Lumbale Spinalkanalstenose

Schulte, Tobias L.; Bullmann, Viola; Lerner, Thomas; Schneider, Michael J.; Marquardt, B.; Liljenqvist, Ulf; Pietilä, Terttu; Hackenberg, Lars

doi:10.1007/s00132-006-0971-5

Cited by 36 publications

(27 citation statements)

References 89 publications

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“…Patients with symptomatic degenerative central LSS with relevant spinal claudication who did not improve after intensive conservative treatment in accordance with international guidelines and recommendations [21,25,34] for at least 3 months were included consecutively. Conservative multimodal treatment comprised physiotherapy (including flexion exercises and traction), physical therapies, strengthening exercises, back schools, braces, medication, infiltration therapies (e.g., epidural steroid injections), patient information about the characteristics and course of the disease, cognitive behavioural therapy and electrical stimulation therapy on an individual basis.…”

Section: Methodsmentioning

confidence: 99%

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Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

et al. 2010

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Symptomatic degenerative central lumbar spinal stenosis (LSS) is a frequent indication for decompressive spinal surgery, to reduce spinal claudication. No data are as yet available on the effect of surgery on the level of activity measured with objective long-term monitoring. The aim of this prospective, controlled study was to objectively quantify the level of activity in central LSS patients before and after surgery, using a continuous measurement device. The objective data were correlated with subjective clinical results and the radiographic degree of stenosis. Forty-seven patients with central LSS and typical spinal claudication scheduled for surgery were included. The level of activity (number of gait cycles) was quantified for 7 consecutive days using the StepWatch Activity Monitor (SAM). Visual analogue scales (VAS) for back and leg pain, Oswestry disability index and RolandMorris score were used to assess the patients' clinical status. The patients were investigated before surgery and 3 and 12 months after surgery. In addition, the radiographic extent of central LSS was measured digitally on preoperative magnetic resonance imaging or computed tomography. The following results were found preoperatively: 3,578 gait cycles/day, VAS for back pain 5.7 and for leg pain 6.5. Three months after surgery, the patients showed improvement: 4,145 gait cycles/day, VAS for back pain 4.0 and for leg pain 3.0. Twelve months after surgery, the improvement continued: 4,335 gait cycles/day, VAS for back pain 4.1 and for leg pain 3.3. The clinical results and SAM results showed significant improvement when preoperative data were compared with data 3 and 12 months after surgery. The results 12 months after surgery did not differ significantly from those 3 months after surgery. The level of activity correlated significantly with the degree of leg pain. The mean cross-sectional area of the spinal canal at the central LSS was 94 mm 2 . The radiographic results did not correlate either with objective SAM results or with clinical outcome parameters. In conclusion, this study is the first to present objective data on continuous activity monitoring/measurements in patients with central LSS. The SAM could be an adequate tool for performing these measurements in spine patients. Except for leg pain, the objective SAM results did not correlate with the clinical results or with the radiographic extent of central LSS.

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Section: Methodsmentioning

confidence: 99%

“…Symptomatic degenerative central lumbar spinal stenosis (LSS) is one of the most frequent indications for spinal decompressive surgery [25,29]. Spinal claudication is the main symptom in these patients, who are usually older [33,39].…”

Section: Introductionmentioning

confidence: 99%

Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

et al. 2010

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“…Undercutting decompression is a standard procedure in the therapy of lumbar spinal stenosis [3,4,13,21,25]. Accompanying segmental instability may occur, which is caused either by degenerative segmental disease involving the intervertebral disc, the zygapophysial joints and ligaments, or as a consequence of the surgical decompression itself [7,8,15,17].…”

Section: Introductionmentioning

confidence: 99%

The effect of dynamic, semi-rigid implants on the range of motion of lumbar motion segments after decompression

et al. 2008

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Undercutting decompression is a common surgical procedure for the therapy of lumbar spinal canal stenosis. Segmental instability, due to segmental degeneration or iatrogenic decompression is a typical problem that is clinically addressed by fusion, or more recently by semirigid stabilization devices. The objective of this experimental biomechanical study was to investigate the influence of spinal decompression alone, as well as in conjunction with two semi-rigid stabilizing implants (Wallis, DynesysÒ) on the range of motion (ROM) of lumbar spine segments. A total of 21 fresh-frozen human lumbar spine motion segments were obtained. Range of motion and neutral zone (NZ) were measured in flexion-extension (FE), lateral bending (LAT) and axial rotation (ROT) for each motion segment under four conditions: (1) with all stabilizing structures intact (PHY), (2) after bilateral undercutting decompression (UDC), (3) after additional implantation of Wallis (UDC-W) and (4) after removal of Wallis and subsequent implantation of DynesysÒ (UDC-D). Measurements were performed using a sensor-guided industrial robot in a pure-moment-loading mode. Range of motion was defined as the angle covered between loadings of -5 and +5 Nm during the last of three applied motion cycles. Untreated physiologic segments showed the following mean ROM: FE 6.6°, LAT 7.4°, ROT 3.9°. After decompression, a significant increase of ROM was observed: 26% FE, 6% LAT, 12% ROT. After additional implantation of a semirigid device, a decrease in ROM compared to the situation after decompression alone was observed with a reduction of 66 and 75% in FE, 6 and 70% in LAT, and 5 and 22% in ROT being observed for the Wallis and DynesysÒ, respectively. When the flexion and extension contribution to ROM was separated, the Wallis implant restricted extension by 69% and flexion by 62%, the DynesysÒ by 73 and 75%, respectively. Compared to the intact status, instrumentation following decompression led to a ROM reduction of 58 and 68% in FE, 1 and 68% in LAT, -6 and 13% in ROT, 61 and 65% in extension and 54 and 70% in flexion for Wallis and DynesysÒ. The effect of the implants on NZ corresponded to that on ROM. In conclusion, implantation of the Wallis and DynesysÒ devices following decompression leads to a restriction of ROM in all motion planes investigated. Flexion-extension is most affected by both implants. The DynesysÒ implant leads to an additional strong restriction in lateral bending. Rotation is only mildly affected by both implants. Wallis and DynesysÒ restrict not only isolated extension, but also flexion. These biomechanical results support the hypothesis that postoperatively, the semirigid implants provide a primary stabilizing function directly. Whether they can improve the clinical outcome must still be verified in prospective clinical investigations.

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“…Diese Begriffe sind aber in Bezug auf ihre klinische Relevanz bislang nicht eindeutig validiert [6] Diese Empfehlung beruht auf der Untersuchung von asymptomatischen Individuen über 60 Jahren, bei welchen die MRT bei 57% pathologische Befunde zeigte. Bei 36% konnte ein Bandscheibenvorfall und bei 21 % eine SKS nachgewiesen werden [15].…”

Section: Praxisunclassified

Lumbale Spinalkanalstenose – Claudicatio spinalis. Pathophysiologie, Klinische Aspekte und Therapie

Cadosch

Gautschi

Fournier

et al. 2008

Praxis

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The lumbar spinal stenosis (LSS) is defined as a narrowing of the spinal canal together with neuronal and vascular structures via circumjacent bone and soft tissue. In patients aged over 65 years, the LSS is among the most frequent causes of lumbago, either with or without sciatica. The prevalence will continue to augment because of the increased life expectancy. The leading symptom is neurogenic claudicatio with lumbogluteal or sciatic pain, which occurs while walking and leads to a limitation of the walking distance. Its typical constellation of symptoms including subjective leg weakness is leading to the tentative diagnosis. Nowadays, the imaging technique of choice for the diagnosis is magnetic resonance imaging. A conservative treatment is initially sufficient in most cases. The indication for surgery is given, if the pain and limitation of walking distance are not tolerable any more. Additional fusion should be taken into account, when degenerative spondylolisthesis or other pathomorphological alterations result in an instability. Conservative and surgical therapeutic goals imply pain relief, amelioration of the physical functionality, mobility and general quality of life.

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Lumbale Spinalkanalstenose

Cited by 36 publications

References 89 publications

Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

The effect of dynamic, semi-rigid implants on the range of motion of lumbar motion segments after decompression

Lumbale Spinalkanalstenose – Claudicatio spinalis. Pathophysiologie, Klinische Aspekte und Therapie

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