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Background and Objective: Thoracic spinal stenosis is characterized by a reduction in the volume of the thoracic spinal canal, leading to compromise of the spinal cord or nerve roots. This article provides an overview of the known etiology, pathogenesis, diagnostic algorithm, and treatment of thoracic spinal stenosis., Materials and Methods: This paper is based on an overview of the literature from the past 25 years as well as the authors' own experience and results., Results and Conclusion: Thoracic spinal stenosis is a rare entity, for which the incidence is unknown. Pathoanatomically, the stenosis is caused by ligament or facet joint hypertrophy. Ventral stenosis can be caused by broad-based thoracic disc protrusion and ossification of the posterior longitudinal ligament (OPLL). Depending on location, main symptoms are pain and, in advanced cases, myelopathic symptoms which spare the upper extremities. Surgical decompression with or without instrumentation is the only treatment option. We present a cohort of 9 patients operated in a time frame of 7 years using a ventral approach, 89% of whom reported a substantial reduction in pain.

Background: In trauma care of fragility fractures of the spine, degenerative stenosis is often seen as an accompanying pathology. This may lead to a possible compression of neurogenic structures. The stenosis of the spinal canal can manifest itself with clinically significant complaints before the fracture occurs. This coexistence may have an impact on the injury itself or may provoke a complicated treatment of the fracture., Aim: The aim of this work is to differentiate these pathophysiologies and their merger in terms of clinical diagnostics and treatment options., Differential Diagnosis: The differential diagnosis is difficult and is often inadequately appreciated in everyday clinical life. The etiology and pathophysiology of both entities show, in several aspects, a congruence that enables joint treatment. If the indication is set for the decompression of a stenosing fracture, a pre-existing relevant stenosis can be addressed in the same session. Conversely, significant degenerative stenosis accompanying a fracture may lead to the indication of decompression.

Background: Anterior cervical corpectomy and fusion (ACCF) has become a standard procedure for patients with spondylotic myelopathy due to multisegmental stenosis of the cervical canal. In addition to the fusion technique using autogenous bone grafts and titanium implants, synthetic polyetheretherketone (PEEK) cages have been used increasingly during the last years. However, limited evidence on the clinical and radiological results of PEEK cages for ACCF exists in the literature. The study presented here is the largest series to date reporting clinical and radiological outcome as well as complication rates after one to three-level ACCF using PEEK cages augmented by an anterior plate-screw osteosynthesis., Materials and Methods: Retrospective study on 101 patients after stand-alone PEEK cage-ACCF with a minimum follow-up of 6 months. The number of hardware failures and implant-related surgical revisions were determined. The rate of subsidence and fusion and the course of lordotic alignment were analysed. The neck disability index (NDI) and the European myelopathy score (EMS) were assessed., Results: Screw complications were detected in 8/101 cases and 3 cases of cage dislocation occurred, resulting in an overall implant related revision rate of 2.9 % (all revision cases showed cage dislocation). The rate of cage subsidence >3 mm was 12 % and solid fusion was achieved in 82 % of the patients. NDI, EMS and lordotic alignment improved significantly., Conclusions: PEEK cages are a safe and effective alternative to titanium cages or autogenous bone graft for ACCF. Further randomized evaluation of different fusion techniques in ACCF is still necessary.

Lumbar spinal stenosis in most cases is due to progressive degeneration of the spine, resulting in thickening of facet joints and flaval ligament. Thus the diameter of the lumbar spinal canal is reduced to less than 12 mm in the AP direction. Typically complaints consist in neurogenic claudication. Patients usually experience improvement of pain when bending their back or walking up a hill. Diagnosis of lumbar spinal stenosis is confirmed by MRI. CT myelography may help detect where compression is most pronounced. Surgical treatment should be based on the clinical symptoms of the mostly elderly people and should be performed as microsurgical decompression or in cases of clinical instability as TLIF.

The DIAM (Device for Interspinous Assisted Motion) interspinous device offers the possibility of a viscoelastic supplementation of the lumbar motion segment with a small, reversible operation. It is intended as a restabilisation procedure after a discectomy to avoid facet joint overload and as a topping of procedure for the segment adjacent to a fusion. The device has been on the German market since 2004. There are several biomechanical studies available showing an effect mainly in extension and flexion, but hardly any in rotation and lateral inclination. Despite frequent clinical use, there have only been a few, mainly retrospective clinical studies indicating the success of the implant; however, sound scientific data are missing. Several prospective, randomised, controlled studies are now underway to fill that gap. Only then will it be possible to assess whether this implant is of true value to improve clinical results and to slow down the degenerative cascade or not.

An increasing number of different interspinous devices are being used for different indications. The Wallis interspinous implant was invented in 1986 by Mr. Jacques Sénégas as one of the first modern interspinous devices. The primary intention of Sénégas was to improve segmental stabilisation, based on the unloading of the facet joints and the disc. The Wallis system is easy to handle and the early clinical results are promising. How far the early outcome will lead to good long-term results is unknown, because there are no long-term results in the literature till now. Limiting factors for the devices are the possible biomechanical overload, the loosening of the implants and the lytic zones around the spinous processes after more than 1 year.

The safety and effectiveness of the Coflex implant has been confirmed in a large retrospective data analysis. Further studies investigated the long-term clinical outcome up to 12 years and evaluated all associated complications showing a strong safety record. Prospective studies oversee only a small patient population at this point and exhibit scientific shortcomings. A large prospective, randomized, concurrently controlled multicenter trial is underway collecting data in seven spine centers in Germany. A similar study is being performed in the USA with a different control group regulated by the Food and Drug Administration (FDA). A differential indication is the stabilization of an adjacent segment next (above) to a fusion. Stabilization of a functional spinal unit after nucleotomy is not promoted by the author.

A growing number of interspinous process devices are currently under investigation. No long-term results are currently available for the X-STOP spacer, but short-term and midterm results are promising.The X-STOP spacer is a good alternative to decompression surgery in elderly patients with moderate spinal stenosis without spondylolisthesis or severe osteoporosis. Further prospective controlled randomized studies comparing the X-STOP with decompression surgery must be done to clearly define the indications and to allow prediction of long-term results.

Dynamic stabilization was introduced in 1994 as a motion preserving device in an attempt to overcome the disadvantages of fusion and to provide sufficient stability, to restore normal segmental kinematics, to prevent instability, and to avoid adjacent segmental degeneration. The results in patients with spinal stenosis with or without degenerative spondylolisthesis can be considered good. Decompression should be performed in the most cases. Disc degeneration of the bridged and the adjacent segment seems to continue despite Dynesys stabilization. It is likely that this continuing degeneration is due to natural disease progression rather than an effect of stabilization.

Most skeletal dysplasias are characterized by small stature. Less well known is the fact that most skeletal dysplasias are also associated with specific spinal problems or deformities. This article summarizes the various aspects of spinal problems in this patient population as well as the diagnostic strategies and current and new treatment options.

In the general category of congenital spinal stenosis, there is a group of patients with particular features: patients suffering from a hereditary or systemic disease with congenital narrowing of the spinal canal. Evaluation of their neurological symptoms is influenced by the peculiarities of the underlying disease. The tendency toward paralysis and paraplegia is much higher in those patients. Attention must especially be given to technical details when operating on achondroplastic dwarfs. Early, most extensive surgery is recommended. We report our experience between 1987 and 1992 with operations on 6 cases of stenosis of the lumbar canal with hereditary or systemic disease.

A review is presented of the nomenclature, taxonomy and clinical presentation of the lumbar canal and lateral stenosis. A historical review of the literature illustrates the growing importance of this clinical entity in the narrow spinal canal. The definition of Verbiest is introduced and explained. It distinguishes two main groups of spinal stenosis: congenital and developmental stenosis. Developmental stenosis contains several subgroups. Special attention is paid to "central" lumbar canal stenosis and lateral spinal stenosis. Both entities are discussed with a description of the etiology, anatomy, and symptomatology. The importance of nerve root infiltration as a diagnostic tool in asymptomatic radiculopathy is emphasized.

In 30%-40% of the patients who are operated on for herniation of lumbar discs, osseous stenosis plays a certain role. However, only in one-third of them are special operative measures such as laminectomy necessary with or without additional lumbar fusion. When spondylodesis is carried out after laminectomy it is often combined with metal implant, which can drastically reduce the time a patient requires perioperative treatment. In younger patients showing typical signs of nerve root compression due to osseous stenosis of lateral recess, only segmental decompression in the form of foraminotomy is done. On the other hand, in cases of narrow spinal canal, which is found in elderly patients, neurogenic intermittent claudication is the predominant clinical picture. Kyphosis, scoliosis, and vertebral displacement can lead to local spinal stenosis. On addition, local pressure and tension on unstabile segments in combination with secondary fibrosis can lead to compression of the neural structures. The diagnosis is based on the clinical history and myelography. Computed tomography helps reveal the presence of herniation of a lumbar disc, which should be simultaneously operated upon. For the operative treatment there is no age limit. All in all, the operative results are so good that one is inclined to decide in favour of operation.