The Hip - book

Section 14, Chapter 5: Decompression for Lumbar Spinal Stenosis Based on a Concept with Biomechanically Proven Minimally Invasive Procedure

Kazuhiro Hasegawa and Kei Watanabe INTRODUCTION Posterior decompression surgery is the first choice of treatment for lumbar spinal stenosis (LSS) if conservative treatment fails. The goal of decompression is to relieve pressure on the nerve tissues while preserving the segmental stability. Because of the possible increase in the instability following a wide laminectomy,1-5 traditional decompression … Read more

Phalen’s Test for Lumbar Stenosis

  – this test attempts to reproduce symptoms of leg pain, weakness, or numbness by causing neural ischemia;   – w/ patient upright, bend the patient into extension for a full minute;   – this should accentuate the Spinal Stenosis;   – positive test will produce a crescendo of leg symptoms followed by rapid relief of these … Read more

MRI of Disc Herniation and Lumbar Stenosis

– Discussion:     – MRI findings in normal subjects (from Boden-SD)           – note that there is a 29% prevalence of disc herniation in asymtomatic individuals;           – patients less than 60 years of age:                  – 20 per … Read more

Lumbar Stenosis

– Discussion:     – spinal stensosis is a narrowing of the lumbar spinal canal and/or neural foramina;     – results in compression of the cauda equina and lumbar nerve roots, producing neural root ischemia and neurogenic claudication;     – compression of neural structures also compresses vascular supply of nerves so that symptoms are predominately those of … Read more

Cervical Stenosis

– See:       – Cross Table Lateral       – Spondylosis – Discussion:     – risk of spinal cord injury with damage to cervical vertebrae is greater in individuals who have narrow spinal-canal diameters;     – narrow mid-sagittal spinal-canal diameter increases risk of severe neurological injury from spinal frx or … Read more

Central stenosis

– Discussion:     – central stenosis produces compression of the thecal sac in contrast to lateral stenosis which involves compression of individual            nerve roots;     – may be congenital (idiopathic or developmental in achondroplastic dwarfs) or acquired;     – acquired stenosis:            – due to degenerative hypertrophic facets … Read more

Section 9, Chapter 8: Osteotomies for Rigid Spinal Deformity: Evaluation, Indications and Techniques

Lawrence G. Lenke and Melvin C. Makhni INTRODUCTION Management of rigid spinal deformities is complex, technically demanding, and can be fraught with significant complications. Many spinal deformities can be managed without osteotomies, particularly primary deformities without congenital abnormalities. However, patients with severe and rigid deformities and those with spinal imbalance often require osteotomies to obtain … Read more