A radicular syndrome from developmental narrowing of the lumbar vertebral canal

Abstract

Background: Spinal stenosis, as a result of bone disease such as chondrodystrophia foetalis, or as a result of a developmental anomaly, has previously been described (Sumita 1910, Vogi and Osborne 1949, Spillane 1952) [ 1[. The narrowing of the spinal canal had been identifi ed as occurring either at the level of the vertebral anomaly or at another level. Sarpyener (1947) also described spinal stenosis in association with spina bifi da and also reported that it frequently occurred at a different (distant) spinal level from the spina bifi da [ 1[. In a subsequent publication he described a small number of cases in which this narrowing occurred without any other developmental anomalies of the vertebral column. Verbiest had previously reported in 1949 spinal stenosis unassociated with any other anomaly of the spine. In that series, and in the series presented in this paper all the patients were male with age of onset of symptoms ranging from 37 to 67 years. Method: Seven cases of lumbar spinal stenosis are reported in this paper. The diagnosis of spinal stenosis was made either intra operatively or on the appearances of myelography. Myelography revealed a complete block in the spinal canal with evidence of compression of the dural sack. Plain radiographs were discussed but not found to be helpful in establishing the diagnosis. Likewise lumbar puncture was performed but not found to be helpful. The results of myelography were confi rmed at operation and the results of the surgical treatment of seven cases is reported. Results: The author reports the symptoms that are characteristic for neurogenic claudication: leg pain as well as numbness and decreased power in the legs brought on by standing or walking and that is relieved by rest (recumbency). Neurological examination was typically normal and the main differential diagnosis was thought to be that of vascular claudication. Conclusion: Verbiest accurately describes the clinical features of neurogenic claudication occurring as a result of lumbar spinal stenosis.