DÄ internationalArchive47/2008Degenerative Lumbar Spinal Stenosis – Current Strategies in Diagnosis: Interdisciplinary Diagnostic System

Correspondence

Degenerative Lumbar Spinal Stenosis – Current Strategies in Diagnosis: Interdisciplinary Diagnostic System

Dtsch Arztebl Int 2008; 105(47): 823. DOI: 10.3238/arztebl.2008.0823b

Engel, K; Seidel, W

LNSLNS I agree with the authors that a multimodal therapeutic concept is required. The symptoms associated with lumbar spinal stenosis are multifactorial. In order to give targeted and appropriate treatment, a standardized interdisciplinary diagnostic setting is necessary—for example Sommerfeld's diagnostic system (1, 2). Functional morphological and psychosocial factors are investigated and assessed for their respective influence in the current disease process. Only in this way is it possible to define a clear indication for the components of complex treatment in disorders with a multifactorial origin; this is very much the case for operative procedures.

A fundamental principle of non-operative treatment is reduction of the lumbar lordosis. This principle was mentioned but not included in the algorithm in the article. "Optional physiotherapy" does not reflect its real importance as a therapeutic option. Insufficient muscular stabilization of the lumbar spine (core stabilization) is a crucial pathogenetic factor for the symptoms of lumbar spinal stenosis. Therapy therefore needs to focus on improving core stabilization, to develop its activation, stamina, and strength.

Neurophysiological physiotherapeutic techniques, training therapy, and targeted customized exercise programs are used to this end. In a second step, activities of everyday life need to be practiced.

Accompanying analgesic medication should be given according to each drug's mechanism of action: anti-inflammatories for the anti-edematous effect, analgesics to reduce myalgias (by reducing the pain reflectory inhibition of muscle activation), appropriate medical if neuropathic pain is present, reacting to exacerbations of pain.

Interventional (3) and surgical procedures should aim to stabilize the muscles and avoid pain related impairments to strength and distances walked.

If this approach is pursued methodically then the human body is able to compensate to an astonishing degree, even in a scenario of pronounced degenerative stenosis of the lumbar spinal canal. Even if symptoms are severe, the initial therapeutic approach should always be an intense, non-surgical one (3).
DOI: 10.3238/arztebl.2008.0823b


Dr. med. Kerstin Engel
Dr. med. Wolfram Seidel
Sana Kliniken Sommerfeld
Klinik für Manuelle Medizin
Fachkrankenhaus für nichtoperative Orthopädie
und Schmerzmedizin
16766 Kremmen, Germany
k.engel@sana-hu.de
1.
Niemier K, Seidel W, Ritz W, Pioch E, Werin A: Introduction and Evaluation of a Multiprofessional Assessment System for the Differential Diagnosis of Chronic Musculoskeletal Pain Syndromes. JOM 2005; 27: 71–80.
2.
Niemier K, Ritz W, Seidel W : Funktionelle muskuloskeletale Diagnostik.. Manuelle Medizin 2007; 45: 123–7.
3.
Theodoridis T, Krämer J, Kleinert H: Konservative Behandlung der lumbalen Spinalkanalstenose – eine Übersicht. Z Orthop Unfall 2008; 146: 75–9 MEDLINE
1. Niemier K, Seidel W, Ritz W, Pioch E, Werin A: Introduction and Evaluation of a Multiprofessional Assessment System for the Differential Diagnosis of Chronic Musculoskeletal Pain Syndromes. JOM 2005; 27: 71–80.
2. Niemier K, Ritz W, Seidel W : Funktionelle muskuloskeletale Diagnostik.. Manuelle Medizin 2007; 45: 123–7.
3. Theodoridis T, Krämer J, Kleinert H: Konservative Behandlung der lumbalen Spinalkanalstenose – eine Übersicht. Z Orthop Unfall 2008; 146: 75–9 MEDLINE