Lumbar Spinal Stenosis - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубліковано 26 гру 2018
- Dr. Ebraheim’s educational animated video describes the condition of lumbar spinal stenosis.
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Lumbar Spinal Stenosis
Lumbar spinal stenosis is a narrowing of the spinal canal and narrowing of the intervertebral foramen (nerve root canal). There are two types of lumbar spinal stenosis- central and lateral. Hypertrophy of the facet joints, hypertrophy of the ligamentum flavum, disc degeneration, or arthritis are all examples of conditions which constrict the nerve root canals causing compression of the spinal nerves and sciatica. Patients will have back pain that is better with flexion, or leaning forward like over a grocery cart. The pain will be worse with extension of the back. Leaning forward increases the foramen size by about 12%. Leaning backwards reduces the foramen size by about 20%. Neurological exam is normal in about 50% of the patients. Central canal stenosis is responsible for giving neurogenic claudication. Patients may have leg pain, back pain, buttock pain, weakness, cramps of the calf, and a heavy sensation. Patients will exhibit grocery cart sign (flexion of the back). The patient history is key for making the diagnosis of spinal stenosis. Lateral recess stenosis will give radicular symptoms. It can occur in the nerve root canal. Neural foraminal stenosis occurs in the intervertebral foramen. Physicians should look for other conditions such as hip problems, metastatic tumors, or vascular conditions. You should always examine the pulses. Neurogenic claudication and vascular claudication may coexist. Walking is bad for both neurogenic and vascular claudication. Sitting will relieve the symptoms in both neurogenic and vascular claudication. Stopping and standing is good for the vascular claudication but still causes symptoms for lumbar spinal stenosis. Using a stationary bicycle will relieve symptoms of lumbar spinal stenosis, however it will aggravate the symptoms in vascular claudication. In vascular claudication, pain starts within the calf and leg. In neurogenic claudication, pain starts proximally and then spreads distally. It seems like postural changes of the spine will make the neurogenic claudication worse, however this will not affect the vascular claudication. Vascular claudication will be affected by muscle movement or muscle function, such as walking of riding a bicycle. In neurogenic claudication, leaning over while riding the bicycle will relieve the symptoms in the same way as the shopping cart sign. Spinal stenosis can be treated operatively. In central canal stenosis, you should do a decompression by laminectomy. In lateral recess stenosis, you should do a medial facetectomy. You should add fusion for instability or if more than 50% of the bilateral facets are removed. You should look at the x-rays or the MRI. If there is a slip of the vertebrae, do a fusion in addition to the laminectomy. The risk of pseudoarthrosis is increased 500% by smoking. Depression and other comorbidities can affect the outcome. In two years, patients who are treated with surgery are better in pain and function than the patient who is treated conservatively. The most common reason for failed surgery is recurrence of the disease (residual foraminal stenosis). Walking is bad without the aid of a shopping cart. Leaning over the shopping cart will relieve the symptoms. If you have a patient with lower back pain and gait disturbance (hyperflexia), then you have an upper motor neuron lesion. Think about the cervical spine. You need to get an MRI of the cervical spine after you examine the patient. Think of cervical spine myelopathy because lumbar stenosis does not give these findings. Patient with spinal stenosis, spondylolisthesis, or facet disease will have pain with extension of the lumbar spine. Pain with lumbar spine flexion will suggest a disc related disorder.
thank you that was very helpful. you have explained it so as the untrained person can understand.
You have the very BEST descriptive ortho vids on youtube!!!
Stonefalconetti thank you
I had pain radiating down both legs at different times of the day and it was continual almost every day and that's why I went to the doctor. She checked me out on two occasions and told me there was nothing wrong. One day when she was away they asked me if I wanted to see a different doctor. I said that's OK. I told him my symptoms he check things out he sent me for x-rays and I was told I have this condition. I'm so glad I went to the other doctor because now we can go forward with treatment. Thank you so much Dr. for this video. Very informative. 🏥
Joining the others here to say thank you, very helpful. While I'm grateful to the neurosurgeon who explained my MRI, he did so in layman terms. He said, your foramen, the spinal cord column or canal, is too narrow for the spinal cord, likely congenital(which makes sense, I was premature and have a lot of congenital issues) and that was great to know, except that he didn't diagnose me with anything, and he never told me that is was stenonis. That was explained later by RMTs after I explained it like he did. They say, oh, lumbar stenosis. I said, what?
In Canada it seems that doctors don't want to diagnose, they want to rule out. With that MRI they ruled out disc herniation, and told me I had too narrow a foramen, and bless him, that first neurosurgeon admitted that he couldn't help with surgery, because it is a birth defect, and the chances of paralysis are too great, unless I am already paralized then they would try he said. Okay, but for years I didn't know what lumbar stenosis is. Today I do. This lead to depression because none of the excersices help that I find, and all I want to do is lean on somthing or sit down, which I'm told, since I have lordosis and scoliosis, makes it worse. So by feeling less pain, I'm making things worse, okay, I thought, push through the pain and work it out and gain strength. So far that approach leaves me numb and having trouble with stairs or walking.
Oh and claudication... My arm swells up and when I walk... turns purple with white spots, the muscles hurt and twitch afterwards... sounds like a goood guess for what the hell that is. Ranting, sorry just meant to say thank you.
Thank you for you very clear explanation. I really like how you combine simple description with visual examples. Outstanding!!!
Very good! Awesome! I have severe bi lateral foraminal stenosis, l4 l5, moderate l3 l4. This video explains ALOT to me! Thanks
Tom
Thank you for covering this condition, great videos and explainations.
Thank you, doctor for ALL your videos. They are very helpful. So much pertinent information packed into a short video with fantastic graphics...a winning combination!
I agree.
Thank you so much , DR . Nabil ...
The best explanation I have yet to listen to. Thank you so much!
Always really helpful! Please keep doing this!
Thank you so much. Clarity and simplicity. Very helpful.
Very useful information...with good clinical demarcation
excellent presentation doctor
Excellent lecture
Excellent lecture. Iam radiology resident and had to read many MRI lumbar spine
Fabulous explanations and graphics. Thank you sir !
It was very helpful thank you so much! My mother was diagnosed recently with this, and I am a musculoskeletal health student so this was very informative (and interesting!)
Best explanation in Internet
MasyaAllah thank you for the explanation! 💜 i love it, simple yet meningful
Very helpful thank you for the quick lecture and animations
Very helpful indeed. Thanks
It was too helpful....THANK YOU
Thank you very informative.
Helpful. Thank you.
Thanks Docter
Thanks doc I learned a lot.
Thank you very much
I was just diagnosed with this with arthritis, bulging disc, degeneration and a tear. Im 37 years old. It's crippling pain
Are you in disability, I have the same problems
Excellent
In my much research of reading, listening and viewing, I cannot find an "answer". My impeded central canal has only a 25% channel for the nerve bundle to pass through. Exercise, stretching, alternative treatments, etc. can possibly OPEN or RELAX "MANY PINCHED AREAS" in the body, PROMOTING MOBILITY and PAIN MANAGEMENT. But non-surgery options WILL NOT REMOVE CENTRAL CANAL HINDERANCES or SPREAD THE CANAL BONES/OPEN THE CANAL ..... in order to enhance mobility and pain management. Is that correct? If so, it seems to me (if generally high success rate) that common sense dictates that limited invasive surgery should be an early option instead of a last option. Clean out the pipe first and then add then add stretching, exercises, etc. Is this faulty reasoning? Thanks for any help!!!!
very much useful for clinical diagnosis , who can not afford undergoing radialogical ivestigations. this video teaches the importance of taking history of the patient (interrogation) which is essential for diagnosis. Thank you sir
Thank you sir, from India
I have bilateral stenosis and sitting causes a lot of problems for me. I lie on my left hand side to ease the pain.
good Thank you
After I had small surgery 2017 , before that when I walk , I need to use the cane until now . I can not walk normal with out the cane . I will try some exercises before I have surgery . Thank you again ...
Thank you - Yes, it was very interesting and useful. =)
Hi, Thank you for always posting such helpful videos, I’ve learned a lot from you! I was wondering if you could answer a question. How are Patients who are at a higher risk for embolism, (for example a h/o of PE w/ (protein C&S-, +factor8) what steps can be taken to help lower the risk of clots post spinal fusion, yet not interfere w/ the bone fusing. Can anticoagulants be given, if so at when post surgery? Thank you 😊
Very helpful and great detail. Helped me understand my diagnosis and to see exactly what was wrong with my S1in detail. While we don't get to see our own MRI scans we only get the text written, your images showed me the areas where my problems are. Thank you!
A good doctor should be showing you the MRI. I have never heard of not seeing your own scans.
@@nka82 Hopefully I'll see on screen when I go for next appointment but yes I agree. In fact they hid the fact I initially had a disc bulge at all and I was told sometimes they avoid telling patients the facts because it's better they don't know. I think it's this Nocebo effect, They feel the facts will make us believe we're sick and unable to carry on normally. For me I carried on using pain meds for a number of years & the constant sciatica well my then GP said 'Oh that goes as quick as it comes' I've ended up with circumferential disc bulge now and ligamentum flavum hypertrophy. Plus serious osteoporosis with 2 foot breaks because she ignored the 'early degeneration of spine' x rays & I had no way of seeing results even though when I eventually got access it states.. make appointment for patient. & also plan treatment. None of this was done & my GP said I needed to attend AA meetings due to being addicted to pain meds. I had to stop taking pain meds to prove I wasn't addicted and pay fortunes for diclofenac gel. I have a new excellent GP now and access to my medical records. Still have to wait to see the MRI results on screen though. It's our body yet we're not allowed copies of the imagery. Ridiculous. I complained to NHS england about the GP as many others have. She stated, in response that she had no reason to not believe me HUH. Thank you for your comment by the way.
This video told me more than what my doctor told me. He just said you have this, that and this other thing and said I need an MRI and then left.
The doctors are under a lot of pressure from the government to not prescribe the needed medications we need. I have gone through ten GP's through this hellish ordeal and they are all the same. One even told me that the high doses of ibuprofen I was taking before I sort help was totally okay. Another told me to seek mental health just in case I was depressed because of my condition! My latest GP asked that I complete a personality test because I stressed over running out of Tramadol because in my country they don't give repeats anymore. I'm am injured and driving to the GP is hell and costly. Good luck and I hope you find a genuinely empathetic Doctor that will want to help you.
@@no2thenwo737 5 emergency room visits, I've seen three doctors and have had two x-rays. They all keep telling me it's spinal stenosis in my back. I've kept telling them it's my hip. After two months of all the pain yesterday I went to step on my brake pedal and my hip popped and now at my pain is gone and I can walk almost normal again. Imagine that.
Thank you, my MRI reveals stenosis in the Lumber Region. Yes, using a shopping cart or Roll-A-Bout helps. Sitting stops the pain immediately in my left leg. Have yet to discuss surgery with my doctor.
Same
Many thanks for your efforts Doctor, Could you please kindly teach us about different gaits? And their examination? As a GP I always struggle with gait, I value your opinion
E.K check my Gaits videos
Thanks Dr Ebrahim , I have tightness and spasm in my lumbar spine no pain radiation or no neurological symptoms in the lower body, I do have a c5,c6 lesion. X rays have not revealed any compression , disc dislocation or misalignment. Could my persistent spasm be as a result of ligaments or tissue injury . It has started with my neck lesion pain.
Your expert opinion is greatly appreciated.
Thanks so me. Trolley is my Friend!
Good Explanation My back bone pained very badly and i am frighted to surgery what you Council me Dr ?Thank You
Thank you for posting this video! I have severe spinal stenosis and central. I am in agony every minute of every day. My neurologist tells me that this does not cause me pain and I'm so frustrated with her.
Go to a spine specialist. Your neuro doesn't know what the hell they're talking about.
Did you got opeated?
Yes, go to an orthopedic doctor/surgeon. A back specialist. That is not a neurologist. Totally different doctors. Look it up. Good luck and God bless.
Hi... Do you recover from stenonis?
Dr. Ebraheim, can spinal stenosis contribute to degenerative disc disease/disc herniations, and if so how?
What kind of imaging do you recommend to check for this? And which specialist? Orthopedic? Or which one is best?
Shopping cart. Yes. Perfect.
This is what I have
Laminectomy operation was done with titanium on 19_01_2011,nervial pain in my left leg was cured but I felt very weighty, hospital physiotherapist advised some exercise, I followed many days but I find not any result. I visit the doctor who operated me advised to go for a pshichiatrist doctor and I am taking the medicines lybotrip, venlafaxine150 till now, yet no result. My request your kind self to advise me some exercise which I can follow and get a positive result. Thanking you.
💞💞💞
So basiclly i get too look forward to vascular disease ?
One Doctor here on YT said that we will eventually die from this problem because of sepsis. He says it's like cancer, but a lot slower. What a guy!!
Alright, people listen up. This should be the last resort option, get yourself some stem cells to regenerate the disc.
Hi , can you translat to arabic,
Does anybody cured from numbness -due to spinal stenosis- in foot?
Hi, how is your health now?
@@ZafarYTC still suffering fro numbness,etc...Thnx 4 yr concern
@@akmalm.baligh590 Me too. This is awful.
I hate my life because this pain, i hate god
Everything you need to know in a 6 minute video? You sir, are a quack. How irresponsible are you to make a video like this, telling people who have this condition that essentially they need to just sit down and don't walk. I have a patient who now refuses to go up and down our short flight stairs for dinner because he is watching your video religiously and ascribing to it like it's a religion, and now he's NOT listening to his own doctor and physical therapist. You're telling him and others EXACTLY what they want to hear. People who are already in a bad state and we are trying to get them better, but now because of this crap, he might just end up to be a vegetable because all he does is lay in bed all day. I hope you're happy with yourself.
This is not the impression I got from this video. He was just stating the obvious, really. I don't get any relief sitting down, just the opposite in fact. My problem is most Doctors giving up, being under pressure from third parties, e.g Government, then palming off the patient with a handful of panadols. Your patient that refuses to get out of bed obviously has other issues that need attending to before physio therapy.