Thoracic spinal canal stenosis

Restricted access

✓ Hypertrophy of the posterior spinal elements leading to compromise of the spinal canal and its neural elements is a well-recognized pathological entity affecting the lumbar or cervical spine. Such stenosis of the thoracic spine in the absence of a generalized rheumatological, metabolic, or orthopedic disorder, or a history of trauma is generally considered to be rare. Over a 2-year period the authors have treated six cases of thoracic myelopathy associated with thoracic canal stenosis. In four patients the deficits developed gradually and painlessly. The three older patients had a clinical profile characterized by complaints of pseudoclaudication, spastic lower limbs, and evidence of posterior column dysfunction. Two patients were younger adults with low thoracic myelopathy associated with local back pain after minor trauma. Both patients also had congenital narrowing of the thoracic spinal canal.

Oil and metrizamide contrast myelography in the prone position were of limited value in diagnosing this condition; in fact, myelography may be misleading and result in erroneous diagnosis of thoracic disc protrusion, when the principal problem is dorsal and lateral compression from hypertrophied facets. Magnetic resonance imaging and computerized tomography sector scanning were more useful in the diagnosis of this disorder than was myelography. Thoracic canal stenosis may be more common than is currently recognized and account for a portion of the failures in anterior and lateral decompression of thoracic disc herniations.

Article Information

Address reprint requests to: Russell W. Hardy, Jr., M.D., Center for the Spine, Department of Neurological Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44106.

Address for Dr. Sypert: Department of Neurological Surgery, University of Florida Health Center, Gainesville, Florida.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Prone lateral (left) and anteroposterior (right) Pantopaque myelograms in Case 1. These were interpreted as demonstrating a small thoracic disc protrusion at T10–11. In retrospect, posterior obliteration of the dye column is suggested.

  • View in gallery

    Radiographic studies in Case 1. Left: True sagittal magnetic resonance image of the thoracolumbar area of Case 1. The T10–11 level is denoted by the arrow. There is no identifiable posterior defect, although an incidental hemangioma is present at T-12 (arrow). Right: Computerized tomography sector scan demonstrating a narrowed canal at T10–11 due to hypertrophy of posterior elements. Arrow indicates an incidental retained droplet of Pantopaque.

  • View in gallery

    Radiographic studies in Case 2. Left: Lateral metrizamide myelogram, with a lack of filling in the area of compression making it difficult to define the cause of compression. Right: Computerized tomography sector scan of the same area showing hypertrophy of the posterior elements. The compression is due to stenosis and not to a thoracic disc protrusion. (It should be noted that this patient has never had oil myelography.)

  • View in gallery

    Parasagittal T1-weighted magnetic resonance image of Case 3 showing posterior obliteration of an epidural fat signal (arrow) by a hypertrophied facet.

  • View in gallery

    Parasagittal T2-weighted magnetic resonance image of Case 4 showing thoracic cord compression (arrow) principally due to hypertrophy of the posterior elements, although a small anterior defect is also present.

References

  • 1.

    Alexander E Jr: Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. Part 5: Achondroplasia. J Neurosurg 31:5135191969Alexander E Jr: Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. Part 5: Achondroplasia. J Neurosurg 31:513–519 1969

  • 2.

    Assmann HBesel R: [Unusual course of an osseous stenosis of the thoracic spinal canal.] Zentralbl Chir 107:867872 (Ger)Assmann H Besel R: [Unusual course of an osseous stenosis of the thoracic spinal canal.] Zentralbl Chir 107:867–872 (Ger)

  • 3.

    Carson JGumpert JJefferson A: Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 34:68771971Carson J Gumpert J Jefferson A: Diagnosis and treatment of thoracic intervertebral disc protrusions. J Neurol Neurosurg Psychiatry 34:68–77 1971

  • 4.

    Epstein BS: The Spine: A Radiological Text and Atlased 4. Philadelphia: Lea & Febiger1976 pp 234235Epstein BS: The Spine: A Radiological Text and Atlas ed 4. Philadelphia: Lea & Febiger 1976 pp 234–235

  • 5.

    Epstein JAEpstein BSLavine LSet al: Cervical myeloradiculopathy caused by arthrotic hypertrophy of the posterior facets and laminae. J Neurosurg 49:3873921978Epstein JA Epstein BS Lavine LS et al: Cervical myeloradiculopathy caused by arthrotic hypertrophy of the posterior facets and laminae. J Neurosurg 49:387–392 1978

  • 6.

    Goldthwait JE: The lumbo-sacral articulation. An explanation of many cases of “lumbago,” “sciatica” and paraplegia. Boston Med Surg J 164:3653721911Goldthwait JE: The lumbo-sacral articulation. An explanation of many cases of “lumbago” “sciatica” and paraplegia. Boston Med Surg J 164:365–372 1911

  • 7.

    Govoni AF: Developmental stenosis of a thoracic vertebra resulting in narrowing of the spinal canal. AJR 112:4014041971Govoni AF: Developmental stenosis of a thoracic vertebra resulting in narrowing of the spinal canal. AJR 112:401–404 1971

  • 8.

    Kodama TOkubo KMatsukado Y: Myelopathy due to ossified ligamenta flava in the lower thoracic spine. Neurosurgery 6:4694701980 (Abstract)Kodama T Okubo K Matsukado Y: Myelopathy due to ossified ligamenta flava in the lower thoracic spine. Neurosurgery 6:469–470 1980 (Abstract)

  • 9.

    Lonstein JMoe JWinter Ret al: Spinal deformity and cord compression. J Bone Joint Surg (Am) 56:13041974(Abstract)Lonstein J Moe J Winter R et al: Spinal deformity and cord compression. J Bone Joint Surg (Am) 56:1304 1974 (Abstract)

  • 10.

    Love JGSchorn VG: Thoracic-disk protrusions. JAMA 191:6276311965Love JG Schorn VG: Thoracic-disk protrusions. JAMA 191:627–631 1965

  • 11.

    Marzluff JMHungerford GDKempe LGet al: Thoracic myelopathy caused by osteophytes of the articular processes. Thoracic spondylosis. J Neurosurg 50:7797831979Marzluff JM Hungerford GD Kempe LG et al: Thoracic myelopathy caused by osteophytes of the articular processes. Thoracic spondylosis. J Neurosurg 50:779–783 1979

  • 12.

    O'Connell JEA: Involvement of the spinal cord by intervertebral disk protrusions. Br J Surg 43:2252471955O'Connell JEA: Involvement of the spinal cord by intervertebral disk protrusions. Br J Surg 43:225–247 1955

  • 13.

    Parfitt AMDuncan H: Metabolic bone disease affecting the spine in Rothman RHSimeone FA (eds): The Spineed 2. Philadelphia: WB Saunders1982 pp 856867880–886 889–890Parfitt AM Duncan H: Metabolic bone disease affecting the spine in Rothman RH Simeone FA (eds): The Spine ed 2. Philadelphia: WB Saunders 1982 pp 856–867 880–886 889–890

  • 14.

    Payne EESpillane JD: The cervical spine. An anatomicopathological study of 70 specimens (using a special technique) with particular reference to the problems of cervical spondylosis. Brain 80:5715961957Payne EE Spillane JD: The cervical spine. An anatomicopathological study of 70 specimens (using a special technique) with particular reference to the problems of cervical spondylosis. Brain 80:571–596 1957

  • 15.

    Pennal GFSchatzker J: Stenosis of the lumbar spinal canal. Clin Neurosurg 18:861051971Pennal GF Schatzker J: Stenosis of the lumbar spinal canal. Clin Neurosurg 18:86–105 1971

  • 16.

    Sachs BFraenkel J: Progressive ankylotic rigidity of the spine (spondylose rhizomélique). J Nerv Ment Dis 27:1151900Sachs B Fraenkel J: Progressive ankylotic rigidity of the spine (spondylose rhizomélique). J Nerv Ment Dis 27:1–15 1900

  • 17.

    Verbiest H: Further experiences on the pathological influence of a developmental narrowness of the bony lumbar vertebral canal. J Bone Joint Surg (Br) 37:5765831955Verbiest H: Further experiences on the pathological influence of a developmental narrowness of the bony lumbar vertebral canal. J Bone Joint Surg (Br) 37:576–583 1955

  • 18.

    Verbiest H: A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg (Br) 36:2302371954Verbiest H: A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg (Br) 36:230–237 1954

  • 19.

    White AAPanjabi MM: The basic kinematics of the human spine. A review of past and current knowledge. Spine 3:12201978White AA Panjabi MM: The basic kinematics of the human spine. A review of past and current knowledge. Spine 3:12–20 1978

  • 20.

    Wilkinson M: Historical introduction in Wilkinson M (ed): Cervical Spondylosis. Its Early Diagnosis and Treatmented 2. Philadelphia: WB Saunders1971 pp 19(see p 2)Wilkinson M: Historical introduction in Wilkinson M (ed): Cervical Spondylosis. Its Early Diagnosis and Treatment ed 2. Philadelphia: WB Saunders 1971 pp 1–9 (see p 2)

  • 21.

    Wilson CBEhni GGrollmus J: Neurogenic intermittent claudication. Clin Neurosurg 18:62851971Wilson CB Ehni G Grollmus J: Neurogenic intermittent claudication. Clin Neurosurg 18:62–85 1971

  • 22.

    Xu ST: [Degenerative thoracic spinal stenosis.] Chung Hua Wai Ko Tsa Chih 20:7477491982 (Chi)Xu ST: [Degenerative thoracic spinal stenosis.] Chung Hua Wai Ko Tsa Chih 20:747–749 1982 (Chi)

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 234 234 43
Full Text Views 295 295 2
PDF Downloads 193 193 2
EPUB Downloads 0 0 0

PubMed

Google Scholar