Lumbalgia: información para pacientes

Dolor de espalda: puntos básicos que hay que conocer
lumbalgia

¿Qué es una lumbalgia?

La lumbalgia es el dolor la región baja de la espalda que suele asociar una contractura dolorosa de los músculos que se encuentran en esta zona lumbar.

Es un de los motivos de consulta más frecuentes y de limitación en la actividad física en los pacientes jóvenes.

¿Qué es la lumbociatálgia o ciática y qué diferencia hay con la lumbalgia?

La ciática es un dolor del nervio ciático que afecta la zona lumbar y se extiende a las extremidades inferiores y a veces los pies. La lumbalgia se manifiesta por dolor localizado en la zona lumbar exclusivamente.

 

¿Por qué se produce la lumbalgia?

La columna vertebral es el soporte principal del cuerpo humano. Además del apoyo, la columna vertebral tiene una importante función ya que protege la médula espinal.

Las sobrecargas continuadas de la musculatura lumbar, ya sea por su actividad laboral o por otros motivos no laborales junto con la falta de actividad física es el principal motivo de lumbalgia en la población. También puede ocasionarse la lumbalgia por trastornos degenerativos de la columna lumbar como la artrosis de las vértebras lumbares, la discopatía o protrusiones discales

 
¿Qué debemos saber sobre la lumbalgia?

Más del 80% de las personas sufren lumbalgia en algún momento de su vida. En la mayoría de las ocasiones el episodio es autolimitado y cede en el transcurso de unos días. El 90% de las veces el origen de la patología es osteomuscular en personas que llevan un estilo de vida sedentario, realizan esfuerzos o adoptan malas posturas.

Sólo entre un 15% y un 20%  del dolor lumbar responde a una lesión anatómica y únicamente un 2% es debido a causas graves.

ciatico

¿Qué síntomas aparecen?

Los signos y síntomas varían según la intensidad y la zona afectada. Sin embargo, considere que, el dolor en la zona lumbar en uno o en ambos lados, irradiación del dolor hacia las extremidades inferiores si hay afectación del nervio ciático, dolor intenso al ponerse de pie e intentar caminar, limitación dolorosa a la movilidad.

¿Cuándo debemos consultar rápidamente al médico?

En la mayoría de los casos el episodio cede sin intervención médica. Pero debe consultar pronto a su médico si: usted tiene más de 50 años, si hay antecedentes de neoplasia, si presenta una enfermedad crónica, si está tomando tratamiento con corticoides por inmunosupresión, si presenta infección local en la espalda, si ha tenido un traumatismo, si presenta asociado al dolor disminución de fuerza y sensibilidad, parestesias o alteración de esfínteres, si hay irradiación del dolor a las piernas. Si pese al tratamiento que nos ha dado el médico no hay mejoría tras un mes.

 

¿Cómo se diagnostica una lumbalgia?

La clínica suele ser suficiente para el diagnóstico de la lumbalgia. El 90% de los casos con la clínica y la exploración que pueda hacer el médico en la consulta es suficiente.

 El médico lo que hará será inspeccionar la a presencia de signos de inflamación, enrojecimiento, hematomas e inspección de las curvas fisiológicas de la columna, después será conveniente la palpación de las vértebras y de la musculatura paravertebral para descartar dolor a la presión. Por último  realizara una  evaluación de la movilidad de la columna.

 

¿Hace falta hacer alguna prueba para el diagnóstico?

Hemos dicho que el 90% son de origen osteomuscular y por sedentarismo, por tanto en pocas ocasiones serán necesarias pruebas. Las pruebas de imagen no pueden identificar una causa patológica del dolor en, al menos, el 85% de los casos.

Cuando existan dudas o el cuadro se cronifíque su médico solicitara una radiografía de la columna lumbar para valorar posibles lesiones orgánicas. En caso de sospecha el médico valorara la posibilidad de realizar otras pruebas mas complejas como resonancias magnéticas, mielografías etc. Siempre valorando la necesidad de las pruebas dado la radiación que conlleva la realización de pruebas cuando además no son necesarias.

 


María Hernández Carrasco
Médico residente, MFyC, Centro de Salud Arturo Eyries, Valladolid

REVISIÓN: abril 2016

REFERENCIAS:

  • Vilches Fernández, Romero Fernández. Capítulo 30: Lumbalgia mecánica. Manual del Residente de Cirugía Ortopédica y Traumatológica, 2014
  • Barrera Portillo. Guía Clínica de Lumbalgia. Fisterrae, 2013.

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