PATENT FORAMEN OVALE

Patent foramen ovale (PFO) is a flaplike opening

between the atrial septa primum and secundum at the
location of the fossa ovalis (see the image below) that
persists after age 1 year. With increasing evidence
being found that PFO is the culprit in paradoxical
embolic events, the relative importance of the anomaly
is being reevaluated.

Spinal stenosis (progressive narrowing of the spinal

canal) is part of the aging process, and predicting who
will be affected is not possible. No clear correlation is
noted between the symptoms of stenosis and race,
occupation, sex, or body type. Treatment in spinal
stenosis can be conservative or surgical. While the
degenerative process can be managed, it cannot be
prevented by diet, exercise, or lifestyle.
Acute and chronic neck and lower back pain represent
major health care problems in the United States. An
estimated 75% of all people will experience back pain at
some time in their lives. Most patients who present with
an acute episode of back pain recover without surgery,
while 3-5% of patients presenting with back pain have a
herniated disc, and 1-2% have compression of a nerve
root. Older patients present with more chronic or
recurrent symptoms of degenerative spinal disease.
(See Epidemiology.)

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. The canal components that contribute to
acquired stenosis include the facets (hypertrophy,
arthropathy), ligamentum flavum (hypertrophy), posterior
longitudinal ligament (ossification of posterior
longitudinal ligament [OPLL]), vertebral body (bone
spurs), intervertebral disk, and epidural fat

Signs and symptoms of spinal stenosis

The primary clinical manifestation of spinal stenosis is
chronic pain. In patients with severe stenosis, weakness
and regional anesthesia may result. Among the most
serious complications of severe spinal stenosis is
central cord syndrome, which is the most common
incomplete cord lesion. The presentation commonly is
associated with an extension injury in a patient with an
osteoarthritic spine. In hyperextension injury, the cord is
injured within the central gray matter, which results in
proportionally greater loss of motor function in the upper
extremities than in the lower extremities, with variable
sensory sparing.
Spinal stenosis of the cervical and thoracic regions may
contribute to neurologic injury, such as development of
a central spinal cord syndrome following spinal trauma.
Spinal stenosis of the lumbar spine is associated most
commonly with midline back pain and radiculopathy. In
cases of severe lumbar stenosis, innervation of the
urinary bladder and the rectum may be affected, but
lumbar stenosis most often results in back pain with
lower extremity weakness and numbness along the
distribution of nerve roots of the lumbar plexus.