Lumbalna spinalna stenoza

Kupnik D, Brodnik T, Praper L.
Med Mes 2008; 4:23-29.

Lumbalna spinalna stenoza

Lumbalna spinalna stenoza je zožitev spinalnega kanala, lateralnega recesusa ali medvretenčnega foramna v ledvenem predelu, kar lahko vodi v utesnitev hrbtenjače ali živčnih korenin s posledično radikulopatijo ali psevdoklavdikacijo. Ponavadi prizadene bolnike v starosti 50 do 60 let in je lahko primarna ali kongenitalna, kjer je degenerativnih sprememb na hrbtenici manj, in sekundarna ali pridobljena, kjer so degenerativne spremembe na hrbtenici bolj izražene.
Simptomi so lahko v smislu nevrogene klavdikacije ali psevdoklavdikacije pri centralni stenozi ali radikularnega tipa pri stenozi lateralnega recesusa. Največkrat obsegajo
bolečino v križu in nogah, parestezije v nogah in motnje občutkov ter zmanjšanje mišične moči nog, njihova pojavnost pa je značilno vezana na zravnan položaj. Sklanjanje, hoja navkreber, vožnja kolesa ali čepenje simptome omilijo. V primeru klavdikacijskih bolečin je le-te potrebno ločiti od tistih, ki nastanejo ob periferni arterijski bolezni.
Zdravljenje je konzervativno ali operativno. Slednje je namenjeno bolnikom s težkimi simptomi in tistim, ki jim konzervativno zdravljenje ne pomaga, glavni cilj zdravljenja pa je poleg omilitve simptomov tudi čimprejšnja povrnitev bolnika v vsakdanje delovne in druge aktivnosti.

Limbar spinal stenosis

Lumbar spine stenosis is characterized by narrowing of the spinal canal, lateral recessus or intervertebral foramen in the lumbar part of the spine with possible compression of the spine or nerve roots, and presents as a pseudoclaudication or a radiculopathy. Most patients are aged over 50 years. Lumbar spine stenosis can be congenital or aquired. The first appears earlier in life and has less spinal degenerative changes, later appears later in life and is characterized with more prominent spinal degenerative features.
Symptoms comprise of neurogenic claudication or pseudoclaudication in central stenosis, and radicular pain and other symptoms in stenosis of lateral recessus. Patients usually complain of insidious onset of low back pain with progression to buttocks and legs over the course of weeks or months. The symptoms tipically worsen in erect standing position, while bending forward, walking uphill, cycling or squatting brings relief. It is important to distinguish between claudication due to peripheral artery disease and neurogenic claudication.
Therapy consists of conservative measures or surgical decompression of neural tissue. The later is reserved for patient who fail to respond to conservative treatment and those with worse initial symptoms. The goal of treatment is to relieve the symptoms and to resume daily working and other activities as soon as possible.

Ključne besede:

spinalna stenoza, nevrogena klavdikacija.

Key words:

spine stenosis, neurogenic claudication.

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