When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Spinal stenosis

Última revisão: 13 Jul 2025
Última atualização: 14 Dec 2021

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
Detalhes completos

Outros fatores diagnósticos

  • pain radiating down the leg
  • bladder or bowel dysfunction
  • muscle weakness or wasting
Detalhes completos

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
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • plain x-ray
  • MRI (T2-weighted)
Detalhes completos

Investigações a serem consideradas

  • CT myelography
  • CT spine
  • electromyographic (EMG) walking test
  • electromyographic paraspinal mapping
Detalhes completos

Algoritmo de tratamento

AGUDA

significant acute neurologic deficit

no significant acute neurologic deficit: pain affecting quality of life and/or functional activities

CONTÍNUA

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

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

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 diferenciais
  • Diretrizes

    • 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 Diretrizes
  • Folhetos informativos para os pacientes

    Spinal stenosis

    Mais Folhetos informativos para os pacientes
  • padlock-lockedConectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal