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Spinal stenose

Sist revidert:
Sist revidert av:

Definisjon:
En innsnevring i spinalkanalen med risiko for trykk mot medulla spinalis (ved cervikal eller thorakal spinal stenose) eller nerverøtter (lumbalt)
Forekomst:
Hyppig tilstand hos voksne. Symptomatisk spinal stenose opptrer oftest hos eldre personer over 65 år
Symptomer:
Kan være asymptomatisk. Kardinalsymptomene er ryggsmerte eller ubehag under gange eller i stående stilling, som stråler ut i sete og ned i lår, legg eller føtter (nevrogen claudicatio). Ofte økende symptomintensitet ved gange nedover bakke der ryggen ekstenderes og lumbale plassforhold blir trangere. Bedring i sittende stilling
Funn:
Nevrologiske funn er sjeldne, noe fremoverlutet holdning under gange
Diagnostikk:
Aktuelle tilleggsundersøkelser er MR og CT
Behandling:
Konservativ behandling i de fleste tilfeller: informasjon, manuell terapi, fysioterapi, ev. akupunktur. Ev. med. behandlingsforsøk med SNRI eller trisyklisk antidepressivum. Tradisjonelle analgetika frarådes. Kirurgisk behandling kan vurderes ved uttalte symptomer som ikke responderer på konservativ terapi 
  • Nasjonal kompetansetjeneste for kirurgisk behandling av rygg- og nakkesykdommer - nettside 
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  8. Konno S, Hayashino Y, Fukuhara S, et al. Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis. Eur Spine J 2007; 16: 1951-7. PubMed  
  9. Suri P, Rainville J, Kalichman L, Katz JN. Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis. JAMA 2010; 304: 2628-36. Journal of the American Medical Association  
  10. Hsiang JK. Spinal stenosis. Medscape, last updated Mar 26, 2020. emedicine.medscape.com  
  11. de Graaf I, Prak A, Bierma-Zeinstra S, Thomas S, Peul W, Koes B. Diagnosis of lumbar spinal stenosis: a systematic review of the accuracy of diagnostic tests. Spine 2006; 31: 1168-76. PubMed  
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  15. Hermansen E, Myklebust TÅ, Austevoll IM, et al. Clinical outcome after surgery for lumbar spinal stenosis in patients with insignificant lower extremity pain. A prospective cohort study from the Norwegian registry for spine surgery. BMC Musculoskelet Disord. 2019 Jan 22;20(1):36. PMID: 30669998. PubMed  
  16. Nerland US, Jakola AS, Solheim O, et al. Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: Pragmatic comparative effectiveness study. BMJ 2015; 350: h1603 DOI: 10.1136/bmj.h1603 DOI  
  17. Austevoll IM, Hermansen E, Fagerland MW, et al. Decompression with or without Fusion in Degenerative Lumbar Spondylolisthesis. N Engl J Med 2021; 385: 526-38. doi:10.1056/NEJMoa2100990 DOI  
  18. Goldberg H, Firtch W, Tyburski M, et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk. A randomized clinical trial. JAMA 2015; 313: 1915-23. doi:10.1001/jama.2015.4468 DOI  
  19. Malmivaara A, Slatis P, Heliovaara M, et al, for the Finnish Lumbar Spinal Research Group. Surgical or nonoperative treatment for lumbar spinal stenosis? a randomized controlled trial. Spine 2007; 32: 1-8. PubMed  
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  • Rune Midgard, dr. med., overlege og førsteamanuensis II emeritus, NTNU
  • Tor Andre Johannessen, lege og redaktør NEL

Tidligere fagmedarbeidere

  • Espen Dietrichs, professor og avdelingsoverlege, Universitetet i Oslo og Nevrologisk avdeling, Rikshospitalet, Oslo