Klassifikation und Therapieempfehlung der lumbalen Spinalkanalstenose

Aufgrund der Alterung der Gesellschaft ist die lumbale Spinalkanalstenose mittlerweile eine der häufigsten wirbelsäulenchirurgischen Diagnosen. Betroffen ist am häufigsten das Wirbelsäulensegment LW 4/5. Nach Ausschöpfen der konservativen Therapie ist die Dekompression des Spinalkanals indiziert, ggf. – bei Instabilität – auch eine fusionierende Operation. Im Rahmen dieser Übersichtsarbeit sollen das Erkrankungsbild der Spinalkanalstenose umfassend dargestellt und die diversen Therapieoptionen aufgezeigt werden.

Abstract

A lumbar spinal canal stenosis is defined by a reduction of the diameter of the spinal canal of the lumbar and lumbosacral spine. The stenosis mostly is caused by degenerative processes. As spinal degeneration is related to age, the incidence of lumbar spinal canal stenosis is increasing with the aging society. The typical complaints are stress-related leg pain. Frequently, back pain and pseudoradicular leg pain are also reported, because the development of a spinal canal stenosis is accompanied by mostly transient segmental instability and even degenerative spondylolisthesis. Today, magnetic resonance imaging is the diagnostic tool of choice, followed or accompanied by computed tomography (CT). If conservative management fails, bilateral decompression of the spinal canal either via a unilateral laminotomy and undercutting to the contralateral side or via a bilateral laminotomy are the surgical treatment options of the first choice. Non-direct decompression by interspinous devices should only be considered in those rare cases in which general anesthesia is contraindicated. Facet blocks might play a therapeutic role in patients with dominant back or pseudoradicular leg pain. Even if the spinal canal stenosis is combined with a degenerative spondylolisthesis, fusion is rarely indicated.

Schlüsselwörter

Wirbelkanal - Nervenkompression - Rückenschmerzen - Lendenwirbelsäule - lumbosakrale Wirbelsäule

Keywords

spinal canal - nerv compression - back pain - lumbar spine - lumbosacral spine

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