What is a spinal stenosis?
Different anatomical structures that form the wall of the spinal canal are involved in the development of a spinal stenosis. Degenerative changes of the vertebral joints, ligaments and intervertebral disks lead to a narrowing of the spinal canal and often enough also of the osseous openings through which the nerves exit (the foramina). An acute narrowing may occur also with a disk protrusion or prolapse.
With increasing degenerative changes spondylophytes develop – these are ossifications of the vertebral margins that narrow the spinal canal as well as the foramina. Another cause may be an abnormal thickening of the intervertebral ligaments. All degenerative changes restrict the amount of space that is available for the nerves running through the spinal canal until they are positively compressed.
To a certain extent the development of a spinal stenosis forms part of the natural aging process of the spine. Undue stress on the spine over many years – for example from constantly carrying heavy loads at workplace – facilitate the development of a spinal stenosis. Symptoms in physically active patients usually start in their early fifties.
- Back pain radiating into your leg
- Difficulty to walk longer distances without pain; maybe you are unable to walk 100 meters without a break
- Numbness in your buttocks or your legs
- Increased symptoms when standing upright
- Fewer symptoms when bending forward or sitting
Thorough diagnosis is a prerequisite of successful treatment
Which treatment is appropriate depends on the individual diagnosis. As a rule, the clinical picture will give enough clues for diagnosis, however, mostly only imaging methods like computed or magnetic resonance tomography will bring ultimate clarity. It is important to know the degree of spine damaging and how many segments are affected by the narrowing. Also it must be determined, if there is already some instability of the spine, if and to what extent osseous outgrowths have to be ablated or if the aimed decompression might be achieved by the insertion of an artificial disk replacement.
Generally all sections of the spine can be affected by a spinal stenosis. However, by far the most often, the lumbar spine is affected.
- conservative treatment
With mild symptoms it might do to give the back physical rest and to treat pain with analgesic drugs. For strengthening of the muscles of the back and the abdominals a targeted physiotherapy is recommended. Concomitant thermal or electrotherapy and manual therapy may provide additional symptom relieve.
In some cases injections of local anesthetics and corticosteroids directly at the compressed nerve root (periradicular infiltration) may be indicated. In specialist shops specific corsages and corsets are available that help to reposition the spine in a more appropriate alignment. This can also add to symptom relieve.
- surgical treatment without fusion
If pain or neurological symptoms cannot be controlled with conservative therapy, a surgery will be necessary. Targeted decompression measures to relieve the affected nerves, like the removal of narrowing structures within the spinal canal are possible only with a surgical intervention.
- Endoscopic decompression for stenosis
If only the foramen is narrowed (foraminal stenosis) an endoscopic decompression with the additional aid of a laser is a possibility. The structures that narrow the osseous opening where the nerves exit can be removed under endoscopic control and the pinched nerves set free.
This is a minimally invasive intervention that can be carried out under local anesthesia!
- Surgical enlargement with spacers
In very rare cases it may be sufficient to enlarge the spinal canal with the aid of special implants, that are inserted between the spinal processes of adjacent vertebrae. These spacers virtually push the spinal processes apart and provide the required relief for the narrowed spinal canal.
The intervention takes about 30 minutes and is normally carried out under general anesthesia. As a rule, patients feel a significant relieve of symptoms immediately after the surgery. The day after the intervention patients may get up; a corset that protects from wrong movements has to be put on during the first four weeks. Desk work is possible after two to three weeks; physically straining activities can be carried out after 6 weeks.