In spinal stenosis, the canal in the spinal column, where the spinal cord, nerve fibers and blood vessels run, is narrowed due to degenerative changes.
The spinal cord, nerve fibers and blood vessels run through the vertebral or spinal canal. The spinal canal normally protects the sensitive nerves from pressure and damage. However, if it is narrowed, pressure on the nerves can cause pain and lead to neurological deficits (paralysis, sensory disturbances). The narrowing is caused by wear and tear of the various parts of the spine (bones, ligaments, intervertebral discs), which is why it often affects people of advanced age.
Spinal stenosis is one of the most common degenerative diseases of the spine. It most commonly occurs in the lumbar spine (lumbar spinal stenosis), but it can also affect the cervical and thoracic spine (cervical/thoracic spinal stenosis).
The disease manifests itself to varying degrees with typical complaints (pain in the back while standing, pain and signs of fatigue in the legs after walking shorter distances, in advanced cases permanent sensory disturbances / paralysis and incontinence). Due to the steadily growing proportion of elderly people in the population, the diagnosis of spinal stenosis is constantly increasing.
The general desire for mobility, activity and a high quality of life in the long term has led to further development of conservative, but also surgical treatment methods. Therefore, after diagnosis, it makes sense to choose a treatment that is individually tailored to the patient.
It is estimated that about 20% of all people over the age of 60 suffer from spinal stenosis. It occurs more frequently in men than in women.
Spinal stenosis develops slowly and over a long period of time. The symptoms can increase steadily over months or years, and often years pass before the symptoms become noticeable at all or the diagnosis is made.
Lumbar spinal stenosis usually manifests itself with pain in the lower back. The pain, which primarily occurs during walking or movement, typically limits the ability of affected persons to cover longer distances (50-500 m) (neurogenic spinal claudication). Under stress, the pain also radiates into the legs. It can usually be alleviated in the short term if the affected person leans his or her upper body slightly forward. In the cervical form, the pain and numbness may radiate to the arms and hands or chronic spinal cord damage may occur (cervical myelopathy).
As the disease progresses, neurologic deficits such as sensory disturbances and paralysis (senso-motor deficit syndrome), pain at rest, bladder and rectum disorders (incontinence), and sexual dysfunction (conus cauda syndrome, cervical myelopathy) are possible.
Through differentiated examinations and clarifications, an exact diagnosis can be made in most cases:
- File study
- Medical history and physical examination
- Use of imaging techniques such as MRI, CT and X-ray
- Neurological-neurophysiological examination
Treatment depends on the severity of the symptoms and, as a first step, conservative therapy is always used. The use of pain medication, CT-guided infiltration, physiotherapy and, if necessary, chiropractic and osteopathy can often alleviate the pain and other symptoms.
Surgery is considered for spinal stenosis only after conservative methods have been exhausted.
The surgical procedure chosen for spinal stenosis is usually microsurgical decompression. In this minimally invasive technique, the degeneratively altered parts (bones, ligaments, intervertebral disc) are removed. This allows the nerve fibers to move more freely again and the blood supply is adequately restored.
In rarer cases, with progressive wear of the spine, fusion of the spinal segment (spondylodesis) becomes necessary.
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