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Traitements chirurgicaux

Surgical treatments

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

Résumé

La sténose lombaire représente une pathologie fonctionnelle invalidante, fréquente chez les « seniors » sous la forme du « canal lombaire étroit dégénératif ». Mais qu’il s’agisse de compressions neurologiques liées à un rachis vieillissant ou à un « canal étroit constitutionnel », les principes stratégiques obéissent aux mêmes règles. Il faut mettre à part les rares cas de syndrome de la queue-de-cheval ou de troubles moteurs sévères qui posent d’emblée le problème d’une indication opératoire parfois urgente. La plupart du temps, le traitement chirurgical n’est envisagé qu’après un traitement médical bien conduit, en tenant compte de la gêne fonctionnelle du patient et en appréciant soigneusement les bénéfices et les risques de cette option thérapeutique. L’analyse radioclinique doit être rigoureuse afin de déterminer les niveaux de compression à traiter, pour décider de l’opportunité d’une décompression segmentaire ou étendue et gérer une éventuelle déstabilisation avérée ou potentielle.

Abstract

Spinal stenosis is a frequently occurring and severe functional disorder, mainly found in elderly patients with degenerative lumbar spine disease. The treatment strategy is the same used for degenerative and congenital stenosis. Severe and advancing neurological defects, including bladder dysfunction, may lead to emergency surgical decompression. In the majority of cases, surgical intervention only takes place after previous medical treatment. The functional status of the patient and the risks and benefits of surgery must be evaluated. Clinical and radiological analysis must be accurate to optimise the decision-making process and determine the best surgical options for decompression and stabilization.

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Authors and Affiliations

  1. Département de chirurgie orthopédique et traumatologique, Paris, France

    J. -Y. Lazennec, M. -A. Rousseau, H. Pascal-Mousselard & Y. Catonné

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  1. J. -Y. Lazennec
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  2. M. -A. Rousseau
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  3. H. Pascal-Mousselard
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  4. Y. Catonné
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Correspondence to J. -Y. Lazennec.

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Lazennec, J.Y., Rousseau, M.A., Pascal-Mousselard, H. et al. Traitements chirurgicaux. Lett Med Phys Readapt 23, 40–48 (2007). https://doi.org/10.1007/s11659-007-0056-9

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  • DOI: https://doi.org/10.1007/s11659-007-0056-9

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