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2006, Número 2

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Acta Med 2006; 4 (2)


Conducto lumbar estrecho

Rosales LM, Manzur D, Miramontes MV, Alpízar AA, Reyes-Sánchez AA

Idioma: Español
Referencias bibliográficas: 79
Paginas: 101-110
Archivo PDF: 136.03 Kb.


RESUMEN

Se define como la reducción del diámetro en el conducto espinal, de los canales laterales y/o de los forámenes. Puede ocurrir como un proceso generalizado de enfermedad o puede ser localizado o segmentario. Hay alteraciones motoras y/o sensitivas de miembros pélvicos. Dentro de la patogenia se clasifica en primaria y secundaria. Es más frecuente el tipo degenerativo. Los cambios metabólicos del disco intervertebral ocasionan una deshidratación discal, lo que inicia un proceso degenerativo que se traduce en inestabilidad. La claudicación neurogénica que es el síntoma cardinal de la enfermedad, se presenta en 6% de los adultos después de 50 años. La frecuencia en hombres varía de 29 a 85%. La estenosis es más frecuente en los niveles lumbares bajos, clínicamente se manifiesta por dolor lumbar de varios años de evolución así como claudicación intermitente que se puede confundir con un problema de tipo vascular. En el diagnóstico diferencial se incluyen además de hernia de disco y espondilolistesis, neoplasias y alteraciones abdominales o pélvicas. Para el diagnóstico definitivo además de una historia clínica se requiere mielografía y/o la resonancia magnética dinámica. El tratamiento puede ser conservador o quirúrgico. Dentro del tratamiento quirúrgico se incluye a la liberación de raíces, fijación y artrodesis.


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