Lumbar spine stenosis: a common cause of back and leg pain

L3-L5レベルの解剖；

FIGURE 1.

Normal anatomic structures of the lumbar spine at the third through the fifth lumbar levels. Note the close association between the nerve roots and the dural tube, and the ligamentum flavum, the facet joints, the pedicles and the lamina. The ligamentum flavum (inter-laminar ligament) attaches laterally to the facet capsules.

馬尾神経；

L1-L2から馬尾神経がある

FIGURE 3.

Posterior view of the lumbar region of the spinal canal, demonstrating the conus medullaris at the L1 to L2 level and the cauda equina nerve roots inferiorly.

病歴；

やや男性優位

中年・高齢＞若年

初期症状は腰痛で見逃されることが多い

その後、足の疲労・痛み・しびれ・脱力感、ときに背中の痛み

下肢症状：両側性＞片側性、臀部や大腿部を含む

症状の重症度と腰部脊柱管狭窄症の程度は相関しない

歩行や起立で悪化、座位や横になると緩和

前屈位で緩和

自転車は問題なし

馬尾神経障害では尿失禁なども起こる

神経性対血管性の間欠性跛行；

TABLE 1

Clinical Differentiation Between Neurogenic and Vascular Claudication

CLINICAL CHARACTERISTICS	NEUROGENIC CLAUDICATION	VASCULAR CLAUDICATION
Location of pain	Thighs, calves, back and, rarely, buttocks	Buttocks or calves
Quality of pain	Burning, cramping	Cramping
Aggravating factors	Erect posture, ambulation, extension of the spine	Any leg exercise
Relieving factors	Squatting, bending forward, sitting	Rest
Leg pulses and blood pressure	Usually normal	Blood pressure decreased; pulses decreased or absent; bruits or murmurs may be present
Skin/trophic changes	Usually absent	Often present (pallor, cyanosis, nail dystrophy)
Autonomic changes	Bladder incontinence (rare)	Impotence may coexist with other symptoms of vascular claudication