizzy" (同)spin around, whirl, reel, gyrate
8. form a web by making a thread; "spiders spin a fine web"
9. make up a story; "spin a yarn"
10. stream in jets, of liquids; "The creek spun its course through the woods"
11. twist and turn so as to give an intended interpretation; "The Presidents spokesmen had to spin the story to make it less embarrassing"
12. of or relating to the spine or spinal cord; "spinal cord"; "spinal injury"
13. abnormal narrowing of a bodily canal or passageway (同)stricture

PrepTutorEJDIC

1. (羊毛などから)〈糸など〉‘を'『紡ぐ』《+『名』+『out of』+『名』〈羊毛〉》,(糸などに)〈羊毛など〉‘を'紡ぐ《+『名』〈羊毛〉+『into』+『名』》 / 〈クモ・カイコなどが〉〈糸〉‘を'『吐く』;〈巣・繭〉‘を'かける / …‘を'くるくる回す / 〈物語など〉‘を'作る,話す / 『糸を紡ぐ』;〈クモ・カイコなどが〉糸を吐く / 〈こまなどが〉くるくる回る / 〈車などが〉疾走する / 〈頭などが〉くらくらする / 〈C〉〈U〉くるくる回すこと;回転 / 〈C〉《単数形で》(車などの)一走り / 〈C〉(飛行機の)きりもみ降下 / 〈C〉《単数形で》(価値などの)急落
2. 背骨の / せき髄麻酔

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2019/07/23 01:20:18」(JST)

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Spinal stenosis
Spinal stenosis
Specialty	Orthopedics, neurosurgery
Symptoms	Pain, numbness, or weakness in the arms or legs
Complications	Loss of bladder control, loss of bowel control, sexual dysfunction
Usual onset	Gradual
Types	Cervical, thoracic, lumbar
Causes	Osteoarthritis, rheumatoid arthritis, spinal tumors, trauma, Paget's disease of the bone, scoliosis, spondylolisthesis, achondroplasia
Diagnostic method	Based on symptoms and medical imaging
Differential diagnosis	Cauda equina syndrome, osteomylitis, peripheral vascular disease, fibromyalgia
Treatment	Medications, exercises, bracing, surgery.
Medication	NSAIDs, acetaminophen, steroid injections
Frequency	Up to 8% of people

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with bending forwards. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

Causes may include osteoarthritis, rheumatoid arthritis, spinal tumors, trauma, Paget's disease of the bone, scoliosis, spondylolisthesis, and the genetic condition achondroplasia. It can be classified by the part of the spine affected into cervical, thoracic, and lumbar stenosis. Lumbar stenosis is the most common followed by cervical stenosis. Diagnosis is generally based on symptoms and medical imaging.

Treatment may involve medications, bracing, or surgery. Medications may include NSAIDs, acetaminophen, or steroid injections. Stretching and strengthening exercises may also be useful. Limiting certain activities may be recommended. Surgery is typically only done if other treatments are not effective, with the usual procedure being a decompressive laminectomy.

Spinal stenosis occurs in as many as 8% of people. It occurs most commonly in people over the age of 50. Males and females are affected equally often. The first modern description of the condition is from 1803 by Antoine Portal. Evidence of the condition, however, dates back to Ancient Egypt.

Signs and symptoms

Drawing showing spinal stenosis with spinal cord compression

Common

• Standing discomfort (94%)
• Discomfort/pain, in shoulder, arm, hand (78%)
• Bilateral symptoms (68%)
• Numbness at or below the level of involvement (63%)
• Weakness at or below the level of involvement (43%)
• Pain or weakness in buttock / thigh only (8%)
• Pain or weakness below the knee (3%)

Neurological disorders

• Cervical (spondylotic) myelopathy, a syndrome caused by compression of the cervical spinal cord which is associated with "numb and clumsy hands", imbalance, loss of bladder and bowel control, and weakness that can progress to paralysis.
• Pinched nerve, causing numbness.
• Intermittent neurogenic claudication characterized by lower limb numbness, weakness, diffuse or radicular leg pain associated with paresthesia (bilaterally), weakness and/or heaviness in buttocks radiating into lower extremities with walking or prolonged standing. Symptoms occur with extension of spine and are relieved with spine flexion. Minimal to zero symptoms when seated or supine.

A human vertebral column

• Radiculopathy (with or without radicular pain) neurologic condition—nerve root dysfunction causes objective signs such as weakness, loss of sensation and of reflex.
• Cauda equina syndrome - Lower extremity pain, weakness, numbness that may involve perineum and buttocks, associated with bladder and bowel dysfunction.
• Lower back pain due to degenerative disc or joint changes.

Causes

Aging

Any of the factors below may cause the spaces in the spine to narrow.

• Spinal ligaments can thicken (ligamenta flava)
• Bone spurs develop on the bone and into the spinal canal or foraminal openings
• Intervertebral discs may bulge or herniate into the canal or foraminal openings
• Degenerative disc disease causes narrowing of the spaces
• Facet joints break down
• Compression fractures of the spine, which are common in osteoporosis
• Cysts form on the facet joints causing compression of the spinal sac of nerves (thecal sac)

Arthritis

• Osteoarthritis
• Rheumatoid arthritis—much less common cause of spinal problems

Congenital

• Spinal canal is too small at birth
• Structural deformities of the vertebrae may cause narrowing of the spinal canal

Instability of the spine

• A vertebra slips forward on another (spondylolisthesis)

Trauma

• Accidents and injuries may dislocate the spine and the spinal canal or cause burst fractures that yield fragments of bone that go through the canal.
• Patients with cervical myelopathy caused by narrowing of the spinal canal are at higher risks of acute spinal cord injury if involved in accidents.

Tumors

• Irregular growths of soft tissue will cause inflammation.
• Growth of tissue into the canal pressing on nerves, the sac of nerves, or the spinal cord.

Types

The most common forms are cervical spinal stenosis, which are at the level of the neck, and lumbar spinal stenosis, at the level of the lower back. Thoracic spinal stenosis, at the level of the mid-back, is much less common.

In lumbar stenosis, the spinal nerve roots in the lower back are compressed which can lead to symptoms of sciatica (tingling, weakness, or numbness that radiates from the low back and into the buttocks and legs).

Cervical spinal stenosis can be far more dangerous by compressing the spinal cord. Cervical canal stenosis may lead to myelopathy, a serious condition causing symptoms including major body weakness and paralysis. Such severe spinal stenosis symptoms are virtually absent in lumbar stenosis, however, as the spinal cord terminates at the top end of the adult lumbar spine, with only nerve roots (cauda equina) continuing further down. Cervical spinal stenosis is a condition involving narrowing of the spinal canal at the level of the neck. It is frequently due to chronic degeneration, but may also be congenital or traumatic. Treatment frequently is surgical.

Diagnosis

Moderate to severe spinal stenosis at the levels of L3/4 and L4/5

The diagnosis of spinal stenosis involves a complete evaluation of the spine. The process usually begins with a medical history and physical examination. X-ray and MRI scans are typically used to determine the extent and location of the nerve compression.

Medical history

The medical history is the most important aspect of the examination as it will tell the physician about subjective symptoms, possible causes for spinal stenosis, and other possible causes of back pain.

Physical examination

The physical examination of a patient with spinal stenosis will give the physician information about exactly where nerve compression is occurring. Some important factors that should be investigated are any areas of sensory abnormalities, numbness, irregular reflexes, and any muscular weakness.

MRI

MRI has become the most frequently used study to diagnose spinal stenosis. The MRI uses electromagnetic signals to produce images of the spine. MRIs are helpful because they show more structures, including nerves, muscles, and ligaments, than seen on X-rays or CT scans. MRIs are helpful at showing exactly what is causing spinal nerve compression.

CT myelogram

A spinal tap is performed in the low back with dye injected into the spinal fluid. X-Rays are performed followed by a CT scan of the spine to help see narrowing of the spinal canal. This is a very effective study in cases of lateral recess stenosis. It is also necessary for patients in which MRI is contraindicated, such as those with implanted pacemakers.

Red flags

• Fever
• Nocturnal pain
• Gait disturbance
• Structural deformity
• Unexplained weight loss
• Previous carcinoma
• Severe pain upon lying down
• Recent trauma with suspicious fracture
• Presence of severe or progressive neurologic deficit

Treatments

Treatment options are either surgical or non-surgical. Overall evidence is inconclusive whether non-surgical or surgical treatment is the better for lumbar spinal stenosis.

Non-surgical treatments

The effectiveness of non surgical treatments is unclear as they have not been well studied.

• Education about the course of the condition and how to relieve symptoms
• Medicines to relieve pain and inflammation, such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs)
• Exercise, to maintain or achieve overall good health, aerobic exercise, such as riding a stationary bicycle, which allows for a forward lean, walking, or swimming can relieve symptoms
• Weight loss, to relieve symptoms and slow progression of the stenosis
• Physical therapy to support self-care. Also may give instructs on stretching and strength exercises that may lead to a decrease in pain and other symptoms.
• Lumbar epidural steroid or anesthetic injections have low quality evidence to support their use.

Surgery

Lumbar decompressive laminectomy: This involves removing the roof of bone overlying the spinal canal and thickened ligaments in order to decompress the nerves and sac of nerves. 70-90% of people have good results.

• Interlaminar implant: This is a non-fusion U-shaped device which is placed between two bones in the lower back that maintains motion in the spine and keeps the spine stable after a lumbar decompressive surgery. The U-shaped device maintains height between the bones in the spine so nerves can exit freely and extend to lower extremities.
• Surgery for cervical myelopathy is either conducted from the front or from the back, depending on several factors such as where the compression occurs and how the cervical spine is aligned.
  • Anterior cervical discectomy and fusion: A surgical treatment of nerve root or spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine with a discectomy in order to stabilize the corresponding vertebrae.
  • Posterior approaches seek to generate space around the spinal cord by removing parts of the posterior elements of the spine. Techniques include laminectomy, laminectomy and fusion, and laminoplasty.

Epidemiology

• The NAMCS data shows the incidence in the U.S. population to be 3.9% of 29,964,894 visits for mechanical back problems.
• The Longitudinal Framingham Heart Study found 1% of men and 1.5% of women had vertebral slippage at mean age of 54. Over the next 25 years, 11% of men and 25% of women developed degenerative vertebral slippage.

External links

Classification	D ICD-10: M48.0 MeSH: D013130 D013130, D013130 DiseasesDB: 31116
External resources	MedlinePlus: 000441

• Uvm.edu
• Ncbi.nlm.nih.gov
• Questions and Answers about Spinal Stenosis - US National Institute of Arthritis and Musculoskeletal and Skin Diseases

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 腰部脊柱管狭窄症：治療および予後 lumbar spinal stenosis treatment and prognosis
• 2. 腰部脊柱管狭窄症：病態生理、臨床的特徴、および診断 lumbar spinal stenosis pathophysiology clinical features and diagnosis
• 3. 多発神経根症：脊柱管狭窄症、感染症、癌、および炎症性神経根症候群 polyradiculopathy spinal stenosis infectious carcinomatous and inflammatory nerve root syndromes
• 4. 成人における選択的脊椎手術のための麻酔 anesthesia for elective spine surgery in adults
• 5. 成人における腰痛の評価 evaluation of low back pain in adults

English Journal

• Epidural lysis of adhesions for failed back surgery and spinal stenosis: factors associated with treatment outcome.

• Hsu E, Atanelov L, Plunkett AR, Chai N, Chen Y, Cohen SP.Author information From the *Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine; †Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine; ‡Department of Anesthesia & Operative Services, Womack Army Medical Center, Fort Bragg, North Carolina; §Department of Neurology, Johns Hopkins School of Medicine; ‖Johns Hopkins School of Medicine; ¶Departments of Anesthesiology and Critical Care Medicine & Physical Medicine and Rehabilitation; at Uniformed Services University of the Health Sciences.AbstractBACKGROUND: Failed back surgery syndrome (FBSS) is a challenging problem. One treatment advocated to treat FBSS is epidural lysis of adhesions (LOA). The results of studies examining LOA for FBSS have been mixed, but are limited because no study has ever sought to identify factors associated with outcomes.
• Anesthesia and analgesia.Anesth Analg.2014 Jan;118(1):215-24. doi: 10.1213/ANE.0000000000000042.
• BACKGROUND: Failed back surgery syndrome (FBSS) is a challenging problem. One treatment advocated to treat FBSS is epidural lysis of adhesions (LOA). The results of studies examining LOA for FBSS have been mixed, but are limited because no study has ever sought to identify factors associated with ou
• PMID 24356168

• Cervical radicular pain: the role of interlaminar and transforaminal epidural injections.

• Manchikanti L, Falco FJ, Diwan S, Hirsch JA, Smith HS.Author information Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, KY, 42003, USA, drlm@thepainmd.com.AbstractChronic neck pain and cervical radicular pain are relatively common in the adult population. Treatment for chronic radicular pain recalcitrant to conservative management includes surgical management as well as interventional techniques with epidural injections utilizing either an interlaminar approach or transforaminal approach. Although there have been multiple systematic reviews and randomized clinical trials of cervical interlaminar epidural injections, the literature is sparse in reference to cervical transforaminal epidural injections. Overall, there is good evidence for the effectiveness of cervical interlaminar epidural injections in managing cervical disc herniation and fair evidence in managing central spinal stenosis and postsurgery syndrome. The evidence is poor, however, for cervical transforaminal epidural injections. Complications with cervical interlaminar epidural injections are rare, but more commonly occur with transforaminal epidural injections and can be fatal. Emerging concepts in pain include further randomized trials; proper placebo design; focus on control design (either active control or placebo control); and appropriate methodologic quality assessment and evidence synthesis.
• Current pain and headache reports.Curr Pain Headache Rep.2014 Jan;18(1):389. doi: 10.1007/s11916-013-0389-9.
• Chronic neck pain and cervical radicular pain are relatively common in the adult population. Treatment for chronic radicular pain recalcitrant to conservative management includes surgical management as well as interventional techniques with epidural injections utilizing either an interlaminar approa
• PMID 24338702

• Neurologic manifestations of achondroplasia.

• Hecht JT1, Bodensteiner JB2, Butler IJ3.Author information 1Department of Pediatrics and Pediatric Research Center, University of Texas Medical School, Houston, TX, USA.2Department of Neurology, Mayo Clinic, Rochester, MN, USA.3Division of Child and Adolescent Neurology, Department of Pediatrics, University of Texas Medical School, Houston, TX, USA. Electronic address: ian.j.butler@uth.tmc.edu.AbstractAchondroplasia is the best described and most common form of the congenital short-limbed dwarfing conditions. Achondroplasia is apparent at birth and has a birth prevalence of 1 in 20000-30000 live-born infants. Achondroplasia is inherited as an autosomal dominant condition, although 80% of cases occur sporadically as new events in their families. Achondroplasia is caused, in virtually all of the cases, by a G380R mutation in fibroblast growth factor receptor 3 (FGFR3). Patients with achondroplasia should be evaluated by a multidisciplinary team of clinicians including geneticists, neurologists, and orthopedists, since there are numerous bony and neurological complications. The most severe complication results from craniocervical stenosis and medullary and upper spinal cord compression, which can have devastating and even lethal sequelae during early childhood. In subsequent decades, including adolescence, spinal cord and nerve compression are more prominent. The neurological complications of achondroplasia have been recognized in adults for more than a century and are attributed to bony defects, connective tissue structures, or both. Similar neurological complications are now appreciated in infants, young children, and teenagers with achondroplasia. Defective connective tissue elements in achondroplasia frequently lead to ligamentous laxity, which can aggravate the complications associated with bony stenosis. Bony abnormalities are known to cause neurological morbidity and lead to a shortened lifespan. Neurological complications associated with achondroplasia are reviewed, including recommendations for the evaluation and management of these clinical problems.
• Handbook of clinical neurology.Handb Clin Neurol.2014;119:551-63. doi: 10.1016/B978-0-7020-4086-3.00036-9.
• Achondroplasia is the best described and most common form of the congenital short-limbed dwarfing conditions. Achondroplasia is apparent at birth and has a birth prevalence of 1 in 20000-30000 live-born infants. Achondroplasia is inherited as an autosomal dominant condition, although 80% of cases oc
• PMID 24365319

Japanese Journal

• 整形手術手技 経皮的内視鏡下椎弓切除術の初期経験

• 橋本 整,中島 健一郎
• 整形外科 = Orthopedic surgery 65(4), 347-349, 2014-04
• NAID 40020027793

• 臨床室 腰部脊柱管狭窄症に合併した硬膜外脂肪腫の1例

• 東村 隆,野原 裕,本田 俊夫 [他]
• 整形外科 = Orthopedic surgery 65(4), 328-331, 2014-04
• NAID 40020027714

• 腰部脊柱管狭窄症に対する腰椎棘突起縦割式椎弓切除術 : 中期成績からみた課題 (特集 低侵襲脊椎手術の利点と問題点 : 中・長期成績からの検討)

• 渡辺 航太
• 整形・災害外科 57(3), 271-274, 2014-03
• NAID 40020003652

Related Links

• Spinal Stenosis - National Library of Medicine - PubMed Health

The spine, a row of 26 bones in your back, allows you to stand up straight and bend over. The spine also protects your spinal cord from being hurt. In people with spinal stenosis, the spine is narrowed in one or more of three parts: The ...

• Spinal Stenosis Details | Spinalstenosis.org

Spinal Stenosis The term ‘stenosis’ means narrowing of a tubular structure in the body. Spinal stenosis, then, means narrowing is in the spinal column, which houses the vertebrae, spinal cord, spinal discs, nerves and other tissues.

Related Pictures

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★リンクテーブル★

リンク元	「脊柱管狭窄症」「脊柱管狭窄」「spinal canal stenosis」
拡張検索	「cervical spinal stenosis」「lumbar spinal stenosis」
関連記事	「spinal」「spin」

「脊柱管狭窄症」

　　[★]

英

spinal stenosis, spinal canal stenosis

同

脊柱管狭窄

椎管狭小 narrow spinal canal narrowing of spinal canal

「脊柱管狭窄」

　　[★]

英

spinal stenosis、spinal canal stenosis

関

脊柱管狭窄症

「spinal canal stenosis」

　　[★]

脊柱管狭窄、脊柱管狭窄症

関

spinal stenosis

「cervical spinal stenosis」

　　[★]

頚椎脊椎管狭窄症、頸椎脊椎管狭窄症

「lumbar spinal stenosis」

　　[★]

腰部脊椎管狭窄、腰部脊椎管狭窄症

「spinal」

　　[★]

• adj.

• 脊髄の、脊髄性の、脊柱の

関

dorsal spine、rachis、spinal column、spinal cord、spine、vertebral column

　 　

「spin」

　　[★]

• スピン