Severe Thecal Sac Stenosis: Causes, Symptoms & Impact
Severe thecal sac stenosis denotes marked narrowing of the dural sac containing the spinal cord/cauda equina, causing neural compression.
Causes
- Congenital narrow canal
- Degenerative: Ligamentum flavum hypertrophy, facet arthropathy, disc bulge, spondylolisthesis
- Trauma: Fracture, dislocation
- Neoplasm: Metastatic, primary spinal tumors
- Inflammatory: Ankylosing spondylitis, Paget's disease
Symptoms
- Neurogenic claudication: Leg pain/heaviness walking, relieved by sitting/flexion
- Radiculopathy: Radiating pain, numbness, weakness in specific dermatomes/myotomes
- Myelopathy (cervical/thoracic): Gait imbalance, fine motor loss, hyperreflexia, bowel/bladder dysfunction
Treatment
- Conservative: PT, NSAIDs, epidural steroids (temporary relief).
- Surgical: Laminectomy ± fusion, laminoplasty (cervical), minimally invasive decompression. Indicated for progressive myelopathy or disabling claudication.
Urgent surgery for cauda equina syndrome (saddle anesthesia, urinary retention).
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