Degenerative lumbar stenosis: update

Abstract

-We present a literature review of the diagnosis and treatment of acquired lumbar spinal stenosis (LS), with a brief description of new surgical techniques. LS is the most common cause of spinal surgery in individuals older than 65 years of age. Neurogenic claudication and radiculopathy result from compression of the cauda equina and lumbosacral nerve roots by degenerated spinal elements. Surgical decompression is a well established treatment for patients with refractory, or moderate to severe clinical symptoms. However, the variety of surgical options is vast. New techniques have been developed with the goal of increasing long term functional outcomes. In this article we review lumbar decompression and fusion as treatment options for LS but also present other recent developments. Prospective long term studies are necessary to know which procedures would result in optimal patient outcome.Key WordS: acquired lumbar stenosis, surgical treatment, new techniques, fusion. estenose lombar degenerativa: atualização resumo -Apresentamos uma revisão de literatura do diagnóstico e tratamento da estenose lombar (eL) adquirida, enfatizando as novas técnicas de manejo cirúrgico. A eL é a causa mais comum de cirurgia na coluna de pacientes com mais de 65 anos de idade. Claudicação neurogênica e radiculopatias são sintomas resultantes da compressão das raízes lombossacrais pelos elementos degenerados. A descompressão cirúrgica é um procedimento bem estabelecido para pacientes com sintomas severos ou refratários ao tratamento clínico. Contudo, as opções cirúrgicas são amplas. Novas técnicas de fusão e artrodese são úteis para melhorar os resultados funcionais. Neste artigo, varias alternativas cirúrgicas são apresentadas, incluindo as novas tecnologias na área. evidências científicas mais contundentes com seguimento longo são necessárias para a incorporação destas práticas na atividade médica de rotina.PALAvrAS-CHAve: estenose lombar adquirida, tratamento cirúrgico, novas técnicas, fusão.

Estenose degenerativa da coluna lombar

“…Absence of fat surrounding the nerve roots indicates foraminal stenosis, especially on T1 images. This examination has the disadvantage of its cost, but it is an excellent noninvasive tool (1,5,6,17) . MRI is the most appropriate noninvasive imaging examination for diagnosing degenerative stenosis.…”

“…Electroneuromyography (ENMG) is recommended when the diagnosis of neuropathy is controversial, especially in relation to patients with diabetes mellitus (1,4,5,17) .…”

“…2012;47(3):286-91 as a consequence of infection, trauma or surgery (3) . Degenerative stenosis may involve the central canal, the lateral recess, the foramens, or a combination of these, and is the commonest cause of acquired stenosis, which especially affects adults and elderly people (1,5) . There has been a continual increase on life expectancy, thus resulting in a concomitant increase in occurrences of this condition.…”

“…There has been a continual increase on life expectancy, thus resulting in a concomitant increase in occurrences of this condition. Although the exact incidence is unknown, it has been estimated that lumbar stenosis affects between three and twelve patients for every 100,000 inhabitants per year over the age of 65 years (5,6) . The natural history of stenosis remains challenging.…”

A change in the sagittal balance in elderly and senile patients with degenerative stenosis of the lumbar spine

“…В комплекс обязательного обследования пациентов по-жилого и старческого возраста с подозрением на стеноз позвоночного канала поясничного отдела позвоночника должна входить обзорная спондилография в прямой и бо-ковой проекциях, функциональная спондилография, СКТ и МРТ позвоночника [1,2]. По данным рентгеногра-фии, оцениваются количественные (фронтальный и са-гиттальный размеры позвоночного канала) и качествен-ные (изменения поясничного лордоза, наличие сколиоза, аномалии развития, изменения высоты межпозвоночных дисков и другие патологические изменения тел позвон-ков) показатели.…”