Diagnostik und Therapie der lumbalen Spinalkanalstenose

Zusammenfassung

Die degenerative lumbale Spinalkanalstenose ist eine häufige Erkrankung mit steigender Prävalenz im höheren Lebensalter. Dabei führt die degenerative Veränderung eines Segmentes zur Einengung von Duralsack und Nervenwurzeln mit typischen Rücken- sowie Beinschmerzen und erheblicher Einschränkung der Lebensqualität und Mobilität der Patienten. Ziel dieser Übersichtsarbeit ist die Darstellung der Pathophysiologie und Diagnostik des Krankheitsbildes mit Evaluation der aktuellen therapeutischen Möglichkeiten mit ihren Limitationen und Erfolgsaussichten. Die modernen mikrochirurgischen Techniken erreichen eine suffiziente Dekompression des Spinalkanals bei deutlicher Reduktion der Invasivität. Aktuelle randomisierte Studien demonstrieren eine klare Überlegenheit der operativen gegenüber der konservativen Therapie; somit sollte diese auch älteren Patienten mit Komorbiditäten bei Versagen der konservativen Therapie angeboten werden. Die begleitende Fusion und Stabilisierung der Wirbelsäule wird nicht empfohlen, ohne dass begleitende höhergradige Instabilitäten oder Deformitäten vorliegen.

Summary

The degenerative lumbar stenosis demonstrates increasing prevalence in older patients. Subsequently to segment degeneration the dural sac and nerve root compression develop and typical symptoms of spinal claudication occur with limited walking distance and reduction in quality of life. The pathophysiology, diagnostic procedure and evaluation of therapeutic options including their limitations and clinical outcome will be discussed. Modern microscopic decompression techniques achieve sufficient decompression of the spinal canal while decreasing the risk of iatrogenic instability and minimize surgery related muscular trauma. Recent randomized studies demonstrated superiority of the surgical vs. non-surgical treatment and therefore surgical intervention should be offered also to older patients with comorbidities refractory to conservative treatment. Additional spinal fusion is not recommended in absence of spinal instabilities or deformities.

Schlüsselwörter

Spinalkanalstenose - Dekompression

Keywords

Spinal stenosis - decompression

• Literatur

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