الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Lumbar Canal stenosis is a progressive degenerative disorder of the
spine most frequently causing morbidity in middle aged and elderly. The
diagnosis is essentially clinical and supported by radiological
investigations.
The lumbar canal stenosis is a clinical picture that must be taken
into account in all patients on the 5th Decade of life, with pain
lumbosciatico uni or bi side. It must be studied with x-rays and magnetic
resonance imaging of the lumbar spine. The initial management is always
conservative with painkillers, physiotherapy and eventually infiltration
with Corticoid epidural or foraminales. When medical management does
not give good result, persisting the patient with severe radicular pain
associated with a significant limitation in activities of daily living, is
planteable surgery.
Traditional non-operative line of treatment is effective for relief of
symptoms in most patients in whom inflammatory edema of nerve roots
cause compromised canal diameter in a relatively narrow canal. But the
pain relief and recovery of sensation and weakness is not as good as in
those subjected to surgery especially when radiological evidences of
irreversible bony and soft tissue changes are already present.
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Prolotherapy injections can be used after degenerative disc disease
and instability has formed in lumbar canal stenosis.By correcting the
instability of the lumbar spine at an early stage .
Surgery for lumbar canal stenosis is performed only when patient
has reached the state of disability i.e. patient is unable to carry out his day
to day activities due to pain. Limited operative decompression with
retention of stabilizing elements may decrease short term morbidity but
lead to long term failure due to recurrent stenosis or development of
stenosis at an adjacent level. Decompression of the stenotic lumbar canal
along with fusion is definitely better than decompression alone, specially
so in patients having degenerative lumbar spinal stenosis with
Spondylolisthesis or Degenerative scoliosis. Pedicle instrumentation
after laminectomy provides segmental fixation, improves the rate of
fusion and avoids the need to extend fusion to adjacent normal
levels.Recently minimally invasive surgery is providing relief of
symptoms and better results with less complications.