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Erschienen in:

09.09.2022 | Spondylolisthese | CME

Lumbale Spinalkanalstenose

verfasst von: Prof. Dr. med. Christof Birkenmaier, Manuel Fuetsch

Erschienen in: Die Orthopädie | Ausgabe 11/2022

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Zusammenfassung

Die lumbale Spinalkanalstenose (LSS) stellt eine der häufigsten Behandlungsdiagnosen unter den degenerativen Wirbelsäulenerkrankungen dar, jedoch ist die Zuordnung entsprechender Beschwerden zu den typischen Bildbefunden einer LSS oft nicht klar. Die hohe Prävalenz von radiologischen Diagnosen einer LSS, ein hoher Prozentsatz an asymptomatischen/oligosymptomatischen LSS sowie die Existenz von Differenzialdiagnosen mit ähnlicher Symptomatik erschweren eine präzise Diagnose. Diese Situation hat Auswirkungen auf die Erfolgschancen insbesondere der operativen Therapien. Bei der operativen Dekompression wiederum existieren Fragen hinsichtlich der Verwendung von Implantaten/Fusionstechniken im Gegensatz zur alleinigen Dekompression und dies insbesondere in Fällen mit degenerativer Spondylolisthesis. Hier deuten neuere und qualitativ hochwertige Studien jedoch darauf hin, dass die alleinige Dekompression der umfangreicheren Versorgung durch Dekompression + Fusion nicht unterlegen ist.

Arnoldi CC, Brodsky AE, Cauchoix J, Crock HV, Dommisse GF, Edgar MA, Gargano FP, Jacobson RE, Kirkaldy-Willis WH, Kurihara A, Langenskiold A, Macnab I, McIvor GW, Newman PH, Paine KW, Russin LA, Sheldon J, Tile M, Urist MR, Wilson WE, Wiltse LL (1976) Lumbar spinal stenosis and nerve root entrapment syndromes. Definition and classification. Clin Orthop Relat Res 115:4–5

Schulitz K‑P, Wehling P, Assheuer J (1996) Die lumbale Wirbelkanalstenose. Dtsch Arztebl 93:A-3340–A-3345

Yabuki S, Fukumori N, Takegami M, Onishi Y, Otani K, Sekiguchi M, Wakita T, Kikuchi S, Fukuhara S, Konno S (2013) Prevalence of lumbar spinal stenosis, using the diagnostic support tool, and correlated factors in Japan: a population-based study. J Orthop Sci 18:893–900PubMedPubMedCentralCrossRef

Jensen RK, Jensen TS, Koes B, Hartvigsen J (2020) Prevalence of lumbar spinal stenosis in general and clinical populations: a systematic review and meta-analysis. Eur Spine J 29:2143–2163PubMedCrossRef

Tomkins-Lane C, Melloh M, Lurie J, Smuck M, Battie MC, Freeman B, Samartzis D, Hu R, Barz T, Stuber K, Schneider M, Haig A, Schizas C, Cheung JPY, Mannion AF, Staub L, Comer C, Macedo L, Ahn SH, Takahashi K, Sandella D (2016) ISSLS prize winner: consensus on the clinical diagnosis of lumbar spinal stenosis: results of an international Delphi study. Spine 41:1239–1246PubMedPubMedCentralCrossRef

Ohtori S, Yamashita M, Murata Y, Eguchi Y, Aoki Y, Ataka H, Hirayama J, Ozawa T, Morinaga T, Arai H, Mimura M, Kamoda H, Orita S, Miyagi M, Miyashita T, Okamoto Y, Ishikawa T, Sameda H, Kinoshita T, Hanaoka E, Suzuki M, Suzuki M, Aihara T, Ito T, Inoue G, Yamagata M, Toyone T, Kubota G, Sakuma Y, Oikawa Y, Inage K, Sainoh T, Sato J, Yamauchi K, Takahashi K (2014) Incidence of nocturnal leg cramps in patients with lumbar spinal stenosis before and after conservative and surgical treatment. Yonsei Med J 55:779–784PubMedPubMedCentralCrossRef

Lai MKL, Cheung PWH, Samartzis D, Cheung JPY (2022) Prevalence and definition of multilevel lumbar developmental spinal stenosis. Global Spine J 12(6):1084–1090PubMedCrossRef

Ferreira Mota Colares SP, Colares GM, Freire de Carvalho J, Ewerton Maia Rodrigues C (2021) High prevalence of metabolic syndrome in patients with lumbar spinal stenosis: association with diabetes and elevated body mass index. Isr Med Assoc J 23:766–772PubMed

Han MH, Lee DH, Park KS, Lee YS, Kim KT, Sung JK, Kim HK, Cho DC (2014) Risk factors and incidence for peripheral arterial disease in patients with typical lumbar spinal stenosis. Korean J Spine 11:183–187PubMedPubMedCentralCrossRef

10.

Papavero L, Ebert S, Marques CJ (2020) The prevalence of redundant nerve roots in patients with lumbar spinal stenosis is body position dependent: a retrospective observational study with repeated measures design in an upright MRI scanner. Neuroradiology 62:979–985PubMedPubMedCentralCrossRef

11.

Zhou Z, Jin Z, Zhang P, Shan B, Zhou Z, Zhang Y, Deng Y, Zhou X (2020) Correlation between dural sac size in dynamic magnetic resonance imaging and clinical symptoms in patients with lumbar spinal stenosis. World Neurosurg 134:e866–e873PubMedCrossRef

12.

Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G (2010) Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine 35:1919–1924PubMedCrossRef

13.

Barz C, Melloh M, Staub LP, Lord SJ, Merk HR, Barz T (2017) Reversibility of nerve root sedimentation sign in lumbar spinal stenosis patients after decompression surgery. Eur Spine J 26:2573–2580PubMedCrossRef

14.

Barz T, Melloh M, Staub LP, Lord SJ, Lange J, Röder CP, Theis JC, Merk HR (2010) Nerve root sedimentation sign: evaluation of a new radiological sign in lumbar spinal stenosis. Spine 35:892–897PubMedCrossRef

15.

Barz T, Staub LP, Melloh M, Hamann G, Lord SJ, Chatfield MD, Bossuyt PM, Lange J, Merk HR (2014) Clinical validity of the nerve root sedimentation sign in patients with suspected lumbar spinal stenosis. Spine J 14:667–674PubMedCrossRef

16.

Ko S (2018) Correlations between sedimentation sign, dural sac cross-sectional area, and clinical symptoms of degenerative lumbar spinal stenosis. Eur Spine J 27:1623–1628PubMedCrossRef

17.

Tomkins-Lane CC, Quint DJ, Gabriel S, Melloh M, Haig AJ (2013) Nerve root sedimentation sign for the diagnosis of lumbar spinal stenosis: reliability, sensitivity, and specificity. Spine 38:E1554–E1560PubMedCrossRef

18.

Wang G, Peng Z, Li J, Song Z, Wang P (2019) Diagnostic performance of the nerve root sedimentation sign in lumbar spinal stenosis: a systematic review and meta-analysis. Neuroradiology 61:1111–1121PubMedCrossRef

19.

Zhang L, Chen R, Liu B, Zhang W, Zhu Y, Rong L (2017) The nerve root sedimentation sign for differential diagnosis of lumbar spinal stenosis: a retrospective, consecutive cohort study. Eur Spine J 26:2512–2519PubMedCrossRef

20.

Zhang L, Chen R, Xie P, Zhang W, Yang Y, Rong L (2015) Diagnostic value of the nerve root sedimentation sign, a radiological sign using magnetic resonance imaging, for detecting lumbar spinal stenosis: a meta-analysis. Skelet Radiol 44:519–527CrossRef

21.

Suzuki K, Takatsu T, Inoue H, Teramoto T, Ishida Y, Ohmori K (1992) Redundant nerve roots of the cauda equina caused by lumbar spinal canal stenosis. Spine 17:1337–1342PubMedCrossRef

22.

Tsuji H, Tamaki T, Itoh T, Yamada H, Motoe T, Tatezaki S, Noguchi T, Takano H (1985) Redundant nerve roots in patients with degenerative lumbar spinal stenosis. Spine 10:72–82PubMedCrossRef

23.

Lee JH, Sim KC, Kwon HJ, Kim JW, Lee G, Cho SS, Choi SS, Leem JG (2019) Effectiveness of lumbar epidural injection in patients with chronic spinal stenosis accompanying redundant nerve roots. Medicine 98:e14490PubMedPubMedCentralCrossRef

24.

Cong L, Zhu Y, Yan Q, Tu G (2017) A meta-analysis on the clinical significance of redundant nerve roots in symptomatic lumbar spinal stenosis. World Neurosurg 105:95–101PubMedCrossRef

25.

Goldberg JL, Wipplinger C, Kirnaz S, Xia J, Sommer F, Meng A, Schwarz J, Giantini-Larsen A, Meaden RM, Sugino R, Gadjradj P, Medary B, Carnevale JA, Navarro R, Tsiouris AJ, Hussain I, Hartl R (2022) Clinical significance of redundant nerve roots in patients with lumbar stenosis undergoing minimally invasive tubular decompression. World Neurosurg 164:e868–e876PubMedCrossRef

26.

Kawasaki Y, Seichi A, Zhang L, Tani S, Kimura A (2019) Dynamic changes of cauda equina motion before and after decompressive laminectomy for lumbar spinal stenosis with redundant nerve roots: cauda equina activation sign. Global Spine J 9:619–623PubMedPubMedCentralCrossRef

27.

Jacobi S, Beynon A, Dombrowski SU, Wedderkopp N, Witherspoon R, Hébert JJ (2021) Effectiveness of conservative nonpharmacologic therapies for pain, disability, physical capacity, and physical activity behavior in patients with degenerative lumbar spinal stenosis: a systematic review and meta-analysis. Arch Phys Med Rehabil 102:2247–2260.e7PubMedCrossRef

28.

Amundsen T, Weber H, Nordal HJ, Magnaes B, Abdelnoor M, Lilleâs F (2000) Lumbar spinal stenosis: conservative or surgical management? A prospective 10-year study. Spine 25:1424–1435 (discussion 1435–1426)PubMedCrossRef

29.

Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE (2000) Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine 25:556–562PubMedCrossRef

30.

Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE (2005) Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine 30:936–943PubMedCrossRef

31.

Chang Y, Singer DE, Wu YA, Keller RB, Atlas SJ (2005) The effect of surgical and nonsurgical treatment on longitudinal outcomes of lumbar spinal stenosis over 10 years. J Am Geriatr Soc 53:785–792PubMedCrossRef

32.

Iguchi T, Kurihara A, Nakayama J, Sato K, Kurosaka M, Yamasaki K (2000) Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis. Spine 25:1754–1759PubMedCrossRef

33.

Kovacs FM, Urrutia G, Alarcon JD (2011) Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine 36:E1335–E1351PubMedCrossRef

34.

Ma XL, Zhao XW, Ma JX, Li F, Wang Y, Lu B (2017) Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: a system review and meta-analysis of randomized controlled trials. Int J Surg 44:329–338PubMedCrossRef

35.

Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, Johnson DR 2nd, Skidmore GA, Vessa PP, Dwyer JW, Puccio S, Cauthen JC, Ozuna RM (2004) A prospective randomized multi-center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1‑year results. Eur Spine J 13:22–31PubMedCrossRef

36.

Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, Johnson DR 2nd, Skidmore GA, Vessa PP, Dwyer JW, Puccio ST, Cauthen JC, Ozuna RM (2005) A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results. Spine 30:1351–1358PubMedCrossRef

37.

Brussee P, Hauth J, Donk RD, Verbeek AL, Bartels RH (2008) Self-rated evaluation of outcome of the implantation of interspinous process distraction (X-Stop) for neurogenic claudication. Eur Spine J 17:200–203PubMedCrossRef

38.

Verhoof OJ, Bron JL, Wapstra FH, van Royen BJ (2008) High failure rate of the interspinous distraction device (X-Stop) for the treatment of lumbar spinal stenosis caused by degenerative spondylolisthesis. Eur Spine J 17:188–192PubMedCrossRef

39.

Lonne G, Johnsen LG, Aas E, Lydersen S, Andresen H, Ronning R, Nygaard OP (2015) Comparing cost-effectiveness of X‑Stop with minimally invasive decompression in lumbar spinal stenosis: a randomized controlled trial. Spine 40:514–520PubMedCrossRef

40.

Lonne G, Johnsen LG, Rossvoll I, Andresen H, Storheim K, Zwart JA, Nygaard OP (2015) Minimally invasive decompression versus x‑stop in lumbar spinal stenosis: a randomized controlled multicenter study. Spine 40:77–85PubMedCrossRef

41.

Schmidt S, Franke J, Rauschmann M, Adelt D, Bonsanto MM, Sola S (2018) Prospective, randomized, multicenter study with 2‑year follow-up to compare the performance of decompression with and without interlaminar stabilization. J Neurosurg Spine 28:406–415PubMedCrossRef

42.

Austevoll IM, Hermansen E, Fagerland MW, Storheim K, Brox JI, Solberg T, Rekeland F, Franssen E, Weber C, Brisby H, Grundnes O, Algaard KRH, Böker T, Banitalebi H, Indrekvam K, Hellum C (2021) Decompression with or without fusion in degenerative lumbar spondylolisthesis. N Engl J Med 385:526–538PubMedCrossRef

43.

Forsth P, Olafsson G, Carlsson T, Frost A, Borgstrom F, Fritzell P, Ohagen P, Michaelsson K, Sanden B (2016) A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 374:1413–1423PubMedCrossRef

44.

Joelson A, Nerelius F, Holy M, Sigmundsson FG (2022) Reoperations after decompression with or without fusion for L3–4 spinal stenosis with degenerative spondylolisthesis: a study of 372 patients in Swespine, the national Swedish spine register. Clin Spine Surg 35:E389–E393PubMedCrossRef

45.

Joelson A, Nerelius F, Holy M, Sigmundsson FG (2021) Reoperations after decompression with or without fusion for L4–5 spinal stenosis with or without degenerative spondylolisthesis: a study of 6,532 patients in Swespine, the national Swedish spine register. Acta Orthop 92:264–268PubMedPubMedCentralCrossRef

46.

Roussouly P, Berthonnaud E, Dimnet J (2003) Geometrical and mechanical analysis of lumbar lordosis in an asymptomatic population: proposed classification. Rev Chir Orthop Reparatrice Appar Mot 89:632–639PubMed

47.

Farcy JP, Schwab FJ (1997) Management of flatback and related kyphotic decompensation syndromes. Spine 22:2452–2457PubMedCrossRef

48.

Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029PubMedCrossRef

49.

Kumar MN, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319PubMedPubMedCentralCrossRef

50.

Lazennec JY, Ramare S, Arafati N, Laudet CG, Gorin M, Roger B, Hansen S, Saillant G, Maurs L, Trabelsi R (2000) Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 9:47–55PubMedPubMedCentralCrossRef

51.

Videbaek TS, Bünger CE, Henriksen M, Neils E, Christensen FB (2011) Sagittal spinal balance after lumbar spinal fusion: the impact of anterior column support results from a randomized clinical trial with an eight- to thirteen-year radiographic follow-up. Spine 36:183–191PubMed

Titel: Lumbale Spinalkanalstenose
verfasst von: Prof. Dr. med. Christof Birkenmaier
Manuel Fuetsch
Publikationsdatum: 09.09.2022
Verlag: Springer Medizin
Schlagwörter: Spondylolisthese
Spinalkanalstenose
Erschienen in: Die Orthopädie / Ausgabe 11/2022
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI: https://doi.org/10.1007/s00132-022-04297-8

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