الفهرس | Only 14 pages are availabe for public view |
Abstract Lumbar Canal stenosis is a progressive degenerative disorder of the spine most frequently causing morbidity in middle aged and elderly. The diagnosis is essentially clinical and supported by radiological investigations. The lumbar canal stenosis is a clinical picture that must be taken into account in all patients on the 5th Decade of life, with pain lumbosciatico uni or bi side. It must be studied with x-rays and magnetic resonance imaging of the lumbar spine. The initial management is always conservative with painkillers, physiotherapy and eventually infiltration with Corticoid epidural or foraminales. When medical management does not give good result, persisting the patient with severe radicular pain associated with a significant limitation in activities of daily living, is planteable surgery. Traditional non-operative line of treatment is effective for relief of symptoms in most patients in whom inflammatory edema of nerve roots cause compromised canal diameter in a relatively narrow canal. But the pain relief and recovery of sensation and weakness is not as good as in those subjected to surgery especially when radiological evidences of irreversible bony and soft tissue changes are already present. 124 Prolotherapy injections can be used after degenerative disc disease and instability has formed in lumbar canal stenosis.By correcting the instability of the lumbar spine at an early stage . Surgery for lumbar canal stenosis is performed only when patient has reached the state of disability i.e. patient is unable to carry out his day to day activities due to pain. Limited operative decompression with retention of stabilizing elements may decrease short term morbidity but lead to long term failure due to recurrent stenosis or development of stenosis at an adjacent level. Decompression of the stenotic lumbar canal along with fusion is definitely better than decompression alone, specially so in patients having degenerative lumbar spinal stenosis with Spondylolisthesis or Degenerative scoliosis. Pedicle instrumentation after laminectomy provides segmental fixation, improves the rate of fusion and avoids the need to extend fusion to adjacent normal levels.Recently minimally invasive surgery is providing relief of symptoms and better results with less complications. |