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Lumbale Spinalkanalstenose

Von der Diagnose bis zur richtigen Therapie

Lumbar spinal stenosis

From diagnosis to correct therapy

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Zusammenfassung

Die Zahl der Patienten mit der Diagnose Spinalkanalstenose steigt stetig. Dabei ist die Erwartungshaltung der Patienten groß. Bislang fehlen Studiendaten, welche Therapie wann angebracht ist. Die Behandlung ergibt sich meist aus der Erfahrung des Behandlers und dessen klinischem Schwerpunkt. Häufig korrelieren die in der Magnetresonanztomographie beschriebenen Befunde nicht mit den Beschwerden des Patienten. Meist sollte mit einem konservativen, am besten multimodalen Therapieansatz begonnen werden. Stärkere Schmerzen mit ausgeprägter Claudicatio-spinalis-Symptomatik, engem Spinalkanal und erfolgloser konservativer Therapie sollten operativ therapiert werden. Absolute Operationsindikationen wie ein Cauda-Konus-Syndrom sind selten. Ziel aller angewandten Operationsverfahren ist die Dekompression des Spinalkanals, ohne dabei die Stabilität des Bewegungssegments zu gefährden. Eine umfangreiche Dekompression kann auch eine zusätzliche Fusion notwendig machen.

Abstract

The number of patients with a diagnosis of lumbar spinal stenosis (LSS) is steadily increasing and the expectations of patients are high; however, valid data for an appropriate therapy are lacking. Treatment is mostly the result of the surgeon’s experience and the clinical focus. The findings in magnetic resonance imaging (MRI) often do not correlate with the patient’s symptoms. It is proposed that treatment should start with a conservative multimodal approach. Increased pain with neurogenic claudication symptoms under conservative treatment should be treated surgically. Absolute indications for surgery, such as a conus cauda syndrome are rare. The goal of all surgical procedures is to decompress the spinal canal without compromising the stability of the motion segment. This can also make an additional fusion necessary.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Benditz, J. Grifka und J. Matussek geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Orthopädische Klinik für die Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland

    A. Benditz, J. Grifka & J. Matussek

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  1. A. Benditz
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  2. J. Grifka
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  3. J. Matussek
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Correspondence to A. Benditz.

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Benditz, A., Grifka, J. & Matussek, J. Lumbale Spinalkanalstenose. Z. Rheumatol. 74, 215–225 (2015). https://doi.org/10.1007/s00393-014-1500-2

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  • DOI: https://doi.org/10.1007/s00393-014-1500-2

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