Degenerative Stenosis of the Lumbar Spine

Abstract

This paper presents an update on degenerative stenosis of the lumbar spine, which is a common pathological condition among patients over the age of 65 years. The anamnesis and physical examination need to be precise, since radiography often only provides indirect signs. Magnetic resonance imaging is necessary if the symptoms persist. The treatment for lumbar stenosis is a matter of controversy. However, there seems to be some benefit from surgical treatment rather than conservative treatment, such that surgery brings improvements in symptoms and functions for a period of up to two years.

Clinical symptoms of lumbar spinal stenosis associated with morphological parameters on magnetic resonance images

“…MRI is frequently used to diagnose LSS, but MRI findings are not always compatible with the symptoms of spinal stenosis [21,22]. LSS characteristically manifests as a dynamic mechanical compression of the nerve root sheaths of the cauda equine and dura [7,23,24].…”

Patient-Reported Outcomes Following Lumbar Decompression Surgery: A Review of 2699 Cases

“…Consequently, a patient with severe narrowing and significant neural effacement may be asymptomatic or may present only with minor symptoms and vice versa. 25 The decision to operate is largely clinically driven and thus a secure and thorough understanding of the features which most affect patients is crucial to guide decision making. [26][27][28][29] Historically, the assessment of surgical success was based on largely subjective clinical and/or radiological assessment by the surgeon.…”

Avaliação clínica e radiográfica de pacientes com estenose do canal lombar submetidos a técnica de artrodese lateral minimamente invasiva

“…A história natural da estenose lombar permanece desafiadora. A existência de uma mobilidade da unidade funcional e seu íntimo contato com as estruturas neurais, associado à existência de uma estrutura avascular principal, o disco intervertebral, são fatores que podem elucidar a etiologia dessa patologia 3,7 .…”

“…de L5S1 e L3L4. Entretanto, deve-se ficar atento à possibilidade de herniação discal, espondilolistese, espondilólise e doença de Paget, que exacerbam o estreitamento 3 Altura Foramen E 8,1 ± 2,0 8,4 (6,75 -9,5) 11,0 ± 2,49 11,0 (9,5 -11,9) 2,9 36% <0,001…”

“…Ademais, os autores sugeriram que o tratamento conservador por mais de 6 anos de acompanhamento pode ser eficaz para dores moderadas, quando não há indícios de piora nos sintomas3,6 .Atlas et al observaram que, após 8 anos de tratamento conservador, 50% dos pacientes apresentaram melhoras na dor axial e irradiada35 . de pressão sobre o nervo espinhal na coluna lombar ou parte inferior das costas.…”