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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(01): 009-017
DOI: 10.1055/s-0040-1712490
Artigo de Atualização
Coluna

Estenose degenerativa do canal lombar

Article in several languages: português | English
Sergio Hennemann 
1   Serviço de Ortopedia, Grupo da coluna, Hospital Mãe de Deus, Porto Alegre, RS, Brasil
,
Marcelo Rodrigues de Abreu 
2   Radiologia Musculoesquelética, Hospital Mãe de Deus, Porto Alegre, RS, Brasil
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Resumo

A estenose degenerativa do canal vertebral lombar é a causa mais frequente de dor lombar e/ou ciática no paciente idoso; sua epidemiologia, fisiopatogenia, manifestações e testes clínicos são revistos em ampla investigação bibliográfica atual. A importância da relação entre a clínica e o estudo por imagens, principalmente a ressonância magnética (RM), é ressaltada. Antes da indicação do tratamento, é necessário identificar a localização precisa da dor, bem como o diagnóstico diferencial entre a claudicação neurogênica e a vascular. O tratamento conservador associando medicações com as diversas técnicas fisioterápicas resolve o problema na maioria dos casos, já o teste terapêutico com os bloqueios, seja epidural, foraminal ou facetário, é realizado quando as dores não cedem com o tratamento conservador e antes da indicação da cirurgia. Os bloqueios costumam dar melhores resultados no alívio dos sintomas de ciatalgia e menos no quadro de claudicação neurogênica. A descompressão da cauda equina e/ou radicular associada ou não à artrodese é o padrão ouro quando a intervenção cirúrgica é necessária. A artrodese após a descompressão é necessária nos casos com instabilidade segmentar, como na espondilolistese degenerativa. Quando a estenose de canal acontece em múltiplos níveis e vem acompanhada de desvio de eixo, seja coronal e/ou sagital, deve ser realizada, além das descompressões e artrodese, a correção dos desvios de eixo, principalmente o eixo sagital, quando a correção da lordose lombar se impõe com técnicas que corrigem a lordose retificada para valores próximos à incidência pélvica.

Palavras-chave

artrodese - claudicação intermitente - descompressão - estenose - dor lombar


Publication History

Received: 12 November 2019

Accepted: 02 March 2020

Article published online:
23 July 2020

© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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