A Radicular Syndrome From Developmental Narrowing of the Lumbar Vertebral Canal

Verbiest, H

doi:10.1016/s1935-9810(09)70010-6

Cited by 83 publications

(109 citation statements)

References 4 publications

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“…Symptoms of spinal canal stenosis include lower back pain and unilateral or bilateral lower extremity pain, numbness, or weakness [2]. Neurogenic claudication, defined as pain, paresthesia, and cramping of one or both lower extremities because of neurological compromise brought on by standing or walking and relieved by sitting, is the most typical symptom of spinal stenosis [2][3][4]. Patients with LSS are more likely to tolerate bicycling (during which the lumbar spine is flexed) better than walking (during which the lumbar spine is extended) [5].…”

Section: Introductionmentioning

confidence: 99%

Dynamic changes in the dural sac of patients with lumbar canal stenosis evaluated by multidetector-row computed tomography after myelography

et al. 2013

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Purpose Some reported studies have evaluated the dural sac in patients with lumbar spinal stenosis (LSS) by computed tomography (CT) after conventional myelography or magnetic resonance imaging (MRI). But they have been only able to evaluate static factors. No reports have described detailed dynamic changes in the dural sac during flexion and extension observed by multidetector-row computed tomography (MDCT). The aim of this study was to elucidate or demonstrate, in detail, the influence of dynamic factors on the severity of stenosis. Methods One hundred patients with LSS were enrolled in this study. All underwent MDCT in both flexion and extension positions after myelography, in addition to undergoing MRI. The anteroposterior diameter (AP-distance) and cross-sectional area of the dural sac (D-area) were measured at each disc level between L1-2 and L5-S1. The dynamic change in the D-area was defined as the absolute value of the difference between flexion and extension. The rate of dynamic change (dynamic change in D-area/D-area at flexion) in the dural sac at each disc level was also calculated. Results The average AP-distance in flexion/extension (mm) was 9.2/7.4 at L3-4 and 8.3/7.4 at L4-5. The average D-area in flexion/extension (mm 2 ) was 96.3/73.6 at L3-4 and 72.3/61.0 at L4-5. The values were significantly lower in extension than in flexion at all disc levels from L1-2 to L5-S1. AP-distance was narrowest and D-area smallest at L4-5 during extension. The rates of dynamic changes at L2-3 and L3-4 were higher than those at L4-5. Conclusions MDCT clearly elucidated the dynamic changes in the lumbar dural sac. Before surgery, MDCT after myelography should be used to evaluate the dynamic change during flexion and extension, especially at L2-3, L3-4, and L4-5.

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Section: Introductionmentioning

confidence: 99%

Dynamic changes in the dural sac of patients with lumbar canal stenosis evaluated by multidetector-row computed tomography after myelography

et al. 2013

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“…De Jerine [18] discovered that claudication can have a spinal etiology in 1911, and later, Verbiest [4] detailed the clinical symptoms of neurogenic claudication as opposed to vascular claudication. As LSS and PAD are usually associated with degenerative conditions, atypical presentations and concomitant affections are not rare [6,10,11].…”

Section: Discussionmentioning

confidence: 99%

“…However, rather than limping, the typical symptom of claudication is being unable to walk due to intermittent cramping pain in the lower legs which is precipitated by exercise and relieved by rest. Furthermore, lumbar spinal stenosis (LSS) produces similar symptoms [1, 3,4].…”

Section: Introductionmentioning

confidence: 99%

The validity of ankle-brachial index for the differential diagnosis of peripheral arterial disease and lumbar spinal stenosis in patients with atypical claudication

et al. 2011

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Purpose Claudication is a typical symptom of peripheral arterial disease (PAD) and lumbar spinal stenosis (LSS). Differential diagnosis of PAD and LSS is often difficult due to the subjective natures of symptoms and atypical signs. The authors aimed to determine the usefulness of ankle-brachial index (ABI) measurement for the differential diagnosis of PAD and LSS when the etiology of claudication is uncertain. Methods Forty-two consecutive patients who had been referred by spine surgeons to a lower extremity vascular surgeon for atypical claudication were retrospectively analyzed. Atypical claudication was defined as claudication not caused by PAD, as determined by clinical manifestations, or by LSS, as determined by MR imaging. A final diagnosis of PAD was established by CT angiography (CTA) and of LSS by excluding PAD. Diagnostic validity of ABI for PAD in atypical presentation was assessed. Results Sixty-two legs of 42 atypical claudication patients were analyzed. Mean patient age was 65.8 ± 8.2 years (38-85) and 29 (69.0%) had diabetes mellitus. Mean ABI was 0.73 ± 0.14 (0.53-0.94) in the PAD group and 0.92 ± 0.18 (0.52-1.10) in the LSS group (P \ 0.001). Of the 33 legs with a low ABI (ABI \ 0.9), 29 legs were diagnosed as true positives for PAD by CTA and 4 were false positives, and of the 29 legs with a high ABI, 5 were false negatives and 24 were true negatives. The sensitivity and specificity of ABI for the diagnosis of PAD in patients with atypical claudication were 85.3 and 85.7%, respectively, and its positive and negative predictive values were 87.9 and 82.8%. Conclusions ABI is a recommended screening test for the differential diagnosis of lower leg claudication when clinical symptoms are atypical.

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“…Verbiest later regretted giving the disease this name and explained that he preferred the name narrow vertebral canal as there had been a lack of consensus on the term stenosis (Verbiest 1992). Verbiest submitted his paper in English to neurosurgical and neurological journals but was repeatedly rejected (Verbiest 1992), but finally the Journal of Bone and Joint Surgery (Br) accepted his paper in which Verbiest (1954) in detail described the clinical manifestations, the radiographic appearance, including myelographic block of the dural sac, in spinal stenosis. In the subsequent years the diagnosis gradually became accepted and surgical treatment started to emerge as one treatment strategy although there for a long time was and still is controversy as regards on how to establish the diagnosis, decide on treatment and, if selecting surgery, the operative methods of choice (Deyo et al 2004;Deyo 2007Deyo , 2010.…”

Section: Historical Aspectsmentioning

confidence: 99%

Determinants of outcome in lumbar spinal stenosis surgery

Sigmundsson¹

2014

Acta Orthopaedica

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Cover illustration: "Spine Talk", acryl paint on stretched canvas. The painting was created in 2008 by the Canadian artist Barbara C. St Jean and is a painting of two people talking to each other over top of a spine of another. The painting was created to illustrate the problems associated with back pain and the discussions with medical professionals over the causes and treatment options. By permission from the artist.

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A Radicular Syndrome From Developmental Narrowing of the Lumbar Vertebral Canal

Cited by 83 publications

References 4 publications

Dynamic changes in the dural sac of patients with lumbar canal stenosis evaluated by multidetector-row computed tomography after myelography

Dynamic changes in the dural sac of patients with lumbar canal stenosis evaluated by multidetector-row computed tomography after myelography

The validity of ankle-brachial index for the differential diagnosis of peripheral arterial disease and lumbar spinal stenosis in patients with atypical claudication

Determinants of outcome in lumbar spinal stenosis surgery

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