Dept. Of Orthopaedics is lead by

Dr. Ibomcha Th - MS(Ortho),FAIMS.

FENESTRATION DECOMPRESSION OF LUMBAR SPINE CANAL STENOSIS ( LSCS)

Degenerative disease of the spine is known as spondylosis in the elderly people. As life span increases in the population worldwide and increase of activities of daily living; people get more wear and tear at the more mobile parts of human body like spinal column and other joints. Epidemilogically, lumbar spinal canal stenosis, (LSCS) is mostly a degenerative disease of the elderly about 10 percent over the age of 65 years. In the spine, more mobile parts of lumbar and cervical get more spondylotic changes than the relatively mobile dorsal spine. Lumbar spine canal stenosis is the commonest degenerative spinal disease with increasing age. Depending on the working style of the individual, LSCS is seen in younger middle age group too. There is no universally accepted definite definition however generally defined as <100mm3 of area for the dura available in the neural canal. Confirmation of diagnosis is done mainly by Myelographic contrast flow images and Magnetic Resonance Imaging (MRI) techniques.

Clinical sings and symptoms :-

1) Cardinal symptom is pseudoclaudication or neurogenic claudication (94%) aggravated by standing or walking.

2) Pain (93%), nubness (63%) and weakness (43%).

3) Mostly affected whole lower limbs (78%) more or less on both sides with or without above knee or below knee differences.

4) Reflxes, ankles reduced or absent (43%), knees reduced or absent (18%).

5) Objective muscle weakness(37%).

6) Electromyography shows abnormal (92%).

7) Symptoms are relieved on flexion postures and aggravated by extended postures.

8) Cycling increases in vascular claudication but is well tolerated in stenosis.

9) Cramping quality muscle pain without paresthetic aggravated by walking and relieved by standing of vascular origin is to be known.

10) Symptoms may wax and wane in intensity in spinal stenosis.

Diagnostics ( Investigations):-

1) X-ray of lumbar spines Antero-posterior view, Lateral views of flexion and extension to differentiate static and dynamic instabilities.

2) Myelography is an effective tool to have spinal canal static and dynamic instabilities by taking flexion-extension spinal lateral views.

3) CT scanning is to have accurate bony canal size and bony deformities.

CT-Myelo is the gold standard.

4) MRI wth high resolution of not less than 1.5 texla may give full details and may decrease the need of Myelography.

Treatment :- 1) Conservative ( Non-operative)

There are wide variety of degenerative spinal management from conservative to operative procedures depending upon the severity and pathology of the disease.

a) Lumbar flexion exercises- flexion increases the size of the neural canal and gives the patient relieved from some degree of neurogenic symptoms.

b) Low