Spirig José Miguel, Farshad Mazda
1 Wirbelsäulenchirurgie, Universitätsklinik Balgrist.
Praxis (Bern 1994). 2018 Jan;107(1):7-15. doi: 10.1024/1661-8157/a002863.
Spinal stenosis can be found in up to 80 % of individuals aged over 70 years. However, about 20 % of asymptomatic individuals demonstrate signs of spinal stenosis on MRI. The pathomechanism of central spinal stenosis is predominantly related to degenerative changes. Those eventually result in a progressive compression of the cauda equina. Patients who exhibit mild to moderate symptoms should undergo multimodal conservative treatment, such as patient education, pain medication, physiotherapy and epidural injections. Surgery should be evaluated in patients with severe symptoms, especially if conservative treatment fails after 3–6 months of trial. Clinically relevant motoric deficits or symptoms of cauda equina syndrome remain absolute indications for surgery.
在70岁以上的人群中，高达80%的人可发现存在椎管狭窄。然而，约20%无症状个体在磁共振成像（MRI）上显示出椎管狭窄的迹象。中央型椎管狭窄的发病机制主要与退行性改变有关。这些改变最终导致马尾神经进行性受压。出现轻至中度症状的患者应接受多模式保守治疗，如患者教育、止痛药物、物理治疗和硬膜外注射。对于症状严重的患者，尤其是在经过3 - 6个月的试验性保守治疗失败后，应评估手术治疗。临床相关的运动功能缺损或马尾神经综合征症状仍然是手术的绝对指征。
