Pathogenesis, presentation, and treatment of lumbar spinal stenosis associated with coronal or sagittal spinal deformities

Abstract

<jats:p>Sagittal- or coronal-plane deformity considerably complicates the diagnosis and treatment of lumbar spinal stenosis. Although decompressive laminectomy remains the standard operative treatment for uncomplicated lumbar spinal stenosis, the management of stenosis with concurrent deformity may require osteotomy, laminectomy, and spinal fusion with or without instrumentation. Broadly stated, the surgery-related goals in complex stenosis are neural decompression and a well-balanced sagittal and coronal fusion. Deformities that may present with concurrent stenosis are scoliosis, spondylolisthesis, and flatback deformity. The presentation and management of lumbar spinal stenosis associated with concurrent coronal or sagittal deformities depends on the type and extent of deformity as well as its impact on neural compression. Generally, clinical outcomes in complex stenosis are optimized by decompression combined with spinal fusion. The need for instrumentation is clear in cases of significant scoliosis or flatback deformity but is controversial in spondylolisthesis. With appropriate selection of technique for deformity correction, a surgeon may profoundly improve pain, quality of life, and functional capacity. The decision to undertake surgery entails weighing risk factors such as age, comorbidities, and preoperative functional status against potential benefits of improved neurological function, decreased pain, and reduced risk of disease progression. The purpose of this paper is to review the pathogenesis, presentation, and treatment of lumbar spinal stenosis complicated by scoliosis, spondylolisthesis, or flat-back deformity. Specific attention is paid to surgery-related goals, decision making, techniques, and outcomes.</jats:p>

A validated finite element analysis of nerve root stress in degenerative lumbar scoliosis

“…Therefore, in the present finite element analysis, rotatory listhesis may generate a traction force on the nerve roots on the convex side, but decreases the compression stress on the nerve roots on the concave side. In contrast with previous studies [1,7,8], actually many patients with DLS often complain of leg pain in the direction of the convex side of the curve; the authors believe that the current study can explain this apparent phenomenon.…”

“…First, the neurological compromise is caused by the various pathologies of spinal stenosis [8,18,22]. Second, the nervous system might be able to adapt to the scoliotic curve because DLS progresses over a long period of time.…”

“…Compared with idiopathic scoliosis, however, DLS has not been extensively studied. Moreover, most studies on DLS have focused on the relationship between the surgical outcomes and radiologic changes, or the correlation between prognosis and radiological findings [7,8,10,15,22,23]. Compared with adolescent idiopathic scoliosis, patients with DLS often complain of persistent back pain and intractable leg pain, such as claudication or radiating pain [1,7,8].…”

The various forms of lumbar spinal stenosis

“…Ce geste concernera les territoires radiculaires impliqués sur le plan clinique. La stabilisation avec instrumentation (ostéosynthèse) est le plus souvent requise [14]. La programmation de ce geste chirurgical devra tenir compte des pathologies médicales associées que pourra éventuellement présenter le patient.…”

Chiropractic treatment of lumbar spinal stenosis: a review of the literature

“…Central LSS involves the narrowing of the spinal canal around the nerve roots of the cauda equina within the dural sac due to facet joint arthrosis and hypertrophy, thickening and bulging of the ligamentum flavum into the spinal canal, encroachment or bulging of a intervertebral disk herniation, or spondylolisthesis. [9][10][11] Lateral LSS typically occurs when the nerve root becomes encroached upon in the nerve root canal and/ or the intervertebral foramen as a result of an intervertebral disk herniation, hypertrophy of the facet joints, loss of intervertebral disk height, or spondylolisthesis. 6,12,13 Several of the aforementioned causes of stenosis are degenerative processes that may lead to the most common type of LSS: degenerative LSS.…”