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Órgano Oficial de Difusión Científica de la Federación Mexicana de Colegios de Ortopedia y Traumatología, A.C. (FEMECOT)

2018, Number 1

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Ortho-tips 2018; 14 (1)

Guidelines on surgical decision for lumbar spinal stenosis

Caldera HG, Ocegueda TE

Language: Spanish
References: 16
Page: 6-10
PDF size: 150.46 Kb.


ABSTRACT

Lumbar spinal stenosis (LES) is defined as the narrowing of the canal through which the neurological and vascular structures pass at the level of the lumbar spine. It is estimated that by the year 2025, approximately 64 million adults over the age of 65 in the U.S. will present clinical data of this pathology. The most common clinical data are pain referred to the buttocks, with irradiation to pelvic limbs, without the presence of pain in the lower back being necessary, most of the studies analyzed use pain and disability rating scales, the condition is aggravated by standing, walking or lumbar extension and is relieved by flexion, sitting or reclining. Options for medical treatment include medications, physical therapy, spinal injections, lifestyle modification, and rehabilitation. Patients with moderate symptoms rarely show deterioration. Surgical decision making in lumbar spinal stenosis involves evaluation of the clinical parameters and severity of the radiological stenosis, such as motor weakness, male sex, morphological stenotic grade, and amount of disability. Typical neurogenic claudication, severe pain/disability, and pronounced constriction of the spinal canal are considered the most important indications for surgical treatment in most patients, as well as horsetail symptoms and degenerative spondylolisthesis/scoliosis, were prognostic factors associated with the indication of surgery in patients with LES.


REFERENCES

  1. Jiménez-Ávila JM, Rubio-Flores EN, González-Cisneros AC, Guzmán-Pantoja JE, Gutiérrez-Román EA. Directrices en la aplicación de la guía de práctica clínica en la lumbalgia. Cirugía y Cirujanos. 2018; 86: 29-37.

  2. Schizas C, Kulik G. Decision-making in lumbar spinal stenosis: A survey on the influence of the morphology of the dural sac. J Bone Joint Surg Br. 2012; 94 (1): 98-101.

  3. Wessberg P, Frennered K. Central lumbar spinal stenosis: natural history of non-surgical patients. Eur Spine J. 2017; 26 (10): 2536-2542.

  4. Bae HW, Rajaee SS, Kanim LE. Nationwide trends in the surgical management of lumbar spinal stenosis. Spine (Phila Pa 1976). 2013; 38 (11): 916-926.

  5. Fukushima M, Oka H, Hara N, Oshima Y, Chikuda H, Tanaka S, et al. Prognostic factors associated with the surgical indication for lumbar spinal stenosis patients less responsive to conservative treatments: An investigator-initiated observational cohort study. J Orthop Sci. 2017; 22 (3): 411-414.

  6. Neuman BJ, Baldus C, Zebala LP, Kelly MP, Shaffrey C, Edwards C 2nd, et al. Patient factors that influence decision making: randomization versus observational nonoperative versus observational operative treatment for adult symptomatic lumbar scoliosis. Spine (Phila Pa 1976). 2016; 41 (6): E349-E358.

  7. Overdevest GM, Moojen WA, Arts MP, Vleggeert-Lankamp CL, Jacobs WC, Peul WC. Management of lumbar spinal stenosis: a survey among Dutch spine surgeons. Acta Neurochir (Wien). 2014; 156 (11): 2139-2145.

  8. Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016; 352: h6234.

  9. Bayerl SH, Pöhlmann F, Finger T, Franke J, Woitzik J, Vajkoczy P. The sagittal spinal profile type: a principal precondition for surgical decision making in patients with lumbar spinal stenosis. J Neurosurg Spine. 2017; 27 (5): 552-559.

  10. Inoue G, Miyagi M, Takaso M. Surgical and nonsurgical treatments for lumbar spinal stenosis. Eur J Orthop Surg Traumatol. 2016; 26 (7): 695-704.

  11. Ulrich NH, Burgstaller JM, Held U, Winklhofer S, Farshad M, Pichierri G, et al. The influence of single-level versus multilevel decompression on the outcome in multisegmental lumbar spinal stenosis: analysis of the lumbar spinal outcome study (LSOS) data. Clin Spine Surg. 2017; 30 (10): E1367-E1375.

  12. Marawar SV, Madom IA, Palumbo M, Tallarico RA, Ordway NR, Metkar U, et al. Surgeon reliability for the assessment of lumbar spinal stenosis on MRI: the impact of surgeon experience. Int J Spine Surg. 2017; 11: 34.

  13. Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015; 162 (7): 465-473.

  14. Roszell K, Sandella D, Haig AJ, Yamakawa KS. Spinal stenosis: factors that influence patients’ decision to undergo surgery. Clin Spine Surg. 2016; 29 (10): E509-E513.

  15. Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H, et al. Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthritis Cartilage. 2013; 21 (6): 783-788.

  16. Smith JS, Shaffrey CI, Glassman SD, Carreon LY, Schwab FJ, Lafage V, et al. Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults. Eur Spine J. 2013; 22 (2): 402-410.




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