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Le canal lombaire rétréci: clinique, diagnostic, évolution

Lumbar spinal stenosis: clinical signs, diagnosis, and course

  • Dossier Thématique
  • Published:
La Lettre de médecine physique et de réadaptation

Résumé

L’étroitesse du canal lombal peut être constitutionnelle ou secondaire à diverses pathologies ou dégénérescences qui favorisent un conflit contenant-contenu. Les manifestations cliniques d’un rétrécissement du canal lombal sont variables en fonction de la situation et du retentissement neurologique qui s’ensuit. La symptomatologie est faite d’une association de lombalgies, d’irradiation dans les membres inférieurs et de claudication intermittente neurogène, influencées par la position du rachis lombaire. Les troubles sensitifs ou moteurs qui sont associés sont pour leur part plus ou moins réversibles, et l’instabilité qui en résulte est un facteur de gravité. Les examens complémentaires radiologiques ou électrophysiologiques objectivent le diagnostic mais n’ont pas de valeur prédictive d’une éventuelle aggravation, ou récupération. L’évolution est le plus souvent faible et l’aggravation ne survient que dans moins de 25 % des cas. La décision thérapeutique doit prendre en compte l’état clinique et le degré de handicap autant que les comorbidités ou les attentes des patients, avant de s’orienter en fonction de la gravité vers un traitement médical ou chirurgical.

Abstract

Lumbar spinal stenosis can be congenital or acquired. Degenerative changes in the spine and other pathological processes can increase the number of symptoms related to the spinal canal’s narrowness. Various symptoms are induced by this conflict between container and contents. Low back pain, leg pain, numbness and paraesthesia may occur, along with neurological claudication. All clinical signs are influenced by the position of the lumbar spine. Objective neurological deficits relating to axonal alterations are frequently reported, and instability must be considered a factor that impacts severity. Radiological and electrophysiological exams are useful in diagnosis and localisation but do not predict outcome. In most cases, symptoms remains stable, and aggravation occurs in less than 20% of cases. Before choosing medical and surgical options, a therapeutic approach must consider many factors, including comorbidities, physical impairment and disability, and the wishes of patients.

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Authors and Affiliations

  1. Service MPR, Pitié-Salpêtrière, 83, boulevard de l’Hôpital, F-75651, Paris Cedex, France

    P. Dupont

  2. Service MPR, hôpital Sud-Francilien, F-91000, Evry, France

    P. Dupont

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  1. P. Dupont
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Correspondence to P. Dupont.

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Dupont, P. Le canal lombaire rétréci: clinique, diagnostic, évolution. Lett Med Phys Readapt 23, 3–7 (2007). https://doi.org/10.1007/s11659-007-0048-9

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  • DOI: https://doi.org/10.1007/s11659-007-0048-9

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