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Degenerative Lumbar Spinal Stenosis

Degenerative lumbar spinal stenosis is the most frequent cause of low back pain and/or sciatica in the elderly patient. Epidemiology, pathophysiology, clinical manifestations and testing are reviewed in a wide current bibliographic investigation. The importance of the relationship between clinical p...

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Autores principales: Hennemann, Sergio, de Abreu, Marcelo Rodrigues
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Thieme Revinter Publicações Ltda. 2021
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895619/
https://www.ncbi.nlm.nih.gov/pubmed/33627893
http://dx.doi.org/10.1055/s-0040-1712490
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author Hennemann, Sergio
de Abreu, Marcelo Rodrigues
author_facet Hennemann, Sergio
de Abreu, Marcelo Rodrigues
author_sort Hennemann, Sergio
collection PubMed
description Degenerative lumbar spinal stenosis is the most frequent cause of low back pain and/or sciatica in the elderly patient. Epidemiology, pathophysiology, clinical manifestations and testing are reviewed in a wide current bibliographic investigation. The importance of the relationship between clinical presentation and imaging study, especially magnetic resonance imaging (MRI), is emphasized. Prior to treatment indication, it is necessary to identify the precise location of pain, as well as the differential diagnosis between neurological and vascular lameness. Conservative treatment combining medications with various physical therapy techniques solves the problem in most cases, while therapeutic testing with injections, whether epidural, foraminal or facetary, is performed when pain does not subside with conservative treatment and before surgery is indicated. Injections usually perform better results in relieving sciatica symptoms and less in neurological lameness. Equine tail and/or root decompression associated or not with fusion is the gold standard when surgical intervention is required. Fusion after decompression is necessary in cases with segmental instability, such as degenerative spondylolisthesis. When canal stenosis occurs at multiple levels and is accompanied by axis deviation, whether coronal and/or sagittal, correction of axis deviations should be performed in addition to decompression and fusion, especially of the sagittal axis, in which a lumbar lordosis correction is required with techniques that correct the rectified lordosis to values close to the pelvic incidence.
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spelling pubmed-78956192021-02-23 Degenerative Lumbar Spinal Stenosis Hennemann, Sergio de Abreu, Marcelo Rodrigues Rev Bras Ortop (Sao Paulo) Degenerative lumbar spinal stenosis is the most frequent cause of low back pain and/or sciatica in the elderly patient. Epidemiology, pathophysiology, clinical manifestations and testing are reviewed in a wide current bibliographic investigation. The importance of the relationship between clinical presentation and imaging study, especially magnetic resonance imaging (MRI), is emphasized. Prior to treatment indication, it is necessary to identify the precise location of pain, as well as the differential diagnosis between neurological and vascular lameness. Conservative treatment combining medications with various physical therapy techniques solves the problem in most cases, while therapeutic testing with injections, whether epidural, foraminal or facetary, is performed when pain does not subside with conservative treatment and before surgery is indicated. Injections usually perform better results in relieving sciatica symptoms and less in neurological lameness. Equine tail and/or root decompression associated or not with fusion is the gold standard when surgical intervention is required. Fusion after decompression is necessary in cases with segmental instability, such as degenerative spondylolisthesis. When canal stenosis occurs at multiple levels and is accompanied by axis deviation, whether coronal and/or sagittal, correction of axis deviations should be performed in addition to decompression and fusion, especially of the sagittal axis, in which a lumbar lordosis correction is required with techniques that correct the rectified lordosis to values close to the pelvic incidence. Thieme Revinter Publicações Ltda. 2021-02 2020-07-23 /pmc/articles/PMC7895619/ /pubmed/33627893 http://dx.doi.org/10.1055/s-0040-1712490 Text en Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Hennemann, Sergio
de Abreu, Marcelo Rodrigues
Degenerative Lumbar Spinal Stenosis
title Degenerative Lumbar Spinal Stenosis
title_full Degenerative Lumbar Spinal Stenosis
title_fullStr Degenerative Lumbar Spinal Stenosis
title_full_unstemmed Degenerative Lumbar Spinal Stenosis
title_short Degenerative Lumbar Spinal Stenosis
title_sort degenerative lumbar spinal stenosis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895619/
https://www.ncbi.nlm.nih.gov/pubmed/33627893
http://dx.doi.org/10.1055/s-0040-1712490
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