Spinal stenosis NHS pdf

Self help for Spinal Stenosis - mcht

Spinal stenosis (or narrowing) is a common condition that occurs when the small spinal canal that contains the nerve roots and spinal cord becomes restricted. This narrowing can squeeze the nerves and the spinal cord causing lower back and leg pain. In general, spinal narrowing is caused by osteoarthritis, or 'wear and tear' arthritis, of. Stenosis means narrowing of the canal (canal stenosis) and/or the (holes on the side) where the nerves exit (foraminal stenosis). Spinal cord Figure 1 Normal spinal canal viewed from A) above and B) from the side. There are 2 main causes for spinal stenosis. 1) Some people are born with narrow spinal canals or foraminal spaces The spinal nerves are like electrical wiring, providing signals to areas within the leg. These control sensation and movement but can cause pain when they are affected. References Schulte, T. L. et al. Lumbar spinal stenosis. Orthopade. [German] 35, 675-692 (2006) Johnsson, K. e., rosén, i. & Udén, A. The natural course of lumbar spinal. @WiltsHC_NHS Wiltshire Health and Care www.wiltshirehealthandcare.nhs.uk Date of last review: September 2020 Document Ref: 301244 Printed on 04/09/2020 at 9:15 AM Lumbar Spinal Stenosis What is lumbar spinal stenosis? Spinal stenosis is a term used to describe a narrowing of the spinal canal that gives rise to low back and leg pain

Management of lumbar spinal stenosis The BM

  1. Spinal stenosis is a common condition affecting the lower back. It affects people over the age of 60 years. Spinal stenosis can result in symptoms including back pain, buttock pain and leg pain. Other symptoms include pins and needles, numbness and sometimes weakness in th
  2. Stenosis in the spine is the narrow-ing of the bony canal that surrounds the nerves. It may result from trauma or as a normal part of aging. When the narrowing happens in the lower part of your back, it is called lumbar stenosis. This may put pressure on the nerves and can cause pain, numbness, or weakness in your buttocks, legs, or feet
  3. Spinal Exercises Information for patients Clinical Support Services - Physiotherapy Exercise has been shown to help with low back pain however it often takes time to take effect. It is important to be patient and persevere with the exercises. They have been selected to help to improve your core stability, spinal control and flexibility
  4. Spivak, JM Degenerative Lumbar Spinal Stenosis in JBJS, Vol 80, No. 7, July, 1998, p 1060. 5. Simotas, AC Nonoperative Treatment of Lumbar Spinal Stenosis. Clin Ortho 384, March, 2001,p155-156. 6. Sengupta DK, Herkowitz HN. Lumbar Spinal Stenosis- Treatment Strategies and Indications for Surgery Ortho . Clin N Am 34(2003), p282
  5. PAPT-$Lumbar$Spinal$Stenosis$3$ $)) Table1:)PAPTSampleLumbar)Spinal)Stenosis)Treatment)Options) Modalities) Manual)Therapy) Therapeutic)Exercises) Neuromuscular)Re
  6. @WiltsHC_NHS Wiltshire Health and Care www.wiltshirehealthandcare.nhs.uk Date of last review: 23/04/2020 Document Ref: 301254 Printed on 07/05/2020 at 8:45 AM Cervical Stenosis and Myelopathy What are cervical stenosis and myelopathy? Cervical stenosis is narrowing of the canal in your neck which contains the spinal cord

Lumbar spinal stenosis (LSS) affects more than 200 000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and. Lumbar spinal stenosis symptoms can include pain, aching, cramping, burning, tingling like pins and needles, numbness and or a heaviness feeling into one or both legs. Some people may feel weaker in their leg and feet muscles, and some may have low back pain as well as leg symptoms nerve root and spinal cord passes through. In cervical stenosis, the spinal cord becomes compressed by arthritic joint swelling and bony overgrowths (osteophytes) or bulging of the intervertebral discs that narrow the spinal canal. This pressure can damage the spinal cord (myelopathy). Rarer causes include cysts or tumours in the spinal canal Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck. Some people with spinal stenosis may not have symptoms. Others may experience pain, tingling, numbness and muscle weakness This is a common reason for having spinal surgery. It is wear and tear of your spine that causes one or more of your spinal nerves to become trapped. Symptoms of a trapped spinal nerve include: • sciatica • leg or foot pain • pins and needles • numbness. Sometimes you have back pain in one specific part of your spine and you may need.

Lumbar Spinal Stenosis - abuhb

Lumbar spinal stenosis is a condition where the spinal canal (central stenosis) or one or more of the lumbar vertebral foramina (foraminal/lateral stenosis) becomes narrowed. If the narrowing is substantial, it can cause compression of the spinal cord or spinal nerves Lumbar spinal stenosis is a condition defined as the narrowing of the bone canal (vertebral foramen) where the spinal nerves and spinal cord pass through the spine. When this narrowing occurs, the spinal nerves and cord are compressed adding pressure which may cause pain and/or nerve damage. Advanced degenerative disc disease (DDD) may cause. Spinal Stenosis. Spinal stenosis is the narrowing of the space in the spinal canal which can put pressure on the spinal cord and nerves that travel through the spine. Lumbar stenosis occurs in the lower back, while cervical stenosis occurs in the neck. We can't predict who will be affected by spinal stenosis apart from, as it is due to ageing. Once your spinal stenosis symptoms are under control, you can start to incorporate aerobic exercise into your routine. Walking is always a good idea for people with back pain. If your symptoms prevent you from walking any distance, you may want to consider bicycle riding to help improve your cardio-respiratory fitness level

Spinal Stenosis Exercises. To get the best out of your daily routine, incorporate the following exercises. The muscles need to continuously be stretched and strengthened. Damage and injury to the spine commonly occurs with poor posture and a sedentary lifestyle. Regular exercises cannot affect the core muscles deep within the body Spinal Stenosis Exercises and Activities to Do More Of. Spinal stenosis is a serious spinal condition that requires a medical diagnosis and a course of treatment. But when that course of treatment permits the use of physical therapy and exercise as a preferred alternative tso something potentially more invasive, there are many options available. Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with bending forwards. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction Lumbar Spinal stenosis can be caused in 2 ways: 1. Acquired Spinal Stenosis - This is a narrowing of the spinal canal due to disc protrusions or bony changes often due to age that take place over time in the low back. 2. Congenital Stenosis - Some people are born with a small spinal canal. The risk of developing lumbar spinal stenosis. approximately 4 to 6 weeks and spinal stenosis 8 - 12 weeks. Preferably try and arrange things such that you do mornings only for the first 2 - 3 weeks back at work. COMPLICATIONS OF SPINAL OPERATIONS Any operation has potential complications whether it is a minor or major procedure. The major procedures do have higher chances of complications

Spinal stenosis - Symptoms and causes - Mayo Clini

Surgery may certainly be needed for some people with lumbar spinal stenosis, and when the condition reaches that point the benefits usually outweigh risks. But before your spinal stenosis reaches that point, if it ever does, stop worrying about surgery and engage in an active program to treat your spinal stenosis Evidence-based information on spinal stenosis in Systematic Reviews or Evidence Summaries from hundreds of trustworthy sources for health and social care. Add filter for NHS Economic Evaluation Database - NHS EED (20 (PDF) Source: Academy of Medical Royal Colleges.

Spinal Stenosis and the Treatment - NHS6

spinal cord causing leakage of spinal fluid (CSF). This is not serious but it can cause a dull headache for up to a week and you will need to lie flat for at least three days after the treatment. The local anaesthetic will keep you pain-free for a while, Spinal nerve injury (affects around one out o Effectiveness of calcitonin in intermittent claudication treatment of patients with lumbar spinal stenosis : a systematic review. Published by Lippincott Williams and Wilkins, 15 October 2009. The link will take you to an abstract of the article. NHS staff wishing to obtain a copy of the full text should contact their health care library Spinal stenosis is a condition where the space around the spinal cord (the spinal column) narrows, compressing a section of nerve tissue. The main symptoms of spinal stenosis are pain, numbness, weakness and a tingling sensation in one or both legs. This can make walking difficult and painful. Most cases of spinal stenosis occur in people aged.

The lumbar spine (lower back) consists of five vertebrae in the lower part of the spine, between the ribs and the pelvis. Lumbar spinal stenosis is a narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs. While it may affect younger patients, due to developmental causes, it is more often a degenerative condition that affects people who are. pain that's getting much worse. lack of co-ordination - for example trouble with tasks like buttoning a shirt. heaviness or weakness in your arms or legs. pins and needles in an arm as well as pain. problems walking. loss of bladder or bowel control. These can be signs of a more severe condition (cervical myelopathy), which can cause. spinal cord stops at the top of the lumbar spine (low back) and below that tiny nerve rootlets splay out like a horse's tail (cauda equina). The spinal cord, nerve roots and cauda equina are protected by a tough outer membrane, or covering, called the dura mater. In spinal stenosis, the spinal nerve roots and / or caud

Spinal Stenosis Symptoms and Treatment Lumbar Spinal

A spinal cord stimulator can only treat certain types of pain. The National Institute for Health and Care Excellence (NICE) is the organisation responsible for recommending which treatments are used by the NHS. NICE recommends spinal cord stimulation for the following diagnosed conditions what a spinal anaesthetic is how it works why you could benefit from having one for your operation. What is a 'spinal'? For many operations it is usual for patients to have a general anaesthetic. However, for operations in the lower part of the body, sometimes it is often possible for you to have a spinal anaesthetic instead Individual patient assessment is crucial, however aortic valve stenosis (and to a lesser degree mitral valve stenosis) are both relative contraindications for spinal blockade due to the rapid cardiovascular changes that occur. Spinal anaesthesia results in a sympathetic blockade and subsequent vasodilatation Agreed at pan-Dorset Spinal Reference Group on 18 July 2012 All tumours, bone and neural Children with spinal problems Paediatric Scoliosis Neck pain with cord compression Thoracic pain with cord or nerve compression Lumbar spine work including: o Lumbar disc disease o Spinal stenosis o Lumbar instabilit Spinal stenosis is more common in people 50 years old or older. Causes. The condition is commonly caused by wear-and-tear on the spine related to osteoarthritis. So, it's more likely to happen as someone ages. But people with other types of arthritis and related conditions that affect the spine may develop spinal stenosis. Younger people with.

Lumbar Spinal Stenosis - Home - NHS Southend CC

Key words: lumbar spinal stenosis, magnetic reso-nance imaging, spine decompression, conservative treat-ment, classification. Spine 2010;35:1919-1924 Lumbar spinal stenosis (LSS) is diagnosed in an ever in-creasing number of patients referred to spinal surgeons for treatment as a result of the availability of magneti Information for people who use NHS services Treating neurogenic claudication caused by lumbar spinal stenosis using a spacer device between the vertebrae This leaflet is about when and how using a spacer device can be used in the NHS to treat people with neurogenic claudication caused by lumbar spinal stenosis Spinal stenosis is a condition in which the spinal column narrows and starts compressing the spinal cord. This process is typically gradual. Learn more about causes, symptoms, and diagnosis Lumbar spinal stenosis can press on the spinal cord and the nerves that travel through the spine. Symptoms include pain or cramping in the legs when standing.. (steroid) around the areas of inflammation in the spinal canal. This is used when nerves in the lower back are inflamed due to irritation from either spinal stenosis (a degenerative narrowing of the spinal canal) or a disc prolapse. In addition to th

spinal cysts This leaflet is about when and how image-guided needle drainage can be used to treat people with spinal cysts in the NHS in England, Wales, Scotland and Northern Ireland. It explains guidance (advice) from NICE (the National Institute for Health and Clinical Excellence) Spinal stenosis occurs when the space around your spinal cord narrows and causes pressure on your nerve roots. The main cause is wear-and-tear arthritis (osteoarthritis).As cartilage wears away. across NHS Lothian will be available in due course. The planned date for the launch of the NHS Lothian integrated low back pain service is Monday 5th October 2015. Please note; NHS Lothian integrated back pain service pathways have been written onto a web based tool- Clinical Knowledge Publisher. Publication is awaiting final sign off Lumbar spinal stenosis causes a constriction of the space for nerves in the lumbar spine. Watch: Lumbar Spinal Stenosis Video. Sciatica Exercises for Spinal Stenosis. Exercises to relieve and treat lumbar spinal stenosis pain are usually flexion-based (forward-bending). This position opens up the constricted bony canals, decompressing the nerve.

Spinal stenosis is a narrowing of the space surrounding your spinal cord and nerve roots, so these exercises are designed to open that space. These 3 gentle stretches promote strength, flexibility, and range of motion throughout your low back—this trifecta helps relieve pressure on your lumbar spinal nerves Lumbar spinal stenosis (LSS) implies spinal canal narrowing with possible subsequent neural compression. Although the disorder often results from acquired degenerative changes (spondylosis), spinal stenosis may also be congenital in nature (see Etiology).In some cases, the patient has acquired degenerative changes that augment a congenitally narrow canal Spinal Stenosis Medications. Spinal stenosis is commonly treated with medication, both over-the-counter and prescription. Nonsteroidal anti-inflammatory drugs reduce pain and inflammation.Examples. Common Causes . Spinal stenosis is typically caused by one or more of the following factors: Spinal osteoarthritis. When the smooth cartilage covering the facet joints (which connect the backs of adjacent vertebrae) start to break down, bones begin to rub against each other and may lead to the formation of abnormal bone growth, called osteophytes or bone spurs Spinal canal stenosis Stenosis of the spinal canal may be diffuse (multi-segmen-tal) or focal (segmental). Stenosis is classified as central, lateral recess or circumferential whetheritis focal or diffuse. Diffuse stenosis is the combined result of multi-segmental thickening of the connective tissues within the bony spinal

Introduction. Lumbar central canal stenosis (LCCS) is defined as the narrowing of the central spinal canal caused by degenerative changes with compression of neural and vascular structures, resulting in various degrees of clinical disability [].As the population ages and average life expectancy increases, the number of patients with symptomatic LCCS has increased [] The additional core strength could help minimize your back pain and leg pain associated with spinal stenosis. If you add walking to this routine, and light weights, there will be improvement to your body. While exercises will not cure your Spinal stenosis, it is a factor you can control. It is a positive action to dealing with the problem

Lumbar Spinal Stenosis Johns Hopkins Medicin

Spinal stenosis - Diagnosis and treatment - Mayo Clinic

15 Spinal Stenosis Exercises You Can Do Anywhere - Pain Docto

An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc. 1996 Mar. 44(3):285-90. . Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE. Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study Spinal stenosis is a narrowing of the spinal canal. It occurs when the bony openings within the spine (foramina) begin to narrow, placing pressure on the nerves traveling throughout the spine. This reduced nerve space can occur within the spinal cord or where the spinal nerves exit the spinal canal

Lumbar Spinal Stenosis - Physiopedi

Lumbar spondylosis refers to degenerative conditions of the lumbar spine that narrow the spinal canal, lateral recesses, and neural foramina. Facet joint and ligamentous hypertrophy, intervertebral disc protrusion, and spondylolisthesis may all contribute to the stenosis, and symptoms result from neural compression of the cauda equina, exiting nerve roots, or both An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain external link opens in a new window Manchikanti L, Falco FJ, Singh V, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part I: introduction and general considerations SPINAL SURGERY REHABILITATION PROTOCOL LUMBAR SPINE When developing a postoperative Physical therapy plan, pathoanatomic abnormalities, surgical procedure, and patient's psycho-physical state should be considered. However, here are some general rehabilitation guidelines with regards to activity and patient education Spinal stenosis most often occurs in adults over 60 years old. Pressure on the nerve roots is equally common in men and women. A small number of people are born with back problems that develop into lumbar spinal stenosis. This is known as congenital spinal stenosis. It occurs most often in men

Lumbar spinal stenosis can be a painful condition. When the spinal cord narrows, it puts pressure on the spinal cord, which often leads to pain, tightness, or numbness down the back or in one leg. This narrowing is sometimes the result of a herniated disc, buckling or inflamed ligaments, bone spurs, or some combination of these factors Spinal Stenosis: This is narrowing of spinal canal through which the spinal nerves pass and therefore pinches one or more nerve root. This could occur as a result of degenerative process or osteophytes (bony outgrowths or ridges) can form at the edges of the vertebrae and may cause narrowing in the spinal canal spinal stenosis, and in post lumbar surgery syndrome (2-5,7,11,51-53). The comparative effectiveness of multiple types of steroids have also been studied (54-56). In addition, utilization of lumbar transforaminal epidural injections has increased 152% for the primary procedure and 218% for subsequent procedures as illustrated from 2002 to 2006. Spinal spondylosis is the non-inflammatory degeneration of the intervertebral disc and vertebral body of the spine. In the literature the term spondylosis can involve several other related conditions including degenerative disc disease (thinning, drying and cracking of discs), spinal stenosis (narrowing of the intervertebral foramen where the.

Spinal Stenosis Local Physi

Spinal Decompression. Spinal decompression is a form of traction therapy we offer here at Back 2 Health. This FDA-approved technology is a proven treatment for many types of back conditions, including spinal stenosis. We offer targeted treatment sessions that provide either cervical or lumbar decompression, depending on your symptoms Oxford Radcliffe Hospitals NHS Trust Oxford OX3 9DU www.oxfordradcliffe.nhs.uk OMI 415.1 If you need an interpreter or need a document in another language, large print, Braille or audio version, please call 01865 221473. When we receive your call we may transfer you to an interpreter. This can take some time, so please be patient A 2017 study in BMC Musculoskeletal Disorders found a strong association between Schmorl's nodes and degenerative spinal stenosis of the lumbar spine. This is a common problem seen in the older population and is the most frequent reason for spinal surgery in persons over 60 years old. The prevalence of lumbar spinal stenosis is about 47% in. Cauda equina syndrome can also be caused by trauma, a spinal tumor, spinal stenosis or a severe infection. In rare cases, spinal stenosis and vertebral fractures from osteoporosis can lead to cauda equina syndrome. Tests and Diagnosis. Cauda equina syndrome is difficult to diagnose. It is rare, and its early symptoms may be similar to symptoms. Lumbar radiculopathy refers to disease involving the lumbar spinal nerve root. This can manifest as pain, numbness, or weakness of the buttock and leg. Sciatica is the term often used by laypeople. Lumbar radiculopathy is typically caused by a compression of the spinal nerve root. This causes pain in the leg rather than in the lumbar spine.

Spinal cord injuries are critical emergencies that must be recognized and treated early to increase the possibility of preventing permanent loss of function.1 The history and clinical presentation. The narrowing of the spinal canal is generally caused by wear and tear and arthritic changes in the lower spine. These changes include bulging discs, thickening of ligaments, and overgrowth of bone spurs, especially at spinal facet joints. Stenosis can compress the nerve roots that control sensation and movement in the lower body. This. Introduction. Neurogenic claudication (NC) is the symptomatic presentation of lumbar spinal stenosis (LSS). Symptoms include intermittent pain, tingling, numbness, weakness, heaviness, or fatigue, radiating into the buttocks and legs; often accompanied by low back pain .NC is commonly triggered or worsened by spinal extension, typically during prolonged standing or walking; and relieved by.

Exercise Program for Spinal Stenosis - Verywell Healt

Overview - StenosisPast and Present, Goals for Today - • Spectrum of Degenerative Lumbar Pathology • Spinal Stenosis • Degenerative spondylolisthesis • Matching procedures with pathology • Defining Value in Management of Spinal Disorders • Evidence-based approach to assessment of new technologie E-mail: paulfettes@nhs.net Although spinal (subarachnoid or intrathecal) anaesthesia is generally regarded as one of the most reliable types of regional block methods, the possibility of failure has long been recognized. Dealing with a spinal anaesthetic which is in some way inadequate can be very difficult; so, th Coming to how long does it take for an individual to recover from surgery for spinal stenosis, the first and the most important thing is to know that the symptoms will not get better overnight or immediately after surgery. On the whole, it will take about 3-6 months for an individual to completely recover from a spinal stenosis surgery and be able to perform all the activities of daily living.

postural spinal changes related to muscle tone, loads on the lumbar spine that increase in a caudal direction rather than being uniform at each spinal level, and the effects of core muscle activation on the spine.10 * Guarantor and correspondent: A. Saifuddin, Department of Radiology, The Royal National Orthopaedic Hospital NHS Trust Dementia with Lewy bodies is a common form of dementia estimated to affect more than 100,000 people in the UK. The term dementia describes a loss of mental ability (cognitive impairment) associated with gradual death of brain cells. It's rare in anyone younger than 65. Symptoms usually develop gradually and become more severe over the course.

The spinal cord lesion is observed between twelfth thoracic and first lumbar vertebrae, similarly cauda equina lesions are observed below second lumbar vertebrae. Spinal stenosis is a degenerative process and occurs gradually over a period of time as a person ages. Causes of spinal stenosis are as follows Spinal stenosis happens when the spaces in the spine narrow and create pressure on the spinal cord and nerve roots. The spinal cord is a bundle of nerves that comes out of the base of the brain and runs down the center of the spine. The nerve roots branch out from the cord. In spinal stenosis, the narrowing usually occurs over time Myelogram patient information leaflet (143.92kB PDF) A myelogram is a diagnostic imaging procedure done by a radiologist. It uses a contrast dye and X-rays or computed tomography (CT) to look for problems in the spinal canal, including the spinal cord, nerve roots, and other tissues. It is also known as myelography

11 Best Exercises for Spinal Stenosis and Exercises to Avoi

  1. Degenerative disc disease describes a group of symptoms that may result from the gradual wear and tear of spinal discs or from an acute spinal injury. If you are looking for help with this condition, request a consultation with one of our orthopaedic spine specialists
  2. Lumbar spinal canal stenosis is not the same as a ruptured disk. A ruptured or herniated disk usually pinches 1 or 2 nerves at a time. The pain caused by a ruptured disk in the lumbar spine is usually easy to diagnose and is known as sciatica. Sciatica usually causes back pain that shoots down one leg along the path of the sciatic nerve
  3. At the foramen magnum, stenosis may result in bulbar dysfunction such as central apneoa, insidious high cervical myelopathy, or even sudden death. Whilst at the thoracolumbar region, symptoms include any combination of spinal pain, spinal claudication, progressive lower limb weakness, or neurogenic sphincter disturbance
  4. Spinal stenosis can cause sciatic pain, and this will require you to perform a series of stretches to alleviate pain. A go-to stretch that works very well is to go into child's pose. PDF Sciatica - cddft.nhs.uk Free cddft.nhs.uk. large print, audio or other languages on request. Remember general exercise is the most helpful way to ease.
  5. Neurogenic claudication is a hallmark symptom of lumbar stenosis, a condition in which the column of the spinal cord or the canals that protect the nerve roots narrows at the lower back. This narrowing can also occur in the spaces between the vertebrae where the nerves leave the spine to travel to other parts of the body
Spine Concepts , Lumbar Spinal Stenosis - Everything YouFull-endoscopic spinal surgery for spinal stenosis; dorsal

Neurogenic claudication (NC), also known as pseudoclaudication, is the most common symptom of lumbar spinal stenosis (LSS) and describes intermittent leg pain from impingement of the nerves emanating from the spinal cord. Neurogenic means that the problem originates within the nervous system. Claudication, from the Latin word for to limp, refers to painful cramping or weakness in the legs Before offering a patient spinal anesthesia, an anesthesiologist not only must be aware of the indications and contraindications of spinal anesthesia but also must be able to weigh the risks and benefits of performing the procedure. This requires a thorough understanding of the available evidence, in particular how the risk-benefit ratio compares to that of any alternative, and an ability to. Myoclonus describes a movement disorder characterised by brief, abrupt and involuntary contractions of muscles or groups of muscles, usually associated with intracranial lesions, with limited evidence linking it to spinal pathologies. The pathophysiology of spinal myoclonus is extensive and multifactorial. Infection, intramedullary and extramedullary space-occupying lesions, trauma, vascular.