Fact-sheet: Congenital lumbar spinal stenosis
Updated on 04/19/2018 at 5:08 PM
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Definition
Constitutional lumbar spinal stenosis
- radiologic measurements to be correlated with clinical findings: low back pain relieved by flexion
- decompensation due to acquired degenerative changes.
- sagittal, coronal, or bidirectional narrowing
- central and/or lateral recess and/or foraminal narrowing
Clinical features
Low back pain relieved by flexion.
Radiography
Central canal narrowing:
- frontal radiograph: reduced interpedicular distance or absence of the normal increase in interpedicular distance from L1 to L5.
- sagittalization or excessive visibility of the posterior facet joint spaces (bilateral, over at least 3 consecutive levels).
- lateral radiograph: shortened pedicles.
CT
Central stenosis:
- anteroposterior diameter of the bony canal (slice through the closed bony ring at the lower part of the pedicles): Normal > 14 mm, relative stenosis: 12–14 mm, absolute stenosis < 12 mm
- interfacet transverse diameter (slice through the disc): d < 15 mm
- decreased cross-sectional area of the bony canal (more reliable measurement on MRI)
Lateral stenosis:
- trefoil appearance of the canal
- anteroposterior diameter of the lateral recess reduced to 3–4 mm
MRI
Dural sac cross-sectional area:
- Normal > 100 mm2
- Relative stenosis < 100 mm2
- Absolute stenosis < 75 mm2
Management
Medical treatment: analgesics, NSAIDs, physical therapy, lumbar bracing, epidural or foraminal injections
Surgical treatment in cases of motor or sensory deficit and/or cauda equina syndrome, severe neurogenic claudication (limited walking distance), or patient request due to intractable pain: laminectomy and partial facetectomy +/- fusion
Differential diagnosis
- Acquired degenerative lumbar stenosis
- PAD
- Popliteal artery entrapment
- Venous claudication
- Diabetic, alcoholic, or other polyneuropathy
- Chronic compartment syndrome
- Sciatica