Claudicación neurogénica como manifestación de conducto lumbar estrecho: claves en su abordaje diagnóstico y terapéutico.

Palabras clave: Claudicación, conducto lumbar estrecho, médula espinal, historia clínica, semiología, canal vertebral

Resumen

La estenosis del conducto lumbar consiste en una condición donde la luz de este canal vertebral central sufre un estrechamiento con múltiples causas de origen como enfermedades degenerativas, traumas, envejecimiento, enfermedades reumatológicas, entre otras, en donde secundario a la formación de osteofitos o inflamación del ligamento amarillo que cubre los espacios entre las láminas de las vértebras, se genera una reducción del diámetro del conducto y posteriormente una compresión de las raíces nerviosas de la médula espinal. El síntoma patognomónico de esta entidad es la claudicación neurogénica, es importante conocer las características propias de la enfermedad realizando un abordaje ordenado por medio de una historia clínica completa y usando todas las herramientas semiológicas posibles dado que sus síntomas pueden confundirse con otras enfermedades. El enfoque correcto del paciente es la clave para realizar intervenciones efectivas y evita el uso innecesario de recursos.

Palabras clave: Claudicación, conducto lumbar estrecho, medula espinal, historia clínica, semiología, canal vertebral.

Abstract:

Lumbar spinal stenosis consists in the reduction of the lumbar spinal size due to multiple causes such as degenerative diseases, trauma, aging, rheumatic diseases, among others. The formation of the osteophytes or ligamentum flavum inflammation, which connects the laminae of adjacent vertebrae, generates shrinkage of the diameter of the spinal canal which in turn compresses the spinal nerve roots. The pathognomonic symptom of this condition is neurogenic claudication, it is important to recognize the intrinsic characteristics of the disease by making an organized approach based on a proper medical history and using as many semiological tools as possible because the symptoms might be mistaken for other diseases. The key to make effective interventions and avoiding wasteful use of resources, is the correct approach to the patient.

Key words: Claudication, spinal stenosis, spinal cord, medical history, semiology, vertebral canal.

Biografía del autor/a

Andres Ricaurte-Fajardo, Pontificia Universidad Javeriana Bogotá (Colombia).

Médico interno, Facultad de Medicina, Pontificia Universidad Javeriana Bogotá (Colombia), Semillero de Neurología y Neurocirugía, Departamento de Neurociencias, Hospital Universitario San Ignacio Bogotá (Colombia).

Juan Sebastian Ricaurte, Pontificia Universidad Javeriana Cali (Colombia).

Estudiante de Medicina Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali (Colombia).

Juan Diego Serrano, Pontificia Universidad Javeriana Bogotá (Colombia).

Estudiante de Medicina Pontificia Universidad Javeriana Bogotá (Colombia).

Citas

Aceves Perez A. Diagnóstico diferencial en la estenosis espinal lumbar. Orthotips. 2018; 14 (1):17-21.

Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med. 2008; 358:818. DOI: 10.1056/NEJMcp0708097

Johnsson KE, Rosén I, Udén A. The natural course of lumbar spinal stenosis. Clin Orthop Relat Res. 1992; 82. DOI: 10.3109/17453679309160122

Schroeder G,Kurd M,Vaccaro A. Lumbar Spinal Stenosis: How Is It Classified? J Am Acad Orthop Surg. 2016; 24(12):843-852. DOI: 10.5435/JAAOS-D-15-00034

Ciol MA, Deyo RA, Howell E, Kreif S. An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc. 1996; 44:285-90. DOI: 10.1111/j.1532-5415.1996.tb00915.x

Deyo RA, Mirza SK, Martin BI. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010; 303:1259-65. DOI: 10.1001/jama.2010.338

Wu AM, Zou F, Cao Y, Xia D, He W, Zhu B et al. Lumbar spinal stenosis: an update on the epidemiology, diagnosis and treatment. AME Med J. 2017; 2:63. DOI: 10.21037/amj.2017.04.13

Thomas SA. Spinal stenosis: history and physical examination. Phys Med Rehabil Clin N Am. 2003; 14(1): 29-39. DOI: 10.1016/ S1047-9651(02)00049-9

Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016; 352:h6234. DOI: 10.1136/bmj.h6234

Andreisek G, Imhof M, Wertli M, Winklhofer S, Pfirrmann CW, Hodler J et al. A systematic review of semiquantitative and qualitative radiologic criteria for the diagnosis of lumbar spinal stenosis. Am J Roentgenol. 2013; 201:W735-46. DOI: 10.2214/AJR.12.10163

Binder DK, Schmidt MH, Weinstein PR. Lumbar spinal stenosis. Semin Neurol. 2002; 22(2):157-66. DOI: 10.1055/s-2002-36539

Swartz KR, Fee DB, Trost GR, Waclawik AJ. Unilateral calf hypertrophy seen in lumbosacral stenosis: case report and review of the literature. Spine. 2002; 27(18): E406-9.

Buser Z, Ortega B, D’Oro A, Pannell W, Cohen JR, Wang J, Golish R, Reed M, Wang JC. Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America. Global Spine J. 2018; 8(1):57-67. DOI: 10.1177/2192568217696688

Katz JN, Dalgas M, Stucki G, Katz NP, Bayley J, Fossel AH, Chang LC, Lipson SJ. Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Arthritis Rheum. 1995; 38(9):1236-41. DOI: 10.1002/art.1780380910

Genevay S, Atlas SJ, Katz JN. Variation in eligibility criteria from studies of radiculopathy due to a herniated disc and of neurogenic claudication due to lumbar spinal stenosis: a structured literature review. Spine. 2010; 35:803-11. DOI: 10.1097/ BRS.0b013e3181bc9454

De Schepper EI, Overdevest GM, Suri P, Peul WC, Oei EH, Koes BW et al. Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976). 2013; 38:E469-81. DOI: 10.1097/BRS.0b013e31828935ac

Steurer J, Roner S, Gnannt R, Hodler J et al. Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord. 2011; 12:175. DOI:10.1186/1471-2474-12-175

Wassenaar M, van Rijn RM, van Tulder MW, Verhagen AP, van der Windt DA, Koes BW et al. Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. Eur Spine J. 2012; 21:220-7. DOI: 10.1007/s00586-011-2019-8

Andreisek G, Deyo RA, Jarvik JG, Porchet F, Winklhofer SF, Steurer J et al. Consensus conference on core radiological parameters to describe lumbar stenosis -an initiative for structured reporting. Eur Radiol. 2014; 24:3224-32. DOI: 10.1007/s00330-014-3346-z

De Graaf I, Prak A, Bierma-Zeinstra S, Thomas S, Peul W, Koes B. Diagnosis of lumbar spinal stenosis: a systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976). 2006; 31:1168- 76. DOI: 10.1097/01.brs.0000216463.32136.7b

Bolender NF, Schönström NS, Spengler DM. Role of computed tomography and myelography in the diagnosis of central spinal stenosis. J Bone Joint Surg Am. 1985; 67:240-6.

Jacobson RE. Lumbar stenosis. An electromyographic evaluation. Clin Orthop Relat Res. 1976; 68-71.

Plastaras CT. Electrodiagnostic challenges in the evaluation of lumbar spinal stenosis. Phys Med Rehabil Clin N Am. 2003; 14:57-69. DOI: 10.1016/S1047-9651(02)00050-5

Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update) Spine J. 2013; 13(7):734-743. DOI: 10.1016/j.spinee.2012.11.059

Atlas SJ, Delitto A. Spinal stenosis: surgical versus nonsurgical treatment. Clin Orthop Relat Res. 2006; 443:198. DOI: 10.1097/01.blo.0000198722.70138.96

Miramontes Martínez V, Rosales Olivares L, Reyes-Sánchez A. Tratamiento quirúrgico del conducto lumbar estrecho Rev Mex Ortop Traum. 2002; 16(2):70-5.

Krebs EE, Lurie JD, Fanciullo G, Tosteson TD, Blood EA, Carey TS et al. Predictors of long-term opioid use among patients with painful lumbar spine conditions. J Pain. 2010; 11(1): 44-52. DOI: 10.1016/j.jpain.2009.05.007

Goren A, Yildiz N, Topuz O, Findikoglu G, Ardic F. Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: a prospective randomized controlled trial. Clin Rehabil. 2010; 24(7):623-31. DOI: 10.1177/0269215510367539

Koc Z, Ozcakir S, Sivrioglu K, Gurbet A, Kucukoglu S. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine. 2009; 34(10): 985-9. DOI: 10.1097/BRS.0b013e31819c0a6b

Cuckler JM, Bernini PA, Wiesel SW, Booth RE Jr, Rothman RH, Pickens GT. The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study. J Bone Joint Surg Am. 1985; 67(1):63-66.

Fukusaki M, Kobayashi I, Hara T, Sumikawa K. Symptoms of spinal stenosis do not improve after epidural steroid injection. Clin J Pain. 1998; 14(2):148-151.

Koc Z, Ozcakir S, Sivrioglu K, Gurbet A, Kucukoglu S. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine. 2009; 34(10):985-989. DOI: 10.1097/BRS.0b013e31819c0a6b

Papagelopoulos PJ, Petrou HG, Triantafyllidis PG, Vlamis JA, Psomas-Pasalis M, Korres DS et al. Treatment of lumbosacral radicular pain with epidural steroid injections. Orthopedics. 2001; 24(2):145-149.

Levendoglu, F, Oǧuz H, Polat E, Bodur S. The Effect of Corset on Walking Time in Lumbar Spinal Stenosis. Turkiye Klinikleri Tip Bilimleri Dergisi. 2009; 29(5):1172-1177.

Prateepavanich, P, Thanapipatsiri S, Santisatisakul P, Somshevita P, Charoensak T. The effectiveness of lumbosacral corset in symptomatic degenerative lumbar spinal stenosis. J Med Assoc Thai. 2001; 84(4):572-6.

Hall S, Bartleson JD, Onofrio BM, Baker HL Jr, Okazaki H, O’Duffy JD. Lumbar spinal stenosis. Clinical features, diagnostic procedures, and results of surgical treatment in 68 patients. Ann Intern Med. 1985; 103:271. DOI: 10.7326/0003-4819-103-2-271

Santos Coto C, Rivas Hernández R, Fleites Marrero E. Tratamiento quirúrgico de la estenosis del canal lumbar. Rev Cubana Ort Traumatol. 2009; 23(1):25-31

Gelalis ID, Stafilas KS, Korompilias AV, Zacharis KC, Beris AE, Xenakis TA. Decompressive surgery for degenerative lumbar spinal stenosis: long-term results. Int Orthop. 2006; 30:59-63. DOI: 10.1007/s00264-005-0030-6

Kanbara S, Yukawa Y, Ito K, Machino M, Kato F. Surgical outcomes of modified lumbar spinous process-splitting laminectomy for lumbar spinal stenosis. J Neurosurg Spine. 2015; 22:353-7. DOI: 10.3171/2014.9.SPINE1457

Hong SW, Choi KY, Ahn Y, Baek OK, Wang JC, Lee SH et al. A comparison of unilateral and bilateral laminotomies for decompression of L4-L5 spinal stenosis. Spine. 2011; 36:E172-8. DOI: 10.1097/BRS.0b013e3181db998c

Baghdadi YM, Moussallem CD, Shuaib MA, Clarke MJ, Dekutoski MB, Nassr AN. Lumbar spinous process-splitting laminoplasty: a novel technique for minimally invasive lumbar decompression. Orthopedics 2016; 39:e950-6. DOI: 10.3928/01477447-20160616-03

Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008; 358(8):794-810. DOI: 10.1056/NEJMoa0707136

Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J. Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine. 2007; 32(1):1-8. DOI: 10.1097/01.brs.0000251014.81875.6d

Arinzon ZH, Fredman B, Zohar E, Shabat S, Feldman JS, Jedeikin R et al. Surgical management of spinal stenosis: a comparison of immediate and long term outcome in two geriatric patient populations. Arch Gerontol Geriatr. 2003; 36(3): 273-9. DOI: 10.1016/S0167-4943(02)00172-3

Wu AM, Tong TJ, Wang XY. A rethink of fusion surgery for lumbar

spinal stenosis. J Evid Based Med. 2016; 9:166-9. DOI: 10.1111/

jebm.12215

Greenway FE, Papadopoulos MC. Fusion surgery for lumbar spinal stenosis? J Spine Surg. 2016; 2:154-7. DOI: 10.21037/jss.2016.06.08

Sclafani JA, Kim CW. Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review. Clin Orthop Relat Res. 2014; 472:1711-7. DOI: 10.1007/s11999-014-3495-z

Nunley PD, Shamie AN, Blumenthal SL, Orndorff D, Block JE, Geisler FH. Interspinous process decompression: expanding treatment options for lumbar spinal stenosis. Biomed Res Int. 2016; 2016:3267307. DOI: 10.1155/2016/3267307

Beyer F,Yagdiran A,Neu P, Kaulhausen T, Eysel P, Sobottke R et al. Percutaneous interspinous spacer versus open decompression: a 2-year follow-up of clinical outcome and quality of life. Eur Spine J. 2013; 22:2015-21. DOI: 10.1007/s00586-013-2790-9

Richter A, Halm HF, Hauck M, Quante M. Two-year follow-up after decompressive surgery with and without implantation of an interspinous device for lumbar spinal stenosis: a prospective controlled study. J Spinal Disord Tech. 2014; 27:336-41. DOI:10.1097/BSD.0b013e31825f7203

Publicado
2020-01-24
Cómo citar
Ricaurte-Fajardo, A., Ricaurte, J., & Serrano, J. (2020). Claudicación neurogénica como manifestación de conducto lumbar estrecho: claves en su abordaje diagnóstico y terapéutico. Salutem Scientia Spiritus, 5(2), 21-26. Recuperado a partir de https://revistas.javerianacali.edu.co/index.php/salutemscientiaspiritus/article/view/2141