الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Spinal stenosis or stenosis of the lumbar spinal canal has
been defined until 1976 as structural narrowing of the canal but
now the definition extends to involve narrowing of the intervertebral
foraminae and nerve root tunnels.
Five major types of stenosis are known:
1. Congenital.
2. Developmental.
3. Degenerative.
4. Mixed.
5. Iatrogenic.
The diagnosis of spinal stenosis is not an easy question for
it depends upon
Proper history taking. the basic symptoms being back pain
radiating to the lower limbs in a bizarre manner with or without
claudication. all accentuated by standing and walkir.g and
relieved by obliteration of the lumber lordosis e.g. squatting.
The examination of patient with stenotic canal may not reveal
any sign or only minimal ones.
The proper investigations .
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Pl~in radiography although used for a long period to asses the
dimensions of the canal by the stenotic index or direct measurement
is now of very limited value.
Myelography and Radiculography although hazardous are the
best way to outline the dural sac and its extensions. To determine
the site and extent of pathology and thus are jI good to asseSS
the plan of surgery.
C.T. scan is the best way to detect the site of narrowing!
the nature of stenosis wether bony or soft tissue , it
illuminates the blind zones or lateral recesses and after all is
least invasive and least hazardous.
Ultrasonography is of value only in mass assesment of the
size of the canal of groups of individuals for preventive medicine
purposes.
Very little has been written about the conservative management
of spinal stenosis and its prognosis , of course its value is
limited to very mild early cases or inoperable cases like
Paget’s disease of spine.
Once nervous deficit occurs , there is absolute indication
for surgery. Back pain needs to be quite resistant and even
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progressive in an emotionally stable patient to warrant surgery
since it is the least symptom to improve by surgery.
The surgical procedure is generous decompression by complete
laminectomy or laminectomies with facetectomy partial or total ,
foraminotomy to rel ief entraped nerve or even exc is ion of
portions of the pedicle.
Neurolysis is essential of both dura and nerve roots especially
in cases of iatrogenic stenosis.
Good surgical techniques and good haemostasis with avoidance
of unneeded manipulation is essential to avoid recurrence of
symptoms some authors even advised to use gel foam and silicon
tubing .
With early detection and accurate localisation of the origin
of pain, surgical decompression at the proper timing with the
proper technique in patient with limited affection ( 2 levels or 3 )
good and. filiI’ reSUIts ~ere obtained In ’t 6 r. 0 f Pabent s
treated.