Spinal stenosis (spinal stenosis)

Sitting and bending over are not a problem, but standing and walking are hard to bear. Spinal canal stenosis is the likely diagnosis for such symptoms - the most common reason for surgery on the spine for older patients. The spinal canal is the channel in the spine where the spinal cord is well protected. Its wall is made up of several structures: the intervertebral discs, the inter-vertebral joints and the ligamentum flavum, a tight ligament that stabilizes the spine in the longitudinal direction.

Causes of spinal canal stenosis

But this coating has its price: Firstly, in a herniated disc, the discs can bulge into the spinal canal and reduce the space for the nerves. On the other hand, it comes with age as the intervertebral joints as in other bones and joints to wear.

Osteoarthritis leads to bony outbreaks. These bony prominences narrow the spinal canal and reduce the exit ports of the nerves. The spinal canal stenosis is aggravated when the spine is stretched, as the ligamentum flavum is then rather short and thick, thus narrowing the space inside even more. When bending forward the spine, for example, when bending over, the band is pulled apart and thus thinner. That's why the symptoms disappear almost immediately.

Spinal stenosis: symptoms and diagnosis

The spinal stenosis occurs mainly in the lumbar spine (lumbar spinal canal stenosis), more rarely as cervical spinal stenosis of the cervical spine (cervical spine) and very rarely also in the thoracic spine (thoracic spine). The symptoms of vertebral canal stenosis arise from the impaired function of the spinal cord nerves due to the narrowness.

The symptoms are typical: Depending on the body position, there is pain in the back and often even more pain in the legs. The pain is pronounced when standing and running, while bending over and sitting against it not or hardly available. In addition, there is often a feeling of heaviness or a cramping in the legs as well as a feeling of numbness in the buttocks, which can extend into the legs.

Sufferers with spinal canal stenosis often know all the seating in the area because they barely stand upright. They therefore often stooping. Due to the pain or numbness in the leg, they are also often limping (claudication spinalis). Over time, the spinal canal stenosis also limits their range of movement and their activities in everyday life.

The diagnosis of spinal canal stenosis usually causes no problems for the doctor because of the typical symptoms. X-ray, computed tomography and magnetic resonance imaging can be used to differentiate other diseases, such as polyneuropathy. A sprayed contrast agent (myelography) shows the constrictions particularly clearly.

Treat spinal canal stenosis

The treatment of spinal canal stenosis is initially conservative - the measures correspond to those of a herniated disc: physiotherapeutic exercises, anti-inflammatory analgesics (anti-inflammatory drugs) and possibly cortisone injections into the spinal canal. In addition, special corsets are offered for spinal canal stenosis patients, which support the spine in an attitude that relieves the spinal canal and the nerves.

If these measures do not sufficiently ameliorate the symptoms of spinal stenosis, surgery must be considered. Depending on the severity of the symptoms, minimally invasive measures and classic surgeries are available. In minimally invasive surgery, implants (called spreaders or interspinous spacers) are inserted between the spinous processes by means of skin incisions and local anesthesia, pushing the vertebrae apart, thus expanding the spinal canal. Since the surgical procedure is relatively new, long-term results are still pending.

OP: Long term successes are good

Mostly for the therapy of the spinal stenosis an operative relief (decompression) of the nerve roots is indispensable. Previously, a complete laminectomy was performed, removing all the structures on the back of the spinal canal: not only the thickened ligamentum flavum and the bony prominences at the joints, but also the spinous processes of the vertebrae and the ligamentous connections between them.

The problem was, however, the resulting instability, which often resulted in shifts in the structures, such as spondylolisthesis and new ailments. Therefore, additional stabilization (spinal fusion) was often required.

For this reason, the spinal canal stenosis surgery usually preserves the spinous processes and small ligaments and removes only the bony outgrowths and the thickened ligamentum flavum. Additional stabilization procedures are only needed if larger bony areas need to be removed. The long-term successes are good - most sufferers of a spinal stenosis are symptom-free even after many years.

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