Revista Colombiana
de Medicina Física y Rehabilitación

Organo Oficial de la Asociación Colombiana de Medicina Física y Rehabilitación

ISSN Impreso: 0121-0041 - ISSN Electrónico: 2256-5655 - DOI: 10.28957/rcmfr

Axonal, bladder and bowel impairment: evidence based clinical review of gaps in guidelines for spinal stenosis

Mario Giraldo-Prieto

Resumen


La destrucción de los axones de raíces sacras, la disfunción de vejiga y la constipación que lentamente progresan en casos graves de estenosis espinal, no se evalúan en literatura de alta evidencia científica. Las decisiones de intervención carecen de orientaciones para confirmar la presencia de estas tres condiciones, su evolución natural, el impacto en la calidad de vida y la funcionalidad, o su manejo. El síntoma de dolor y la espera de una perdida avanzada de función motora parecen ser los criterios que determinan el seguimiento en estenosis espinal aunque las guías de manejo y revisiones sistemáticas muestran un efecto limitado del ejercicio o los medicamentos. La utilidad de los estudios de electrodiagnóstico se ha comparado con la de la resonancia magnética para diagnosticar la estenosis lumbar, limitando su verdadero poder diagnóstico.
Esta artículo propone un uso alterno de estos dos métodos, utilizando el Teorema de Bayes, el Nomograma de Fagan y los cocientes de robabilidad pre test y post test para confirmar la presencia de destrucción axonal mediante la electromiografía de músculos paraespinales y el reflejo H del nervio tibial, como complemento de una resonancia magnética positiva para estenosis lumbar. Con el mismo método se evalúan la ecografía de vejiga y la urodinamia para confirmar la disfunción vesical. Se presenta un caso de estenosis espinal para ilustrar el seguimiento de guías, el declive funcional y la propuesta para usar herramientas de evidencia científica que amplíen los elementos de juicio en la toma de decisiones de intervención en estenosis espinal.


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DOI: http://dx.doi.org/10.28957/rcmfr.v25n1a6


© Rev Col Med Fis Reh 

DOI: 10.28957/rcmfr

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