Estretament de l'espai per on passen la medul·la espinal i les arrels nervioses. Segons la seva localització, es diferencia entre estenosi del canal cervical i estenosi del canal lumbar. Habitualment afecta persones més grans de 50 anys, encara que pot aparèixer en edats més precoces, si la persona ha patit algun tipus de traumatisme de columna.
La causa més freqüent és la degenerativa; altres causes: hèrnia discal, traumatismes o tumors de columna.
Quan es comprimeix el nervi, es manifesta amb dolor, formigueig, entumiment i debilitat muscular de la zona afectada. En cas d'estenosi del canal lumbar, el dolor empitjora en caminar i s'alleuja en inclinar-se cap endavant o en seure. En casos greus, pot aparèixer incontinència urinària.
El diagnòstic es fa mitjançant interrogatori clínic i per proves d'imatge com radiografies i/o ressonància magnètica.
S'ha de tractar el dolor agut mitjançant analgèsics convencionals, antiinflamatoris no esteroidals i/o opiacis. Pot usar-se cortisona oral o a través d'injeccions properes al punt de pinçament del nervi. Si el dolor es fa crònic, poden associar-se antidepressius tricíclics, anticonvulsius i tractament amb fisioteràpia. Els casos més greus poden requerir cirurgia per descomprimir l'arrel nerviosa.
La gravetat de l'estenosi acostuma a ser proporcional a la intensitat del dolor i es correlaciona de forma inversa amb els metres que una persona pot caminar sense tenir dolor. Es considera estenosi greu si presenta dolor abans d'arribar a caminar 200 metres i molt greu quan és inferior als 50 metres.
- Atlas SJ, Delitto A. Spinal stenosis: surgical versus nonsurgical treatment. Clin Orthop Relat Res 2006; 443:198.
- Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med 2008; 358:818.
- Markman JD, Gewandter JS, Frazer ME, et al. Evaluation of outcome measures for neurogenic claudication: A patient-centered approach. Neurology 2015; 85:1250.
- Lee MJ, Dettori JR, Standaert CJ, et al. The natural history of degeneration of the lumbar and cervical spines: a systematic review. Spine (Phila Pa 1976) 2012; 37:S18.
- Xia XP, Chen HL, Cheng HB. Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976) 2013; 38:597.
- Ammendolia C, Stuber KJ, Rok E, et al. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst Rev 2013; :CD010712.
- Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ 2016; 352:h6234.
- Mazanec DJ, Podichetty VK, Hsia A. Lumbar canal stenosis: start with nonsurgical therapy. Cleve Clin J Med 2002; 69:909.
- Rittenberg JD, Ross AE. Functional rehabilitation for degenerative lumbar spinal stenosis. Phys Med Rehabil Clin N Am 2003; 14:111.
- Bodack MP, Monteiro M. Therapeutic exercise in the treatment of patients with lumbar spinal stenosis. Clin Orthop Relat Res 2001; :144.
- Whitman JM, Flynn TW, Childs JD, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine (Phila Pa 1976) 2006; 31:2541.
- Greenwood J, McGregor A, Jones F, et al. Rehabilitation Following Lumbar Fusion Surgery: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2016; 41:E28.
- McGregor AH, Probyn K, Cro S, et al. Rehabilitation following surgery for lumbar spinal stenosis. Cochrane Database Syst Rev 2013; :CD009644.
- Roelofs PD, Deyo RA, Koes BW, et al. Nonsteroidal anti-inflammatory drugs for low back pain: an updated Cochrane review. Spine (Phila Pa 1976) 2008; 33:1766.
- Markman JD, Frazer ME, Rast SA, et al. Double-blind, randomized, controlled, crossover trial of pregabalin for neurogenic claudication. Neurology 2015; 84:265.
- Radcliff K, Kepler C, Hilibrand A, et al. Epidural steroid injections are associated with less improvement in patients with lumbar spinal stenosis: a subgroup analysis of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976) 2013; 38:279.
- Chou R, Hashimoto R, Friedly J, et al. Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med 2015; 163:373.
- Friedly JL, Comstock BA, Turner JA, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 2014; 371:11.
- Gibson JN, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev 2005; :CD001352.
- Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev 2016; :CD010264.
- Chang Y, Singer DE, Wu YA, et al. The effect of surgical and nonsurgical treatment on longitudinal outcomes of lumbar spinal stenosis over 10 years. J Am Geriatr Soc 2005; 53:785.
- Martin BI, Mirza SK, Comstock BA, et al. Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine (Phila Pa 1976) 2007; 32:2119.
- Modhia U, Takemoto S, Braid-Forbes MJ, et al. Readmission rates after decompression surgery in patients with lumbar spinal stenosis among Medicare beneficiaries. Spine (Phila Pa 1976) 2013; 38:591.
- Radcliff K, Curry P, Hilibrand A, et al. Risk for adjacent segment and same segment reoperation after surgery for lumbar stenosis: a subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 2013; 38:531.
- Aalto TJ, Malmivaara A, Kovacs F, et al. Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review. Spine (Phila Pa 1976) 2006; 31:E648.
