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Retrolisthesis - symptoms, causes, diagnosis, Treatment
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back pain Spinal Treatment
It may be associated with disk bulging or herniation, hypertrophy of the posterior elements (namely, the facet statement and ligamentum flavum and, occasionally, calcification of ligamentum flavum. Primary central thoracic spinal stenosis is rare. In some cases, hypertrophy or ossification of the posterior longitudinal ligament results in central canal stenosis. 6 lateral thoracic stenosis may result from hypertrophy of facet joints with occasional synovial cyst encroachment. Lumbar spinal stenosis The diameter of the normal lumbar spinal canal varies from 15 to. Lumbar stenosis results from a spinal canal diameter of less than 12 mm in some patients; a diameter of 10 mm is definitely stenotic.
Keim and colleagues present the following lumbar spinal stenosis (LSS) anatomical classification scheme 18 : Lateral, secondary to superior articulating process (SAP) hypertrophy medial, secondary to inferior articulating process (IAP) hypertrophy central, due to hypertrophic spurring, bony projection, or ligamentum flavum/laminar thickening Fleur de lis.
In the central cervical spinal region, hypertrophy of the ligamentum flavum, bony spondylitic hypertrophy, and bulging of the disc annulus contribute to development of central spinal stenosis. In each case, the relative significance of each structure contributing to the stenotic pattern is variable. Congenital stenosis of the cervical spine may predispose an individual to myelopathy as a result of minor trauma or spondylosis. 5, 6, 10, 11, 12, 13, 14, cervical spondylosis refers to age-related degenerative changes of the cervical spine. These changes, which include intervertebral disk degeneration, disk space narrowing, spur formation, and facet and ligamentum flavum hypertrophy, can lead to the narrowing of the cervical spinal canal. Cervical spondylotic myelopathy (CSM) refers to the clinical presentation resulting from these degenerative processes.
Csm is the most common cause of spinal cord dysfunction in adults older than 55 years. Degenerative changes of the cervical spine have been observed in as many as 95 of asymptomatic individuals older than 65 years. Myelopathy is believed to develop in up to 20 of individuals with evidence of spondylosis. 5, 11, 13, 14, 15, 16, 17 lateral cervical stenosis results from encroachment on the lateral recess and the neuroforamina of the cervical region, primarily as a result of hypertrophy of the uncovertebral joints, lateral disc annulus bulging, and facet hypertrophy. Thoracic spinal stenosis The thoracic spinal canal varies from 12 to 14 mm in diameter in the adult. Thoracic spinal stenosis is often associated with focal disease of a long-standing nature.
Anterolisthesis - grading, causes, Treatment and diagnosis
Sagittal measurements taken of the anteroposterior diameter of the cervical professional spinal canal are highly variable in otherwise healthy persons. An adult male without spinal stenosis has a diameter of 16-17 mm in the upper and middle cervical levels. Magnetic resonance imaging (MRI) scans and reformatted computed tomography (CT) images are equally as effective in obtaining these measurements, while radiography is not accurate. View Media gallery, movement of the cervical spine exacerbates congenital or acquired spinal stenosis. In hyperextension, the cervical cord increases in diameter. Within the canal, the anterior roots are pinched between the annulus margins and spondylitic bony bars. In the posterior canal, hypertrophic facet joints and thickened infolded ligamentum flavum compress the dorsal nerve roots. In hyperflexion, neural structures are tethered anteriorly against the bulging disc annulus and spondylitic bars. In the event of a vertebral collapse, the cervical spine loses its shape, which may result in anterior cord compression.
arises from osteophytosis under the pars interarticularis and bursal or fibrocartilaginous hypertrophy at a spondylolytic defect. Exit-zone stenosis involves an area surrounding the foramen and arises from facet joint hypertrophy and subluxation, as well as superior disk margin osteophytosis. Such stenosis may impinge the exiting spinal nerve. Far-out (extracanalicular) stenosis entails compression lateral to the exit zone. Such compression occurs with far lateral vertebral body endplate osteophytosis and when the sacral ala and L5 transverse process impinge on the L5 spinal nerve. Cervical stenosis, the anteroposterior (AP) diameter of the normal adult male cervical canal has a mean value of 17-18 mm at vertebral levels C3-5. The lower cervical canal measures 12-14. Cervical stenosis is associated with an ap diameter of less than 10 mm, while diameters of 10-13 mm are relatively stenotic in the upper cervical region.
Lumbar computed tomography (CT) myelogram scan demonstrates a normal central canal diameter. Lateral recess stenosis (ie, lateral gutter stenosis, subarticular stenosis, subpedicular stenosis, foraminal canal stenosis, intervertebral foramen stenosis) is defined as narrowing (less than 3-4 mm) between the facet superior articulating process (SAP) and the posterior vertebral margin. Such narrowing may impinge the nerve root and subsequently elicit radicular pain. This lateral region is compartmentalized into entrance zone, paper mid zone, exit zone, and far-out stenosis. Amundsen and colleagues found concomitant lateral recess stenosis in all cases of central canal stenosis. 9 (see the image below. lateral and axial magnetic resonance imaging (MRI) scan demonstrating right L4 lateral recess stenosis secondary to combination of far lateral disk protrusion and zygapophysial joint hypertrophy. View Media gallery, the entrance zone lies medial to the pedicle and sap and, consequently, arises from facet joint sap hypertrophy. Other causes include developmentally short pedicle and facet joint morphology, as well as osteophytosis and hnp anterior to the nerve root.
Folliculitis - pictures, symptoms, Treatment and Prevention
Central canal stenosis, commonly occurring at an intervertebral disk level, defines midline sagittal spinal canal diameter narrowing that may elicit neurogenic claudication (NC) or pain in the buttock, thigh, or leg. Such stenosis entry results from ligamentum flavum hypertrophy, inferior articulating process (iap facet hypertrophy of the cephalad vertebra, vertebral body osteophytosis, vertebral body compression fractures, and herniated nucleus pulposus (HNP). Abnormalities of the disk usually do not cause symptoms of central stenosis in a normal-sized canal. In developmentally small canals, however, a prominent bulge or small herniation can cause symptomatic central stenosis. Large disk herniations can compress the dural sac and compromise its nerves, particularly at the more cephalad lumbar levels where the dural sac contains more nerves. (see the images below.). Lateral T2-weighted magnetic resonance imaging (MRI) scan demonstrating narrowing of the central spinal fluid signal (L4-L5 suggesting central canal stenosis. View Media gallery, axial T2 magnetic resonance imaging (MRI) scan (L4-L5) in the same patient as in the above image, confirming central canal stenosis. View Media gallery, trefoil appearance characteristic of central canal stenosis due to a combination of zygapophysial joint and ligamentum flavum hypertrophy.