Spinal stenosis is a common cause of pain and disability. The degenerative changes that cause progressive narrowing of the spinal canal may also give rise to myelopathy or cauda equina syndrome (CES). In the cervical spine, stenosis will usually present as pain or radiculopathy with or without myelopathy. Lumbar spinal stenosis may present in numerous ways, such as low back pain, radiculopathy, CES, and bladder/bowel dysfunction. Despite advances in diagnosis and surgical treatment, many patients still have pain and/or neurologic deficits caused by this condition. An overview of the pathophysiology, clinical presentation, management, and outcomes of spinal stenosis associated myelopathy and CES is presented.
Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. 1972;95:87–100.
,
The pathogenesis of the spinal cord disorder associated with cervical spondylosis
, Brain
, vol. 95
(pg. 87
-100
) Lees F, Turner J. Natural history and prognosis of cervical spondylosis. Br Med J. 1963;2:1607–1610.
,
Natural history and prognosis of cervical spondylosis
, Br Med J.
, vol. 2
(pg. 1607
-1610
) Katz J, Dalgas M, Stucki G, Lipson SJ. Diagnosis of lumbar stenosis. Rheum Dis Clin N Am. 1994;20:471–483.
,
Diagnosis of lumbar stenosis
, Rheum Dis Clin N Am.
, vol. 20
(pg. 471
-483
) McKinley W, Tellis A, Cifu D, Johnson M, Kubal W, Keyser-Marcus L, et al. Rehabilitation outcome of individuals with nontraumatic myelopathy resulting from spinal stenosis. J Spinal Cord Med. 1998;21:131–136.
,
Rehabilitation outcome of individuals with nontraumatic myelopathy resulting from spinal stenosis
, J Spinal Cord Med.
, vol. 21
(pg. 131
-136
) McKinley WO, Hardman J, Seel R. Nontraumatic spinal cord injury: Incidence, epidemiology and functional outcome. Arch Phys Med Rehabil. 1998;79:1186–1187.
,
Nontraumatic spinal cord injury: Incidence, epidemiology and functional outcome
, Arch Phys Med Rehabil.
, vol. 79
(pg. 1186
-1187
) Gibson CJ. Final Report of the Rochester Regional Model Spinal Cord Injury System. 9-30-85 to 7-29-90. Rochester, NY: Rochester Regional Model Spinal Cord Injury System; 1991.
,
Final Report of the Rochester Regional Model Spinal Cord Injury System. 9-30-85 to 7-29-90
Taylor JR, Twomey LT. Human intervertebral disc acid glycosaminoglycans. J Anat. 1992;180:137–141.
,
Human intervertebral disc acid glycosaminoglycans
, J Anat.
, vol. 180
(pg. 137
-141
) Thomas NNM, Rea GL, Weinstein PR. Anatomy and pathophysiology of acquired spinal lesions. In: Benzel EC. Spine Surgery: Techniques, Complication Avoidance and Management. 2nd ed. Philadelphia: Elsevier; 2005:88–99.
,
Spine Surgery: Techniques, Complication Avoidance and Management
, Anatomy and pathophysiology of acquired spinal lesions
(pg. 88
-99
) Yamaura I, Yone K, Nakahara S et al. Mechanism of destructive pathologic changes in the spinal cord under chronic mechanical compression. Spine. 2002;27:21–26.
,
Mechanism of destructive pathologic changes in the spinal cord under chronic mechanical compression
, Spine
, vol. 27
(pg. 21
-26
) Storm P, Chou D, Tamargo R. Lumbar spinal stenosis, cauda equina syndrome, and multiple lumbosacral radiculopathies. Phys Med Rehabil Clin N Am. 2002;13:713–733.
,
Lumbar spinal stenosis, cauda equina syndrome, and multiple lumbosacral radiculopathies
, Phys Med Rehabil Clin N Am.
, vol. 13
(pg. 713
-733
) Lorenz M, Patwardhan A, Vanderby R. Loadbearing characteristics of lumbar facets in normal and surgically altered spinal segments. Spine. 1983;8:122–130.
,
Loadbearing characteristics of lumbar facets in normal and surgically altered spinal segments
, Spine
, vol. 8
(pg. 122
-130
) Cooper PR. Cervical spondylotic myelopathy. Contemp Neurosurg. 1997;19(25):1–7.
,
Cervical spondylotic myelopathy
, Contemp Neurosurg.
, vol. 19
(pg. 1
-7
) Hayashi H, Okada K, Hashimoto J, et al. Cervical spondylotic myelopathy in the aged patient: A radiological evaluation of the aging changes in the cervical spine and etiologic factors of myelopathy. Spine. 1988;13:618–625.
,
Cervical spondylotic myelopathy in the aged patient: A radiological evaluation of the aging changes in the cervical spine and etiologic factors of myelopathy
, Spine
, vol. 13
(pg. 618
-625
) Henderson F, Benzel E, Kim D. Pathophysiology of cervical myelopathy: biomechanical concepts. In: Benzel EC. Spine Surgery: Techniques, Complication Avoidance and Management. 2nd ed. Philadelphia: Elsevier; 2005:160–168.
,
Spine Surgery: Techniques, Complication Avoidance and Management
, Pathophysiology of cervical myelopathy: biomechanical concepts
(pg. 160
-168
) Ogino H, Tada K, Okada K, et al. Canal diameter, anteroposterior compression ratio, and spondylotic myelopathy of the cervical spine. Spine. 1983;8:1–15.
,
Canal diameter, anteroposterior compression ratio, and spondylotic myelopathy of the cervical spine
, Spine
, vol. 8
(pg. 1
-15
) Al-Mefty O, Harkey HL, Marawi I, et al. Experimental chronic compressive cervical myelopathy. J Neurosurg. 1993;79:550–561.
,
Experimental chronic compressive cervical myelopathy
, J Neurosurg
, vol. 79
(pg. 550
-561
) Shapiro S. Cauda equina syndrome secondary to lumbar disc herniation. Neurosurgery. 1993;32:743–747.
,
Cauda equina syndrome secondary to lumbar disc herniation
, Neurosurgery
, vol. 32
(pg. 743
-747
) Orendacova J, Cizkova D, Kafka J, et al. Cauda equina syndrome. Prog Neurobiol. 2001;64:613–637.
,
Cauda equina syndrome
, Prog Neurobiol.
, vol. 64
(pg. 613
-637
) Delamarter RB, Sherman JE, Carr JB. Cauda equina syndrome: Neurologic recovery following immediate, early, or late decompression. Spine. 1991;16:1022–1029.
,
Cauda equina syndrome: Neurologic recovery following immediate, early, or late decompression
, Spine
, vol. 16
(pg. 1022
-1029
) Sekiguchi M, Kikuchi S, Myers RR. Experimental spinal stenosis: Relationship between degree of cauda equina compression, neuropathology and pain. Spine. 2004;104:191–198.
,
Experimental spinal stenosis: Relationship between degree of cauda equina compression, neuropathology and pain
, Spine
, vol. 104
(pg. 191
-198
) Yonetake T, Sekiguchi M, Shin-ichi K, et al. Compensatory neovascularization after cauda equina compression in rats. Spine. 2008;33:140–145.
,
Compensatory neovascularization after cauda equina compression in rats
, Spine
, vol. 33
(pg. 140
-145
) Otani K, Arai I, Mao GP, et al. Nucleus pulposus-induced nerve root injury: Relationship between blood flow and motor nerve conduction. Neurosurgery. 1999;45:614–620.
,
Nucleus pulposus-induced nerve root injury: Relationship between blood flow and motor nerve conduction
, Neurosurgery
, vol. 45
(pg. 614
-620
) Delamarter RB, Bohlman HH, Dodge LD, et al. Experimental lumbar spinal stenosis. Analysis of the cortical evoked potentials, microvasculature, and histopathology. J Bone Joint Surg. 1990;72A:110–120.
,
Experimental lumbar spinal stenosis. Analysis of the cortical evoked potentials, microvasculature, and histopathology
, J Bone Joint Surg.
, vol. 72A
(pg. 110
-120
) McCormack BM, Weinstein PR. Cervical spon dylosis. An update. West J Med. 1996;165(1-2):43–51.
,
Cervical spon dylosis. An update
, West J Med.
, vol. 165
(pg. 43
-51
) Heller JG. The syndromes of degenerative cervical disease. Orthop Clin North Am. 1992;23(3):381–394.
,
The syndromes of degenerative cervical disease
, Orthop Clin North Am.
, vol. 23
(pg. 381
-394
) Umerah BC, Mukherjee BK, Ibekwe O. Cervical spondylosis and dysphagia. J Laryngol Otol. 1981;95(11):1179–1183.
,
Cervical spondylosis and dysphagia
, J Laryngol Otol
, vol. 95
(pg. 1179
-1183
) Young WF. Cervical spondylotic myelopathy: A common cause of spinal cord dysfunction in older persons. Am Fam Physician. 2000;62(5):1064–1070,1073.
,
Cervical spondylotic myelopathy: A common cause of spinal cord dysfunction in older persons
, Am Fam Physician
, vol. 62
(pg. 1064
-1070
) Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J Neurosurg. 1954;11(6):546–577.
,
The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine
, J Neurosurg.
, vol. 11
(pg. 546
-577
) Cusick JF. Pathophysiology and treatment of cervical spondylotic myelopathy. Clin Neurosurg. 1989;37:661–681.
,
Pathophysiology and treatment of cervical spondylotic myelopathy
, Clin Neurosurg.
, vol. 37
(pg. 661
-681
) Yu YL, du Boulay GH, Stevens JM, et al. Computed tomography in cervical spondylotic myelopathy and radiculopathy: Visualization of structures, myelographic comparison, cord measurements and clinical utility. Neuroradiology. 1986;28:221–236.
,
Computed tomography in cervical spondylotic myelopathy and radiculopathy: Visualization of structures, myelographic comparison, cord measurements and clinical utility
, Neuroradiology
, vol. 28
(pg. 221
-236
) Adams C, Logue V. Studies in cervical spondylotic myelopathy. III. Some functional effects of operations for cervical spondylotic myelopathy. Brain. 1971;94:587–594.
,
Studies in cervical spondylotic myelopathy. III. Some functional effects of operations for cervical spondylotic myelopathy
, Brain
, vol. 94
(pg. 587
-594
) Greenburg MS. Handbook of Neurosurgery. 6th ed. New York: Thieme; 2006:289–364.
,
Handbook of Neurosurgery
(pg. 289
-364
) Tay E, Chacha PB. Midline prolapse of a lumbar intervertebral disc with compression of the cauda equine. J Bone Joint Surg. 1979;61B:43–46.
,
Midline prolapse of a lumbar intervertebral disc with compression of the cauda equine
, J Bone Joint Surg.
, vol. 61B
(pg. 43
-46
) Kostuik J, Harrington I, Alexander D, et al. Cauda equina syndrome and lumbar disc herniation. J Bone Joint Surg. 1986;68:386–391.
,
Cauda equina syndrome and lumbar disc herniation
, J Bone Joint Surg.
, vol. 69
(pg. 386
-391
) O’Laoire S, Crockard H, Thomas D. Prognosis for sphincter recovery after operation for cauda equina compression due to lumbar disc prolapse. Br Med J. 1981;282:1852–1854.
,
Prognosis for sphincter recovery after operation for cauda equina compression due to lumbar disc prolapse
, Br Med J.
, vol. 282
(pg. 1852
-1854
) Shapiro S. Medical realities of cauda equine syndrome secondary to lumbar disc herniation. Spine. 2000;25:348–351.
,
Medical realities of cauda equine syndrome secondary to lumbar disc herniation
, Spine
, vol. 25
(pg. 348
-351
) Kostuik J. Point of view: comment on Shapiro S: Medical realities of cauda equine syndrome secondary to lumbar disc herniation. Spine. 2000;25:351.
,
Point of view: comment on Shapiro S: Medical realities of cauda equine syndrome secondary to lumbar disc herniation
, Spine
, vol. 25
pg. 351
Onel D, Sari H, Donmez C. Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention? Spine. 1993;18:291–298.
,
Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention?
, Spine
, vol. 18
(pg. 291
-298
) Porter RW, Hibbert C, Evans C. The natural history of root entrapment syndrome. Spine. 1984;9:418–421.
,
The natural history of root entrapment syndrome
, Spine
, vol. 9
(pg. 418
-421
) Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted metaanalysis of the literature. Spine. 1992;17:1–8.
,
Surgery for lumbar spinal stenosis. Attempted metaanalysis of the literature
, Spine
, vol. 17
(pg. 1
-8
) Chen TY, Dickman C, Eleraky M, Sonntag V. The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis. Spine. 1998;23(22):2398–2403.
,
The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis
, Spine
, vol. 23
(pg. 2398
-2403
) Chiles BW, Leonard MA, Choudhri HF, Cooper PR. Cervical spondylotic myelopathy: Patterns of neurological deficit and recovery after anterior cervical decompression. Neurosurgery. 1999;44(4):762–769; discussion 769–770.
,
Cervical spondylotic myelopathy: Patterns of neurological deficit and recovery after anterior cervical decompression
, Neurosurgery
, vol. 44
(pg. 762
-769
) Verbiest H. Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal. A review of twenty-seven years experience. J Bone Joint Surg. 1977;59:181–188.
,
Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal. A review of twenty-seven years experience
, J Bone Joint Surg.
, vol. 59
(pg. 181
-188
) Epstein JA, Janin Y, Carras R, Lavine LS. A comparative study of the treatment of cervical spondylotic myeloradiculopathy. Experience with 50 cases treated by means of extensive laminectamy, foraminotomy, and excision of osteophytes during the past 10 years. Acta Neurochir. 1982;61:89–104.
,
A comparative study of the treatment of cervical spondylotic myeloradiculopathy. Experience with 50 cases treated by means of extensive laminectamy, foraminotomy, and excision of osteophytes during the past 10 years.
, Acta Neurochir.
, vol. 61
(pg. 89
-104
) Hall S, Bartleson JD, Ontorio BM, Baker HL Jr, Okazaki H, O’Duffy JD. Lumbar spinal stenosis. Clinical features, diagnostic procedures, and results of surgical treatment in 68 patients. Ann Int Med. 1985;103:271–275.
,
Lumbar spinal stenosis. Clinical features, diagnostic procedures, and results of surgical treatment in 68 patients
, Ann Int Med.
, vol. 103
(pg. 271
-275
) Caputy A, Lussenhop AJ. Long-term evaluation of decompressive surgery for degenerative lumbar stenosis. J Neurosurg. 1992;77:669–676.
,
Long-term evaluation of decompressive surgery for degenerative lumbar stenosis
, J Neurosurg.
, vol. 77
(pg. 669
-676
) Weir B, de Leo R. Lumbar stenosis: Analysis of factors affecting outcome in 81 surgical cases. Canada J Neuro Sci. 1981;8:295–298.
,
Lumbar stenosis: Analysis of factors affecting outcome in 81 surgical cases.
, Canada J Neuro Sci.
, vol. 8
(pg. 295
-298
) DeVivo M, Kartus P, Rutt R, Stover S, Fine P. The influence of age at time of spinal cord injury on rehabilitation outcome. Arch Neurol. 1990;47:687–691.
,
The influence of age at time of spinal cord injury on rehabilitation outcome
, Arch Neurol.
, vol. 47
(pg. 687
-691
) Ditunno J Jr, Cohen M, Formal C. Functional outcomes. In: Stover S, DeLisa J, Whiteneck G, eds. Spinal Cord Injury: Clinical Outcomes from the Model Systems. Gaithersburg, MD: Aspen Publishers; 1995:1170–1184.
,
Spinal Cord Injury: Clinical Outcomes from the Model Systems
, Functional outcomes
(pg. 1170
-1184
) McKinley W, Tewksbury M, Mujteba N. Spinal stenosis vs traumatic spinal cord injury: a rehabilitation outcome comparison. J Spinal Cord Med. 2002;25:28–32.
,
Spinal stenosis vs traumatic spinal cord injury: a rehabilitation outcome comparison
, J Spinal Cord Med.
, vol. 25
(pg. 28
-32
)
This content is only available as a PDF.
