الفهرس 
Anatomy of the lumbar vertebrae & vertebral canalOnly 14 pages are availabe for public view
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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 only 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
lumbociatico 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.
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.
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 dayto-
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.
Surgery is aimed only at providing relief of symptoms and not for
achieving improvements in neurological status. If any neurological
improvement occurs it is to be regarded as an additional bonus benefit of
the surgery.