Estenose do canal lombar : relação do equilíbrio sagital com a avaliação clínica = Lumbar canal stenosis: relationship with the sagittal balance and the clinical evaluation / Lumbar canal stenosis : relationship with the sagittal balance and the clinical evaluation
AUTOR(ES)
Paulo Tadeu Maia Cavali
FONTE
IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia
DATA DE PUBLICAÇÃO
30/07/2012
RESUMO
There is a great variation in the results of previous studies analyzing sagital alignment parameters (SAP) in normal individuals and in patients with degenerative diseases of the lumbar spine. Most studies associate SAP only with chronic lumbar pain, in groups of patients with different lumbar degenerative diseases, which makes it difficult to apply these data clinically both in diagnostic evaluation and in therapeutics. The objective of this prospective, diagnostic case-control study was to examine the relationship between sagittal balance parameters and different symptoms of spine disease in patients with lumbar canal stenosis (LCS) and controls and the same associations between subgroups of patients with different symptoms. We collected clinical history, clinical exam data from 23 patients with spinal stenosis and 17 healthy volunteers (controls). Magnetic resonance imaging (MRI) and x-rays allowed the measurement of sagittal axis parameters. The SAP analyzed were thoracic kyphosis, lumbar lordosis, sagittal axis, anterior-posterior listesis, total and regional lumbar-pelvic lordosis, sagittal axis in T1, T4 and T9, pelvic tilt, sacral slope, pelvic morphology, sacro-femoral angle, sacro-femoral distance and overhang. In the first phase of the study, SAP data were correlated between controls and patients, and in the second phase, the subgroups inside the group of patients with stenosis were compared for symptoms as lumbar pain, radiculopathy, neurogenic claudication and pain, measure by the visual analogue scale (VAS). In the first phase, it was observed that the stenosis patients presented lower values of total lumbopelvic lordosis (p = 0.006) and regional lordosis L1, L2 and L3 (p <0.026). Those with stenosis and radiculopathy also had higher values of pelvic tilt (p = 0.004) and lower values for total lumbopelvic lordosis and regional lordosis in L1 and L2 (p <0.05) than controls. All patients complaining of back pain had higher values of thoracic kyphosis (p = 0.035), regional lumbopelvic lordosis in L1 (p = 0.028), lower values for pelvic tilt (p = 0.029), sagittal T1 offset (p = 0.022), sacro-femoral distance (p = 0.014) and overhang (p = 0.035) compared to patients without the complaint. Patients with stenosis and radiculopathy were less prone to have regional lordosis in L2, L3 and L4 (p = 0.047, p = 0.047 and p = 0.023 respectively). In conclusion, this study shows that there are significant correlations between symptoms and sagittal axis parameters between patients with and without spinal canal stenosis and also in subgroups of the patients with stenosis with different complaints.These data indicate a better clinical interpretation of SAP, as well as suggest a better therapeutic approach.
ASSUNTO(S)
estenose espinal vértebras lombares dor lombar spinal stenosis lumbar vertebrae low back pain
ACESSO AO ARTIGO
http://libdigi.unicamp.br/document/?code=000879237Documentos Relacionados
- NATURAL HISTORY OF LUMBAR CANAL STENOSIS: CLINICAL ASPECTS AND SAGITTAL BALANCE
- Estenose degenerativa do canal lombar : correlação entre o índice de Oswestry e imagem de ressonância magnética = Degenerative lumbar spinal stenosis: correlation with Oswestry index and magnetic ressonance
- Evolução psicossomática e clínica de pacientes com estenose do canal lombar operados com sistema interespinhoso
- Estenose degenerativa do canal lombar
- LUMBAR SPINAL STENOSIS: EVALUATION OF PAIN AND LIFE QUALITY AFTER SURGICAL TREATMENT