Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- início e duração dos sintomas
- dorsalgia
- dorsalgia relacionada a atividades físicas
- dor nas pernas ao andar
- postura recurvada ao andar
- dormência nas pernas ou parestesia
- ausência de achados nos exames
Other diagnostic factors
- dor que se irradia para as pernas
- disfunção da bexiga ou do intestino
- fraqueza ou desgaste muscular
Risk factors
- idade >40 anos
- trabalho manual
- cirurgia prévia das costas
- histórico familiar de dorsalgia
- tabagismo
- diabetes mellitus
- doença vascular periférica oclusiva
- lesão prévia
- acondroplasia
- acromegalia
Diagnostic tests
1st tests to order
- radiografia simples
- RNM (ponderada em T2)
Tests to consider
- mielotomografia
- tomografia computadorizada (TC) da coluna vertebral
- teste de marcha com eletromiografia (EMG)
- mapeamento paraespinhal por eletromiografia
Treatment algorithm
deficit neurológico agudo significativo
sem deficit neurológico agudo significativo: dor afetando a qualidade de vida e/ou as atividades funcionais
sintomas crônicos
Contributors
Authors
Michael David Tseng MD, MD
Clinical Assistant Professor
Department of Orthopaedic Surgery
Stanford University School of Medicine
Stanford
CA
Disclosures
MDT declares that he has no competing interests.
Acknowledgements
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.
Disclosures
WAA and AMP are authors of references cited in this topic. JKH and MC declared that they had no competing interests.
Peer reviewers
John Ratliff, MD, FAANS, FACS
Associate Professor
Department of Neurosurgery
Stanford University
Stanford
CA
Disclosures
JR declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res. 1982 May;(165):110-23. Abstract
Jane JA Sr, Jane JA Jr, Helm GA, et al. Acquired lumbar spinal stenosis. Clin Neurosurg. 1996;43:275-99. Abstract
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.Full text Abstract
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. Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Doença vascular periférica
- Hérnia de disco intervertebral lombossacral
- Fratura por compressão vertebral
More DifferentialsGuidelines
- 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
More Guidelines患者教育信息
Estenose da coluna vertebral
更多 患者教育信息
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