Spinal stenosis

A Spinal stenosis is a narrowing of the spinal canal, which in most cases is due to degenerative processes in the area of ​​the spine. Accordingly, older people in particular are affected by spinal stenosis.

What is spinal stenosis?

As Spinal stenosis is a local narrowing (stenosis) of the spinal canal, which is usually due to wear and tear in the spinal area.

As a result of the narrowing in the spinal canal, the nerves and blood vessels leading through the spinal canal are narrowed, which causes the symptoms characteristic of spinal stenosis such as back pain that can radiate into the legs when moving (lumbar sciatica), as well as weakness and sensory disorders in the legs, impairment of the bladders - and rectal function or sexual function at an advanced stage.

In most cases there is a stenosis in the lower back or lumbar vertebrae.

causes

In most cases there is one Spinal stenosis attributable to degeneration processes in the spine area. The intervertebral discs can lose fluid and height with increasing age, so that the distance between two vertebral bodies (corpus vertebrae) becomes smaller. As a result, they are more stressed, the cover plates of the vertebral bodies thicken and lead to a compression of the bones, as a result of which a pronounced stenosis of the vertebral canal can be observed.

In addition, the ligaments that stabilize the spine lose their elasticity and thicken due to the smaller distance between the vertebral bodies. The resulting displacement of the spinal column segments (spondylolisthesis) is attempted by the human body with so-called osteophytes (bony extensions at the edge of the bone), which additionally narrow the spinal canal.

In addition, spondylarthrosis (widening of the vertebral arch joints) can cause additional narrowing. If the trunk muscles are weak, the process of wear and tear and thus the development of spinal stenosis are accelerated. Furthermore, genetic constrictions of the spinal canal, hormonal changes (Cushing's disease) or diseases of the bone system (Paget's disease) can cause spinal stenosis.

Symptoms, ailments & signs

The effects of spinal stenosis are very multifaceted and do not initially suggest a narrowing of the spinal canal. Especially in the early stages, the characteristics are considered unspecific. This includes general back pain radiating to the legs (lumbar sciatica). At the same time, patients suffer from restricted movement of the lumbar spine, which is accompanied by strong tension in individual muscles.

Later on, other symptoms such as pronounced paresthesia in the legs appear. These manifest themselves in the form of pins and needles, aggressive burning or the feeling of cotton wool under the feet. At the same time, those affected report an increased feeling of cold in the region. A growing weakness in the leg muscles has a lasting effect on gait security.

At the same time, there are more irregularities when using the toilet due to functional disorders of the bladder and rectum. The incontinence that occurs makes it difficult for patients to urinate in a controlled manner. In addition, spinal stenosis has a negative effect on sexual function in some people. Typical features of the spinal canal narrowing only emerge in later stages and thus facilitate diagnosis.

Existing complaints such as pain and paresthesia decrease significantly in specific body positions. A change in body load from standing to bent over activities such as cycling or bending over noticeably relieves the patient. Medicine calls the massive change in the level of suffering depending on posture as spinal claudication. If intermittent claudication is in the foreground with the involvement of narrowed blood vessels in the pelvis, however, the symptoms increase.

Diagnosis & course

A Spinal stenosis is usually diagnosed using imaging techniques. Bony changes in the area of ​​the spine, spondylarthrosis and degenerative disc changes can be determined on the basis of an X-ray. For the direct diagnosis of spinal stenosis, computed tomography or magnetic resonance tomography, each of which allows statements about a narrowing of the spinal canal, is required.

Magnetic resonance imaging can simultaneously detect degenerations in the soft tissues (intervertebral discs, nerve roots). With the help of neurological examinations it can also be shown whether nerve structures have been damaged as a result of the spinal stenosis. Although the causes of spinal stenosis cannot be eliminated, the progression of the disease can be significantly slowed down as part of conservative therapy. In addition, surgical therapy is usually successful and provides those affected by spinal stenosis with relief from the symptoms.

Complications

Spinal canal stenosis is always associated with restricted mobility. Often there are also sensory disorders in the legs and back pain. As a result of sensory disturbances and problems with fine motor skills, there is an increased gait uncertainty and a tendency to fall. If the symptoms are not immediately clarified and treated by a doctor, chronic pain can develop.

Bad posture can also occur, which can lead to joint wear, muscle pain, tension and other complaints elsewhere. In most cases, the well-being and quality of life of those affected are also significantly impaired. There is a risk of infection during surgery. Then - depending on the severity of the infection - local wound treatment and antibiotics are required.

If a blood vessel suture loosens, it can lead to bleeding and the formation of a bruise. Injuries to the blood vessels and circulatory problems can occur even during the procedure. In addition, allergic reactions to the contrast agent are conceivable. With cervical spinal nerve analgesia there is a low risk of damage to the pleura, as a result of which air can penetrate the chest cavity (pneumothorax).

An epidural-cervical injection can lead to infection of the epidural space. Furthermore, injuries and inflammation of the spinal cord can occur.

When should you go to the doctor?

Spinal stenosis must always be treated by a doctor. If left untreated, severe and serious complications can occur, which can have a very negative effect on the patient's quality of life. For this reason, a doctor must be consulted at the first signs of spinal stenosis in order to prevent further complications and complaints. The earlier a doctor is consulted, the better the further course of the disease is usually.

A doctor should be consulted for spinal stenosis if the person is suffering from severe back pain. Tension in the muscles can also indicate spinal stenosis and should also be examined by a doctor if it occurs over a long period of time. In many cases, abnormal sensations also indicate the disease. Furthermore, some people affected may also suffer from incontinence, so that a doctor should also be consulted.

The spinal stenosis can be detected by a general practitioner. Further treatment is then carried out by a specialist.

Treatment & Therapy

The therapeutic measures depend on one Spinal stenosis on the extent of the individual complaints as well as the presence of nerve involvement.

If no impairment of the nerves could be determined with the help of the diagnostic procedures, treatment is usually conservative, i.e. surgery is not required for the time being. To strengthen the core muscles that stabilize the spine, physiotherapy and physiotherapeutic measures are used, as well as walking training to produce a physiologically favorable walking pattern.

In some cases, the lumbar spine is temporarily stabilized with a brace to prevent additional narrowing of the spinal canal. If those affected are in pain, drug-based pain therapy is indicated. Acupuncture therapy can also help reduce pain. If the spinal stenosis causes severe pain, in some cases a local anesthetic in combination with cortisone is injected into the spinal canal (epidural infiltration).

If there is also damage to the nerves, an operation to reduce the pressure on the affected structures caused by the spinal stenosis (decompression) is indicated. Different surgical procedures are available depending on the specific symptoms.

If nerve deficits (numbness, paralysis), impaired walking ability and / or abdominal pressure can be determined, a partial or complete laminectomy (removal of the vertebral arch) is performed. In addition, implants can be used surgically to treat spinal stenosis, which act as spacers between the vertebral processes and accordingly prevent a narrowing of the vertebral canal.

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prevention

One Spinal stenosis can be indirectly prevented by avoiding factors that promote degeneration of the spine and intervertebral discs. Activities that stress the spine accelerate the degeneration process. In addition, studies show that nicotine consumption promotes wear and tear on the intervertebral discs. Regular exercise, strengthened core muscles and avoiding obesity, on the other hand, relieve the spine and reduce the risk of developing spinal stenosis.

Aftercare

In the case of spinal stenosis, the person affected usually has only limited and only a few measures and options for direct follow-up care available. There can also be no independent healing. The earlier a doctor is consulted about spinal stenosis, the better the further course of this disease is usually.

Those affected depend on taking various medications in order to permanently relieve the symptoms. The person affected should always pay attention to the correct dosage and also to regular intake in order to counteract the symptoms correctly and, above all, permanently. In many cases with this disease, the help and care of one's own family is very important, as this can also prevent depression and other psychological upsets.

If the symptoms are alleviated by surgery, the person affected should definitely rest and not engage in any physical activity. This disease does not usually reduce life expectancy.

You can do that yourself

Spinal stenosis is a disease that is also accessible to self-help in everyday life. The cooperation of those affected can even make an operation unnecessary. The aim is to stabilize the spine and improve back health by changing behavior in everyday life and at work as well as strengthening the muscles of the abdomen and back. Ideally, all measures taken by the patient are discussed in advance with the treating orthopedic surgeon or physiotherapist.

In physiotherapy, the person concerned learns exercises that straighten the spine in a physiological and healthy posture and also stabilize it there. These exercises are carried out regularly by the patient at home. In fitness sports or rehabilitation facilities, there are back courses or a special back school, in which correct lifting and bending are learned and the muscular corset of the back is strengthened.

Warmth is an important factor when it comes to helping yourself with pain. Baths or hot water bottles loosen the music and contribute to relief. In most cases, however, relieving your posture is not the right approach, as the already tense muscles are even more stressed. With moderate symptoms, a walk or some other form of controlled exercise is often helpful. Getting a good night's sleep is also important: lying relaxed on the right mattress clearly supports the patient's well-being.