Causes of Stenosis Degenerative spondylo-listhesis Facet subluxation and hypertrophy Pagets disease Tumour Facet joint cyst Congenital- achondroplasia.

Slides:



Advertisements
Similar presentations
MANUAL THERAPY LUMBER SPINE SELECTION OF THE TECHNEQUES
Advertisements

PATHOLOGY Degenerative changes in the lumbar spine disc degeneration vertebral compression deformities ligamentous laxity deterioration of facet joint.
British Spinal Registry British Association of Spine Surgeons Middlesbrough February 2007 John O’Dowd Nicky Courtier.
Cervical Instability in the EDS Population
Assessment of LBP and Hip pain GP Registrar Training 24 th November 2009 Sue Hammersley and Julie James.
Spinal Infections in the Elderly Manoj Krishna Spine Surgeon
The different types of patients with Sciatica from a lumbar disc Manoj Krishna. Spinal Surgeon
Evaluation of back pain and other disorders of the Spine.
Lumbar Spinal Stenosis – Symptoms and Treatment Slide presentation will automatically advance to the next page every 12 seconds. If you wish to move ahead.
September 5 th – 8 th 2013 Nottingham Conference Centre, United Kingdom
Lumbar Spine Surgery: Indications & Outcomes Nelson Saldua, LCDR, MC, USN Eric Harris, CDR, MC, USN Department of Orthopaedic Surgery.
Is patient younger than 16 years
Spondylosis (OA) - Lumbar
Back Pain after a Road Traffic Accident Normal looking disc with Low Back Pain.
4 patients with pains in their legs………………. Mr H 65 years of age Type II Diabetes Developed shortness of breath when walking the dog Worse when he is climbing.
Degenerative Disease of the Spine
Lumbar Spine Orthopedic Tests.
Sciatica Differential Diagnosis
BACKACHE BLOCK BACKPAIN Prof. Mthunzi Ngcelwane HoD: Orthopaedics.
Cervical Spine Pathologies and Treatments Physician Name Physician Institution Date.
SPINAL STENOSIS Jung U. Yoo, M.D. Professor and Chairman Department of Orthopedics and Rehabiliatation Oregon Health and Science University.
DEGENERATIVE DISC DISEASE By: Michaela Watson. What is it?  Not actually a disease.  A term used to describe normal changes.  Spinal discs are soft,
MINIMAL ACCESS SURGERY LUMBAR SPINE DR. PARTHA P BISHNU MCh Neurosurgeon.
Correlating Clinical and MRI Scan Findings in Low Back Pain Jim Messerly D.O.
Objectives  Discuss the anatomy of the spine in relation to fractures or degenerative disease.  Identify common nursing goals in care of the adult spine.
CERVICAL SPONDYLOSIS DR T.P MOJA STEVE BIKO ACADEMIC HOSPITAL
© 2005 The McGraw-Hill Companies, Inc. All rights reserved. The Spine PE 236 Amber Giacomazzi MS, ATC.
Lumbar Surgery Audit Period 1 st Jan st Dec 2007 Presented at Britspine teaching Hospital consultants 2 District General Hospitals.
Basic Diseases That Affect The Vertebral Column And Management.
SPONDYLOLISTHESIS. Outcomes  Be familiar with the definition of Spondylolisthesis.  Be familiar with the pathology of a typical Spondylolisthesis. 
Back Pain Christopher D. Sturm, M.D., F.A.C.S Medical Director Mercy Institute of Neuroscience & Mercy Regional Neurosurgery Center.
Pathophysiology Pathophysiology Decreased volume of spinal canal due to osteoarthritis of disc and facet joints. Less space available for neural elements.
kyphosis lordosis and scoliosis
Low Back Pain. What is low back pain? Pain in the low back.
Lumbar Radiculopathy Jack Moriarity, M.D. Division of Surgery NewSouth NeuroSpine.
Traction ESAT 3640 Therapeutic Modalities. Traction Process of drawing or pulling apart of a body segment Mostly used on spine, but can be used on other.
SPINAL NERVE ROOT COMPRESSION AND PERIPHERAL NERVE DISORDERS Group A – AHD Dr. Gary Greenberg.
Anthony Chiodo, MD, MBA University of Michigan Health System AAPMR Meeting 2015, Boston.
Sciatica Causes and 4 case presentations Manoj Krishna Spinal Surgeon.
Vertebral End Plate Fracture. Normal Anatomy End Plate – Thin layer of hyaline cartilage between bone and intervertebral disc – Prevents highly hydrated.
Cervical Stenosis and Myelopathy
In the name of God H. Moin M.D, F. R.C.S Oct
Cervical Spondylosis (Degenerative Disc Disease).
Spondylolysis and Spondylolisthesis. Normal Anatomy Pars interarticularis – Part of vertebra between inferior and superior articular process of the facet.
Neck Pain Frequently Asked Questions … Moe R. Lim, MD UNC Orthopaedics (919-96B-ONES) UNC Spine Center ( )
Leaders in minimally-invasive spine surgery….!. Introduction Dr Abhijit Pawar the chief surgeon at Endo-Spine clinic is affiliated as Spine Surgeon in.
SURGERIES IN BACK PAIN MANAGEMENT Chaloupka R., Repko M. University Hospital Brno, Orthopaedic Dept Brno-Bohunice.
بسم الله الرحمن الرحيم. Acute intervertebral disc prolapse.
Herniated Disc Surgery. Anatomy A herniated disc most often occurs in the lumbar region (low back). This is because the lumbar spine carries most of the.
OUTCOME OF SPINE SURGERY IN ELDORET
Degenerative disease of Lumbar spine
Osteoarthritis Name : Abdulaziz Bader ID:
Physician determines eligibility
Lumbar Stenosis.
Cervical spine Symptoms:
Neurosurgical Updates 2016 Brain & Spine Symposium:
One-year follow up of a prospective case control study of 60 patients
Low Back Pain.
First Year Experience with Lipogems
Lumbar Problems and their Surgical Results
Primary Care Management of the Degenerative Spine
Spine Surgery WHO NEEDS IT?
Approach to Degenerative Lumbar Spine
19,628 operations in NSW for LSS between 2003 and 2013
Lumbar stenosis case (MT-ULBD)
Percutaneous screw and rod placement
Lumbar spondylolisthesis (MISS TLIF)
Presentation transcript:

Causes of Stenosis Degenerative spondylo-listhesis Facet subluxation and hypertrophy Pagets disease Tumour Facet joint cyst Congenital- achondroplasia Scoliosis with lateral shift

Differential Diagnosis Vascular Claudication Hip OA Lumbar disc protrusion MS Tumour AV malformation Peripheral Neuropathy

Zones of nerve compression in Spinal Stenosis

Types of Stenosis Central: No pain, but legs ‘slow’ on walking Lateral recess: Unilateral leg pain, increased on walking.

Diagnosis Congenital Stenosis Infectious Stenosis Traumatic Stenosis

Diagnosis Degenerative Stenosis

JT. Right L45 Facet Joint Cyst. Severe Right sided leg pain and Low back pain Treated with decompression surgery

65/M. Pagets Disease causing stenosis. Long standing LBP. Neurogenic claudication distance 50 yards

Symptoms 70% also have back pain Leg pain worse on walking and standing and eased on sitting or bending forwards Can cycle or walk leaning forwards on a trolley Gradually Progressive Increased on walking on hard surfaces, down an incline and in high heels

Tandem Stenosis In 15-20% of patients both cervical and lumbar stenosis are present Hoffman Sign positive. Heel-Toe gait – poor balance. Usually operate on the neck first

Signs Minimal!! One of the hallmarks of these patients is that they have no spinal tenderness, a full range of movement, SLR is normal and there is no neuro-deficit. Diagnosis is purely in the history

Spinal Stenosis- what’s new? Diagnosis often missed as no positive examination findings Diagnosis on history: difficulty walking with cramps in legs, eased on sitting Epidural injections- short term relief Surgery- Now never do a laminectomy alone- alters the biomechanics Always add dynamic stabilization- excellent outcomes

When to refer? Pain uncontrolled in primary care Walking getting progressively worse Surgery is straight forward No increase in surgical risk due to age.

Treatment Conservative -Rest, analgesics, anti- inflammatories, oral steroids, antispasmodics, physiotherapy, weight loss, steroid injections

T reatment- Laminectomy and Dynamic Stabilization( my preferred option)

Complications and Outcomes of Surgery 2-4% risk of infection, CSF leak, and Neural Injury No death, or paralysis in 17 years of practise in over 4000 cases Surgery has become safer, outcomes better and recovery quicker 80% better on average Increased age alone does not result in increased risk of surgery

Dynamic Stabilization 29 elderly patients with degenerative scoliosis. Decompressive laminectomy and dynamic stabilization without fusion. (Dynesis) 54 month mean follow up. Oswestry score improvement of 51.6%. 51.7% improvement in VAS leg pain, and 57.8% for VAS back pain. Sivestre M, Lolli F, Bakaloudis G. Dynamic stabilization for degenerative lumbar scoliosis in elderly patients. Spine 2010 Jan

Dynamic Stabilization 100 patients. Decompression and pedicle screw based dynamic stabilization (Cosmic) Improved disability scores. ODI pre-op of 51, and post-op of 21. Improvement in pain. VAS pre-op 6.5 and post-op 2.1. SF-36 outcomes were also improved. Stoffel M, Behr M, Reinke A, Meyer B. Pedicle screw-based dynamic stabilization of the thoracolumbar spine with the Cosmic-system: a prospective observation. Achta Neurochirurg 2010 May