Spinal deformity
- thoracolumbar kyphosis
- excessive lordosis
Spinal canal stenosis
- Due to
- Reduce spinal canal diameter
- Short pedicles making the AP length smaller than the lateral length
- Due to thickening of the connective structures such as the ligamentum flavum
- Ligamentous laxity may also result in increased movement of the bony structures and increase the possibility of compression of the cord
- spinal narrowing becomes potentially more problematic at the cervical regions and at the cervical and lumbar cord enlargements
- Presents as CES/Neurogenic claudication
Management
- Lumbar stenosis
- nonoperative
- weight loss, physical therapy, corticosteroid injections
- indications
- first line of treatment and frequently effective
- operative
- multilevel laminectomy and fusion
- indications
- spinal stenosis with severe symptoms
- nonoperative management has failed
- Lumbar hyperlordosis
- nonoperative
- observation
- treatment typically not required
- Thoracolumbar kyphosis
- nonoperative
- Observation
- 90% improve
- bracing
- if persistent vertebral wedging after age 3 years
- may be poorly tolerated
- Operative
- Anterior strut corpectomy with posterior fusion or isolated posterior fusion
- indications
- bracing has failed
- kyphosis of > 45-60°
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