[The arthritic narrow lumbar canal. Anatomoradiologic study - technical considerations]

Area of Science:

• Neurosurgery
• Radiology
• Orthopedics

Background:

• Lumbar spinal stenosis caused by spondylosis is a common cause of cauda equina syndrome.
• Symptoms range from low back pain and sciatica to neurogenic claudication and sphincter disturbances.
• Standard radiological measurements of canal diameter are insufficient for evaluating the lesion.

Purpose of the Study:

• To highlight the importance of qualitative radiological analysis in diagnosing lumbar spinal stenosis due to spondylosis.
• To correlate specific lesion types with appropriate surgical management strategies.
• To evaluate the efficacy of a tailored diagnostic and therapeutic approach.

Main Methods:

• Qualitative analysis of spondylosis using plain X-ray, tomography, and sacco-radiculography (Dimer X).
• Assessment of dural sac changes with flexion-extension films.
• Classification of lesions into anterior, posterior, and mixed types based on anatomical and radiological findings.

Main Results:

• Three distinct lesion types (anterior, posterior, mixed) were identified, each requiring specific surgical intervention.
• Anterior lesions were treated with discectomy; posterior lesions with facetectomy and/or laminectomy; mixed lesions with combined procedures.
• Laminectomy alone was insufficient for treating lateral radicular entrapment.

Conclusions:

• Specialized radiological investigations are crucial for accurate diagnosis of spondylotic lumbar spinal stenosis.
• Tailored surgical management based on lesion type leads to improved patient outcomes.
• This diagnostic and therapeutic strategy offers better results than non-specific approaches.