Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 54. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 518 Section Degenerative Disorders Table 1. Etiology-based classification Congenital stenosis Acquired stenosis idiopathic degenerative achondroplastic congenital with secondary degenerative changes isthmic spondylolisthesis metabolic iatrogenic postlaminectomy post-traumatic eralized disorders such as achondroplasia. Identification is usually in infancy or childhood. Stenosis may develop at several levels of the vertebral column and may often lead to serious neurologic deficits. The vast majority of patients present with acquired lumbar canal stenosis. It may occur due to degenerative processes of the lumbar spine during aging 65 99 or less frequently is caused by general metabolic disorders postsurgical or post-traumatic conditions. An anatomic classification differentiates Fig. 3 central stenosis lateral recess stenosis foraminal stenosis Figure 3. Classification of spinal stenosis a Central spinal stenosis with severe compression of the cauda equina arrows . b Lateral recess stenosis with compression of the exiting nerve roots. c Lateral stenosis with compression of the nerve root as a result of enlargement of the superior process of the facet joint arrowhead and a foraminal disc herniation arrow . Lumbar Spinal Stenosis Chapter 19 519 A pathomorphological classification considers the underlying pathology such as hypertrophy of the ligamentum flavum hypertrophy of the facet joints osteophyte formations spurs disc herniation synovial facet joint cysts vertebral displacements anterior lateral Clinical Presentation History Lumbar spinal stenosis is usually a chronic condition sometimes but not typically with a long history of low-back pain. Occasionally the stenosis may become symptomatic after a minor trauma or unusual physical stress but usually the onset is insidious. Patients with a congenitally narrow canal may acutely present with major neurologic deficit due to the occurrence of an additional disc protrusion. In patients with severe congenital stenosis .
