La stenosi lombare. Evidenze e clinica

Based on the anatomic location of the narrowing, lumbar spinal stenosis (LSS) can be classified as either central or lateral; based on the etiology it is classified as primary (less frequent) or secondary. The symptoms of LSS are posturedependent. A diagnostic strategy based on a combination of various clinical findings has a high diagnostic power. Morphologic examination of the spinal canal with CT or MRI scanning is essential to confirm the diagnosis; symptomatic spinal stenosis is not so much related to the crosssectional dimension of the osseous spinal canal as to the cross-sectional area of the dural sac. The natural history of LSS does not automatically lead to deterioration: usually its course is progressive and gradual. The treatment of LSS can be conservative (farmacological and physiotherapeutic) or surgical. In the literature there is no evidence of unanimous agreement about what is the best treatment, but there is agreement to some extent that it is better to start with a conservative approach, in particular in patients with mild to moderate symptoms. Surgery is clearly indicated in cases of cauda equine syndrome and in those with a rapidly deteriorating neurological status. In the first instance conservative may be directed at local lumbar impairments (orthotics, flexion exercises and flexion mobilisations, exercises to improve motor control, lumbar traction), and at local impairments ofadjacent joints, in particular the hip (maintaining extension range of motion). With regards to impairments of the condition in general), conservative treatment may be directed at obtaining a more correct and economic posture, especially by addressing adjacent areas, and at neurodynamic evaluation and treatment. To address disability and social participation simple programmes of aerobic and maintenance exercises are proposed as well as education, ergonomic advice and instructions regarding the correlation between symptoms on the one hand and postures and movements on the other hand, loosing weight if indicated, making the bed more confortable, and the use of supports during walking. To give an example of the conservative treatment of a patient with LSS a case report is illustrated.