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2018, Número 2

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Revista Cubana de Ortopedia y Traumatología 2018; 32 (2)


Relación entre la degeneración discal y la inestabilidad lumbar

Tabares NH, Díaz QJM, Tabares SH, Tabares SL

Idioma: Español
Referencias bibliográficas: 47
Paginas: 1-16
Archivo PDF: 331.78 Kb.


RESUMEN

Introducción: La inestabilidad lumbar es una de las causas más frecuentes del dolor en la espalda. Las dificultades para el diagnóstico provocan que su incidencia sea menor de lo esperado en la práctica clínica y dificultan su tratamiento.
Objetivo: Evaluar lo publicado relativo al proceso de degeneración discal, así como su influencia sobre la estabilidad de la columna lumbar.
Métodos: Se revisaron los principales avances relacionados con la degeneración discal que guardan relación con la inestabilidad vertebral lumbar. Se consultaron artículos publicados en PubMed, en idioma inglés, desde 2012 hasta 2017. Se examinaron artículos accesibles de forma libre o a través de Clinical Key e Hinari. Se tuvieron en cuenta algunos artículos que sobrepasan los cinco años de antigüedad, pero que son claves en el tema.
Resultados: Dos procesos afectan al disco intervertebral lumbar como consecuencia del envejecimiento y la degeneración: espondilosis deformante y osteocondrosis intervertebral. Los cambios degenerativos están relacionados con el tiempo. Se pueden diferenciar tres fases que, a manera de cascada, desencadenan trastornos del movimiento e inestabilidad.
Conclusiones: Los cambios degenerativos vertebrales producen aumento de la movilidad segmentaria (posible causa de inestabilidad lumbar). La zona neutra es un parámetro solo medible in vitro. No existe una prueba que permita confirmar el diagnóstico de inestabilidad vertebral. Los hallazgos clínicos y por imágenes constituyen la mejor recomendación para llegar al diagnóstico. El concepto de inestabilidad vertebral lumbar y su tratamiento, a través de la fusión vertebral, no están suficientemente justificados.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Izzo R, Guarnieri G, Guglielmi G, Muto M. Biomechanics of the spine. Part II: Spinal stability. European Journal of Radiology. 2013;82:127-38.

  2. Inoue N, Espinoza Orías AA. Biomechanics of Intervertebral Disk degeneration. Orthop Clin N Am. 2011;42:487-99.

  3. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Rothman SG, Sze GK. Lumbar disc nomenclature: version 2.0 Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. The Spine Journal. 2014;14:2525-45.

  4. Resnick D, Niwayama G. Degenerative disease of the spine. In: Resnick D, ed. Diagnosis of bone and joint disorders. 3rd ed. Philadelphia: WB Saunders; 1995:1372-462.

  5. Schmorl G, Junghanns H. The human spine in health and disease. 2nd Ed. New York: Grune and Stratton, 1971:141-8, 186-98.

  6. Sachs BL, Vanharanta H, Spivey MA. Dallas discogram description. A new classification of CT/discography in low-back disorders. Spine. 1987;12:287-94.

  7. Ross JS. Babel 2.0. Radiology. 2010;254:640-1.

  8. Fujiwara A, Lim TH, An HS. The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine. 2000;25:3036-44.

  9. Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. Journal of Spinal Disorders. 1992;5:390-7.

  10. Jinkins JR. Acquired degenerative changes of the intervertebral segments at and suprajacent to the lombosacral junction. A radioanatomic analysis of the non discal structures of the spinal column and perispinal soft tissues. European Journal of Radiology. 2004;50(2):134-58.

  11. Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res. 1982;(165):110-23.

  12. Herkowitz HN. Spine update: degenerative lumbar spondylolisthesis. Spine. 1995;20:1084-90.

  13. Park AL. Instability: clinical manifestations and assessment. In: Slipman CW, Derby R, Simeone FA, Mayer TG, editors. Interventional spine an algorithmic approach. Philadelphia: Saunders Elsevier; 2008. p. 187-92.

  14. White AA III, Panjabi MM. Clinical Biomechanics of the Spine. 2nd ed. Baltimore, MD: Lippincott Williams & Wilkins; 1990:23-45.

  15. Izzo R, Guarnieri G, Guglielmi G, Muto M. Biomechanics of the spine. Part I: Spinal stability. European Journal of Radiology. 2013; 82:118-26.

  16. Solmaz B, Aydin AL, Gomleksiz C, Ataker Y, Sasani M, Oktenoglu T. Skipping posterior dynamic transpedicular stabilization for distant segment degenerative disease. Adv Orthop. 2012;12:496817.

  17. Cansever T, Civelek E, Kabatas S, Yilmaz C, Caner H, Altinors MN. Dysfunctional segmental motion treated with dynamic stabilization in the lumbar spine. World Neurosurg. 2011;75(5-6):743-9.

  18. Rodrigues LF, Cavallari F. Nonfusion Techniques for Degenerative Lumbar Diseases Treatment. Brazil: InTech; 2012.

  19. Kirkaldy-Willis WH, Wedce JH, Yong Hing K. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine. 1978;3(4):319-28.

  20. Kirkaldy-Willis WH. The Relationship of structural pathology to the nerve root. Spine 1984;9(1):49-52.

  21. Suri P, Miyakoshi A, Hunter DJ. Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population. BMC Musculoskelet Disord. 2011;12:202.

  22. Panjabi MM. Clinical spinal instability and low back pain. Journal of Electromyography and Kinesiology. 2003;13:371-9.

  23. Kettler A, Rohlmann F, Ring C, Mack C, Wilke HJ. Do early stages of lumbar intervertebral disc degeneration really cause instability? Evaluation of an in vitro database. Eur Spine J. 2011;20:578-84.

  24. Ito K, Creemers L. Mechanisms of intervertebral disk degeneration/Injury and Pain: A Review. Global Spine J. 2013;3:145-52.

  25. Micankova AB, Vohanka S, Jarkovsky J, Bednarik J. Prediction of long-term clinical outcome in patients with lumbar spinal stenosis. Eur Spine J. 2012;21(12):2611-9.

  26. Kumar SP. Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: A randomized placebo controlled crossover study. N Am J Med Sci. 2011;3(10):456-61.

  27. Frymoyer JW, Brandt K. New perspectives on low back pain. Rosemont III: American Academy of Orthopaedic Surgeons; 1989.

  28. Frymoyer JW, Selby DK. Segmental instability. Rationale for treatment. Spine. 1985;10(3):280-6.

  29. Benzel EC. Biomechanics of spine stabilization. New York: Thieme Medical Publishers; 2001.

  30. Knutson F. The instability associated with disc degeneration in the lumbar spine. Acta Radiol. 1944;25:593-609.

  31. Panjabi MM. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J. 2006;15:668-76.

  32. Pitkanen M, Manninen HI, Lindgrer KA, Turunen M, Airaksinen O. Limited usefulness of traction-compression films in the radiographic diagnosis of lumbar spinal instability. Comparison with flexion-extension films. Spine. 1997;22(2):193-7.

  33. Dupuis PR, Yong-Hing K, Cassidy JD, KirkaldyWillis WH. Radiologic diagnosis of degenerative lumbar spinal instability. Spine. 1985;10(3):262-76.

  34. Friberg O. Lumbar instability: a dynamic approach by traction-compression radiography. Spine. 1987;12(2):119-29.

  35. Breen AC, Teyhen DS, Mellor FE, Breen AC, Wong KW, Deitz A. Measurement of intervertebral motion using quantitative fluoroscopy: report of an international forum and proposal for use in the assessment of degenerative disc disease in the lumbar spine. Adv Orthop. 2012;2012:802350.

  36. Iguchi T, Ozaki T, Chin T, Tsumura N, Kanemura A, Kasahara K. Intimate relationship between instability and degenerative signs at L4/5 segment examined by flexion-extension radiography. Eur Spine J. 2011;20(8):1349-54.

  37. Leone A, Guglielmi G, Cassar-Pullicino VN, Bonomo L. Lumbar intervertebral instability: a review. Radiology. 2007;245(1):62-77.

  38. Biely S, Silfies S. Clinical Instability of the Lumbar Spine: Diagnosis and Intervention. Orthopaedic Practice. 2016;18(3):11-8.

  39. Elliot DM, Yerramalli CS, Auerbach JD. Biomechanics of the intervertebral disc. In: Slipman CW, editor. Interventional spine. Philadelphia: Saunders; 2008. p. 827-38.

  40. McGregor AH, Anderton L, Gedroyc WM. The use of interventional open MRI to assess the kinematics of the lumbar spine in patients with spondylolisthesis. Spine. 2002;27(14):1582-6.

  41. Matsunaga S, Ijiri K, Hayashi K. Nonsurgically managed patients with degenerative spondylolisthesis: a 10- to 18-year follow-up study. Journal of Neurosurgery. 2000;93:194-8.

  42. Matsunaga S, Sakou T, Morizono Y. Natural history of degenerative spondylolisthesis: pathogenesis and natural course of the slippage. Spine. 1990;15:1204-10.

  43. Mulholland RC. The myth of lumbar instability: the importance of abnormal loading as a cause of low back pain. European Spine Journal. 2008;17:619-25.

  44. Deyo RA. Fusion surgery for lumbar degenerative disc disease: still more questions than answers. The Spine Journal. 2015;15:272-4.

  45. Carragee EJ. The increasing morbidity of elective spinal stenosis surgery. Is it necessary? JAMA. 2010;303:1309-10.

  46. Yoshihara H, Yoneoka D. National trends in the surgical treatment for lumbar degenerative disc disease: United States, 2000 to 2009. Spine J. 2015;15:265-71.

  47. Goz V, Weinreb JH, Schwab F, Lafage V, Errico TJ. Comparison of complications, costs, and length of stay of three different lumbar interbody fusion techniques: an analysis of the Nationwide Inpatient Sample database. Spine J. 2014;14:2019-27.




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