Analysis of cauda equina compression in lumobar spinal stenosis

硬膜外压力测量的研究清楚地表明，椎管狭窄患者狭窄水平的局部硬膜外压力会因运动而改变。卧位和坐位的压力较低，而站立位的压力较高。特别是，压力增加腰椎伸展，但减少前屈。硬膜外压力的变化与神经根受压临床症状的发生有关。这些压力变化可以解释椎管狭窄症症状的姿势依赖性。神经源性间歇性跛行患者行走时硬膜外压力也发生了变化。硬膜外压力的变化有一个模式的增加和减少，这种模式是重复在步行。单纯行走时硬膜外压高，而腰屈行走时硬膜外压低。步行时对神经根的间歇性压迫可能在神经源性间歇性跛行的发病机制中起重要作用。G.背部肌肉力量练习。结论：腰椎管狭窄症患者的静态压力低于腰椎间盘突出症患者。腰椎运动的动态压迫对腰椎管狭窄症的病理生理学有重要意义

The study of epidural pressure measurements clearly demonstrated that the local extradural pressure at the stenotic level was changed by motion in patients with spinal stenosis. The pressure was low in lying and sitting, and high in standing. Especially, the pressure was increased by lumbar extension, but decreased by forward flexion. Changes of the epidural pressure correlated with the occurence of clinical symptoms of nerve roots compression. These pressure changes may explain the postural dependency of symptoms in spinal stenosisThe epidural pressure was also changed at walking in patients with neurogenic intermittent claudication. The epidural pressure change had a pattern of increase and decrease, and this pattern was repeated during walking. The epidural pressure was high at simple walking and low at walking with lumbar flexion. Intermittent compression to the nerve roots during walking might have a important role in the pathogenesis of neurogenic intermittent claudicationThe pressure was extremely increased by trunk muscle exercises e. g. back muscle strength exercise. This result imply that back muscle exercise might be dangerous for patients with lumbar spinal stenosisIn conclusion, static compression in lumbar spinal stenosis is low compared to lumbar disc herniation. Dynamic compression by lumbar motion would be important for the pathophysiology of lumbar spinal stenosis