Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- onset and duration of symptoms
- back pain
- activity-related back pain
- leg pain when walking
- stooped posture when walking
- leg numbness or paresthesias
- absence of exam findings
Outros fatores diagnósticos
- pain radiating down the leg
- bladder or bowel dysfunction
- muscle weakness or wasting
Fatores de risco
- age over 40 years
- manual labor
- previous back surgery
- family history of back pain
- smoking
- diabetes mellitus
- peripheral vascular occlusive disease
- previous injury
- achondroplasia
- acromegaly
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- plain x-ray
- MRI (T2-weighted)
Investigações a serem consideradas
- CT myelography
- CT spine
- electromyographic (EMG) walking test
- electromyographic paraspinal mapping
Algoritmo de tratamento
significant acute neurologic deficit
no significant acute neurologic deficit: pain affecting quality of life and/or functional activities
chronic symptoms
Colaboradores
Autores
Michael David Tseng MD, MD
Clinical Assistant Professor
Department of Orthopaedic Surgery
Stanford University School of Medicine
Stanford
CA
Declarações
MDT declares that he has no competing interests.
Agradecimentos
Dr Michael David Tseng would like to gratefully acknowledge Dr Adam M. Pearson, Dr William A. Abdu, Dr John K. Houten, and Dr Mark Chwajol, previous contributors to this topic. WAA is an author of a reference cited in this topic. JKH and MC declare that they have no competing interests.
Declarações
WAA and AMP are authors of references cited in this topic. JKH and MC declared that they had no competing interests.
Revisores
John Ratliff, MD, FAANS, FACS
Associate Professor
Department of Neurosurgery
Stanford University
Stanford
CA
Declarações
JR declares that he has no competing interests.
Referências
Principais artigos
Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res. 1982 May;(165):110-23. Resumo
Jane JA Sr, Jane JA Jr, Helm GA, et al. Acquired lumbar spinal stenosis. Clin Neurosurg. 1996;43:275-99. Resumo
Garfin SR, Herkowitz HN, Mirkovic S. Nonoperative and operative treatment of lumbar stenosis. In: Rothman R, Simeone F, eds. The spine. 3rd ed. Philadelphia, PA: WB Saunders; 1991:857-75.
Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2010 Jun 15;35(14):1329-38.Texto completo Resumo
Zdeblick TA. The treatment of degenerative lumbar disorders: a critical review of the literature. Spine (Phila Pa 1976). 1995 Dec 15;20(24 Suppl):126S-37S. Resumo
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007 May 31;356(22):2257-70.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Peripheral vascular disease
- Lumbosacral intervertebral disk herniation
- Spinal compression fracture
Mais Diagnósticos diferenciaisDiretrizes
- Natural course and diagnosis of lumbar spinal stenosis: WFNS Spine Committee recommendations
- ISSLS prize winner: consensus on the clinical diagnosis of lumbar spinal stenosis: results of an international delphi study
Mais DiretrizesFolhetos informativos para os pacientes
Spinal stenosis
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