Spinal Stenoz
Özet
Spinal stenoz, spinal kanalın daralması sonucu radiküler ve medulla spinalis etkilenmesi ile ortaya çıkan, tek taraflı veya bilateral olabilen bir durumdur. Servikal, torakal veya lomber segmentleri etkileyebilir; konjenital veya dejeneratif, travmatik gibi akkiz nedenlerle gelişebilir. Lomber stenozda en önemli semptom ağrı ve nörojenik kladikasyodur. Ağrı ayakta durma ve yürümeyle artarken, öne eğilme veya bisiklet sürme gibi kanal basıncını azaltan pozisyonlarda rahatlama görülür. Fizik muayenede bel ekstansiyonunda kısıtlanma, motor güçsüzlük ve reflekslerde azalma saptanabilir. Servikal stenoz ise ileri yaşlarda ekstremitelerde parestezi, güçsüzlük ve yürüme bozukluğu ile kendini gösterir. Tanı; klinik bulgular, nörolojik muayene ve MRG ile BT gibi görüntüleme yöntemlerinin korelasyonu ile konur. Ayırıcı tanıda vasküler kladikasyon, ALS, periferik nöropatiler, MS ve B12 eksikliğine bağlı subakut kombine dejenerasyon yer alır.
Spinal stenosis is a condition characterized by the narrowing of the spinal canal, leading to radicular and spinal cord involvement, which can be unilateral or bilateral. Affecting cervical, thoracic, or lumbar segments, it arises from congenital or acquired causes such as degenerative and traumatic factors. In lumbar spinal stenosis, the most prominent symptom is pain and neurogenic claudication. Pain exacerbates during prolonged standing or walking and relieves in positions that reduce canal pressure, such as forward flexion or cycling. Physical examination typically reveals restricted lumbar extension, motor weakness, and diminished deep tendon reflexes. Cervical stenosis, often manifesting in advanced ages, presents with shock-like paresthesias in extremities, weakness, and gait disturbances. Diagnosis is established by correlating clinical findings and neurological examination with imaging modalities like MRI and CT. Differential diagnosis includes vascular claudication, non-specific back pain, amyotrophic lateral sclerosis (ALS), peripheral neuropathies, multiple sclerosis, and subacute combined degeneration associated with vitamin B12 deficiency.
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