Talk:Lumbar spinal stenosis

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This article was the subject of a Wiki Education Foundation-supported course assignment, between 6 September 2018 and 13 December 2018. Further details are available on the course page. Student editor(s): Apocalyssa, 12teej. Peer reviewers: Martin Lawson.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 02:58, 17 January 2022 (UTC)

Question

Should this page be merged or linked to spinal cord compression ?

suggested template for Orthopaedic Conditions

I have been going through the list of orthopaedic conditions listed as stubs and suggesting this template for Orthopaedic Conditions (see Talk:Orthopedic surgery)
Name
Definition
Synonyms
Incidence
Pathogenesis and predisposing factors
Pathology
Stages
Classification
Natural History/Untreated Prognosis
Clinical Features
Investigation
Non-Operative Treatment
Risks of Non-Operative Treatment
Prognosis following Non-Operative Treatment
Operative Treatment (Note that each operations should have its own wiki entry)
Risks of Operative Treatment
Prognosis Post Operation
Complications
Management
Prevention
History
--Mylesclough 06:31, 8 October 2005 (UTC)

Surgery

Trial out today showed that surgery is better in many settings. JFW | T@lk 06:57, 21 February 2008 (UTC)

Thank you so much for this! — Preceding unsigned comment added by 99.102.94.76 (talk) 04:45, 27 June 2012 (UTC)

The Fluorosis Connection to Spinal Stenosis

Fluorosis, or an excess of fluoride in the body can calcify spinal ligaments, which will compress and shorten the spine - http://www.myspinedoctors.com/conditions.aspx?srv=spinal_stenosis

There are a few conditions that cause spinal stenosis that are neither congenital nor the result of aging. Tumors--- can invade any of the spinal spaces and compress nerves. Paget’s Disease--- is a bone disorder that causes the vertebrae to thicken, obstructing the openings. Fluorosis--- or excessive exposure to fluoride, causes calcification of the ligaments around the spinal openings. The posterior longitudinal ligament, which runs down the back behind the spinal cord, may turn to bone and put pressure on nerves. - http://www.stenosisadvisor.com/spinal-stenosis-causes

Spinal Stenosis. Sciatica can also be caused by pressure on the nerve due to a narrowing of the spinal canal. There are several possible conditions that lead to spinal stenosis: Fluorosis--- Fluorosis is an excessive level of fluoride in the body. It may result from chronicinhalation of industrial dusts or gases contaminated with fluorides, prolonged ingestion of water containing large amounts of fluorides, or accidental ingestion of fluoride-containing insecticides. The condition may lead to calcified spinal ligaments or softened bones and to degenerative conditions like spinal stenosis. - http://www.stenosisadvisor.com/what-is-sciatica-and-what-causes-it

Concerns about fluoride use Nov 11, 2007 Symptoms of chronic end-stage poisoning may include sleep disturbance, mitral valve prolapse, cognitive difficulties, muscle pain/stiffness and spinal stenosis. Non-water sources include food contaminated with herbicides, pesticides, phosphate fertilizers, vehicle emissions, industrial wastes and Scotchgard. (La Crosse Tribune, WI) - http://health.surfwax.com/files/Spinal_Stenosis.html

Causes A lot of things can cause spinal stenosis. Some of them are: Congenital spinal stenosis--- you are born with it Scoliosis--- or other progressive inherited conditions that narrow the spinal openings Injury--- that results in a slipped disc, vertebral fractures or other trauma to the vertebral column Medical conditions--- such as Paget's disease [and Fluorosis], where abnormal bone metabolism causes deformity of the vertebrae. Toxins--- particularly excessive exposure to fluoride in insecticides, which causes abnormal bone growth. Degenerative diseases--- such as arthritis, that are part of the aging process - http://www.back-ache.org/a173687-what-is-spinal-stenosis.cfm

Fluorosis - An excessive level of fluoride in the body. It may result from chronic inhalation of industrial dusts or gases contaminated with fluorides, prolonged ingestion of water containing large amounts of fluorides, or accidental ingestion of fluoride-containing insecticides. The condition may lead to calcified spinal ligaments or softened bones and to degenerative conditions like spinal stenosis. - http://www.drjarmain.com/SpineConditions.asp?typ=spinalstenosis

Bone sampling can be done in special cases to measure long-term exposure to fluorides. - http://www.atsdr.cdc.gov/tfacts11.html

There is no way, short of taking a bone sample, to unequivocally determine one's cumulative exposure to fluoride. It isn't possible to remove fluoride from the body as can be done for lead and other heavy metals. But "if you stop exposure, it will very gradually come out of the bone," committee member Thomas Webster of Boston University said. - http://www.fluoridealert.org/health/epa/nrc/wsj.html

- http://balancingcenter.com/articles/fluoride.html

It is reasonable that 99% of the fluoride in humans resides in bone and the whole body half-life, once in bone, is approximately 20 years (see Chapter 3 for more discussion of pharmacokinetic models) -http://books.nap.edu/openbook.php?record_id=11571&page=133 —Preceding unsigned comment added by 138.163.106.71 (talk) 17:25, 2 June 2009 (UTC)

RCE article

The Rational Clinical Examination has covered lumbar stenosis: JAMA. JFW | T@lk 08:59, 15 December 2010 (UTC)

Case report on a single individual-- we need secondary reviews. SandyGeorgia (Talk) 09:52, 25 December 2010 (UTC)

Non-surgical intervention

This is a fine, well-developed, and well-cited article, but it could do a better job of distinguishing cervical vs lumbal spinal stenosis and mentioning non-surgical interventions, discussed:

• Mayo treatment and drugs
• Mayo lifestyle and home remedies
• Medline
• WebMD
• NIH

Most of the PubMed literature I could find focuses on surgical intervention, as does this article, but other interventions might be better covered.

Also, the citations are not complete, journal titles are missing, as are PMIDs, making it hard to find most of the sources in PubMed.[1] The citations also use ibid, which is not used on Wiki and should be replaced with named refs,[2] and the article should rely mostly on secondary review articles rather than primary sources. I've left a talk page not for A E Francis (talk · contribs) about completing the missing citation info using the Diberri PMID template filler, and have converted all of the ibids and repeat citations to named refs.

PMID 17212913 is a review article that could be more heavily used to discuss non-surgical interventions and lower the use of primary sources in the article, per WP:MEDRS; of the first seven citations I completed, only one is a secondary review, and the others are case studies or reports. As I work through the citations, I will list the secondary reviews that are in the article and can be used to replace primary sources. SandyGeorgia (Talk) 15:39, 24 December 2010 (UTC)

Upon closer examination, I'm finding significant amounts of plagiarism and copyvio,[3] and an extreme overreliance on primary sources and lack of secondary reviews. Additionally, multiple citations are tagged on to the end of long paragraphs, making it difficult to determine what text was taken from what source, and since most of them are primary studies, suggesting synthesis or original research. SandyGeorgia (Talk) 06:09, 25 December 2010 (UTC)

Secondary review articles used

• Englund J (2007). "Lumbar spinal stenosis". Curr Sports Med Rep. 6 (1): 50–5. PMID 17212913. {{cite journal}}: Unknown parameter |month= ignored (help)
• Arce CA, Dohrmann GJ (1985). "Herniated thoracic disks". Neurol Clin. 3 (2): 383–92. PMID 3894922. {{cite journal}}: Unknown parameter |month= ignored (help) (1985, very old)

Secondary, free full text, review articles available but not used

• Manchikanti L, Boswell MV, Datta S; et al. (2009). "Comprehensive review of therapeutic interventions in managing chronic spinal pain" (PDF). Pain Physician. 12 (4): E123–98. PMID 19668281. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

Another problem

Sample only, found throughout the article:

• Post-operative infection in the site of the dural canal is relatively infrequent, reported in the surgical literature to be 1% to less than 12%.[113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128]

This kind of statement needs only to be sourced to one review, but in order to determine if any of those sources are reviews, I have to look up and complete each citation in PubMed! SandyGeorgia (Talk) 07:01, 25 December 2010 (UTC)

Another example (they are everywhere):

• Despite this, MRI remains the best method of diagnosing and evaluating spinal stenosis of all areas of the spine, including cervical, thoracic and lumbar. Newer enhanced MRI techniques have been recently introduced which lead to improved visualization of cervical spondylotic myelopathy (degenerative arthritis of the cervical spine with associated damage to the spinal cord).[28][29][30][31][32][33][34][35][36]

This kind of statement should be sourced to one secondary review, not multiple primary sources; what we have here is original research (pending verification of those citations, which would be much easier if they had included PMIDs). SandyGeorgia (Talk) 07:29, 25 December 2010 (UTC)

More of same:

• Recent studies have shown that tobacco smokers will routinely fail all spinal surgery, if the goal of that surgery is the decrease of pain and impairment. Many surgeons consider smoking to be an absolute contraindication to spinal surgery.[10][131][132][133][134][135][136]

• Nicotine appears to interfere with bone metabolism through induced calcitonin resistance and decreased osteoblastic function. It may also restrict small blood vessel diameter, leading to increased scar formation.[137][131][132][133][134][135][136][138]

• Most failed back syndrome patients who have had two or more surgeries will become chronic pain patients, addicted or habituated to strong narcotics, unemployed and experiencing a limited social existence.[139][140][131][141][142]

Ugh; locating PMIDs and completing all of these citations is unnecessary work; they should all be replaced with one citation to a secondary review. SandyGeorgia (Talk) 07:31, 25 December 2010 (UTC)

Additional problem: multiple citations at end of paras

Multiple citations at the end of paragraphs make it difficult to determine what text is taken from what source (and VERY old sources are used here; the article should be rewritten to current secondary reviews). SandyGeorgia (Talk) 08:32, 25 December 2010 (UTC)

Also, incorrect author names

I am finding incorrect author names throughout, which is making it harder to locate sources: one sample only; also here, Simeone and here, Szapalski. SandyGeorgia (Talk) 09:34, 25 December 2010 (UTC)

Rewrite

Agree to improve this article it needs some major reworking. Should probably be a disambig to Cervical spinal stenosis and Lumbar spinal stenosis as they are very different conditions and this page confuses the issue. Doc James (talk · contribs · email) 14:26, 25 December 2010 (UTC)

Have rewrote the treatment section based on recent review articles.Doc James (talk · contribs · email) 14:56, 25 December 2010 (UTC)

That is most helpful-- thank you for pitching in! At times like this, I wish I had journal access :) The distinction between lumbar and cervical spinal stenosis is what initially brought me to this article, but looking up and locating all of those citations is turning into quite a chore ... are you able to replace any of those very long strings of multiple primary sources, still in the article, with review sources, so I will have less citations to look up? I'll continue completing citations later. And the image layout is much improved! Best, SandyGeorgia (Talk) 16:07, 25 December 2010 (UTC)

Verbiest

This is a historical paper in which the Dutch neurosurgeon Verbiest made some vital observations. I'm as yet unsure as to whether the actually described the condition.

Verbiest H (1954). "A radicular syndrome from developmental narrowing of the lumbar vertebral canal" (PDF). J Bone Joint Surg Br. 36-B (2): 230–7. PMID 13163105. {{cite journal}}: Unknown parameter |month= ignored (help)

Should probably be included. JFW | T@lk 00:35, 26 December 2010 (UTC)

I now have two recent (2010) reviews, which do specifically mention Verbiest's contributions and his 1954 publication ...

• Genevay S, Atlas SJ (2010). "Lumbar spinal stenosis". Best Pract Res Clin Rheumatol. 24 (2): 253–65. doi:10.1016/j.berh.2009.11.001. PMID 20227646. {{cite journal}}: Unknown parameter |month= ignored (help)
• Djurasovic M, Glassman SD, Carreon LY, Dimar JR (2010). "Contemporary management of symptomatic lumbar spinal stenosis". Orthop. Clin. North Am. 41 (2): 183–91. doi:10.1016/j.ocl.2009.12.003. PMID 20399357. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

I'll work them in as soon as I find a moment, unless Doc James gets to it first. SandyGeorgia (Talk) 01:40, 26 December 2010 (UTC)

I've added a "History" section, mostly direct quotes since my prose is poor; if someone wants to rewrite it, that would be good! SandyGeorgia (Talk) 14:24, 26 December 2010 (UTC)

What establishes the diagnosis

Article seems to contradict itself. In one place it says

"The definitive diagnosis is established by either CT (computerized tomography) or MRI scanning. Identifying the presence of a narrowed canal makes the diagnosis of spinal stenosis.[14][15][16]", 

elsewhere it says

"...diagnosis of spinal stenosis which is based on clinical findings of radiculopathy, neurogenic claudication, weakness, bowel and bladder dysfunction, spasticity, motor weakness, hyperreflexia and muscular atrophy. These findings, taken from the history and physical examination of the patient (along with the anatomic demonstration of stenosis with an MRI or CT scan), establish the diagnosis.[24]"

Is one out of date ? - Rod57 (talk) 10:15, 18 January 2016 (UTC)

No spinal cord in the lumbar spine

SandyGeorgia and Doc James, I have removed "the spinal cord" from the intro paragraph, This is because: there is no spinal cord in the lumbar spine. Refer to https://www.ncbi.nlm.nih.gov/books/NBK11160/ (Figure 1.10A) shows the spinal cord ending at T12, this is the textbook picture from the NIH. Magihudson (talk) 05:22, 18 December 2017 (UTC)

I am actually surprised to see that how long this information has been there on the page. Can you check and validate this info.Magihudson (talk) 05:24, 18 December 2017 (UTC)

User:Magihudson It is somewhat variable per Conus_medullaris.

The book is NOT from the NIH but simple hosted by the NIH. And the picture shows it down at L1. Doc James (talk · contribs · email) 15:36, 18 December 2017 (UTC)

The spinal cord usually ends at T12 or L1, therefore almost all lumbar epidural injections are done where there is no spinal cord, that would be very accurate. I will find a better source for it. Magihudson (talk) 04:58, 19 December 2017 (UTC)

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