SPINAL STENOSIS-MECHANICS
Journal Title: Journal of Turkish Spinal Surgery - Year 2003, Vol 14, Issue 3
Abstract
Intial Symptoms Patients with spinal stenosis always commence with sensory problems long before motor symptoms appear. They feel unnatural heaviness or deadness of the limbs and a sense that their legs are going to give way. Most cases describe these symptoms as commencing in the feet spreading up the legs though some describe the opposite. Severe cases describe the onset of perineal numbness as they walk or even the development of priapism. In some cases the sensory symptoms may ascend to a clinical level significantly higher than the radiological level, almost certainly due to a vascular effect on the cauda equina. In some cases, as the patients walk they will become aware of weakness of the dorsiflexion of the ankle and describe that their feet slap on the ground as they walk further or that they start to trip up. In all cases these neurologic spymptoms are promptly relieved by sitting down or by leaning forward, whereas merely standing still affords no relief at all. Typically, they will develop the symptoms at a regular distance (the threshold) but be able to continue walking for a further similar distance before having to flex forward for relief. Symptoms of sphincteric disturbance are rare, but some patients may describe a sensation of urgency of micturition. At rest, the patients usually complain of little other than backache on prolonged sitting, though some will complain of cramp or a sensation of “restless legs” especially at night. Neurologic examination of a patient with lumbar spinal stenosis often is remarkably normal. Loss of ankle jerk and distal vibration sense may be present, but in any case are common in the age group of affected patients. A voluntary decrease in the range of lumbar extension often is seen as it may precipitate symptoms. Straight-leg raising is usually normal. Dermatomal sensory loss and muscle weakness are uncommon at rest, although they may appear if the patient is reexamined after walking to their tolerance limit. In view of the age range of the typical patient, diminished peripheral pulses or limitation of hip movement may be found.
Authors and Affiliations
Prof. Dr. Tar›k YAZAR, MD
Keywords
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