Spinalkanalstenose: Ursachen, Symptome und Behandlung

Spinalkanalstenose: Ursachen, Symptome und Behandlung

Sitting and bending are not a problem, but standing and walking are almost unbearable. With such symptoms, spinal stenosis is the likely diagnosis – for older patients, it is the most common reason for spinal surgery. The spinal canal is the canal in the spine that protects the spinal cord. Its wall comprises several structures: the intervertebral discs, the intervertebral joints, and the ligamentum flavum, a taut band that longitudinally stabilizes the back of the spine.

Causes of spinal canal stenosis

However, this covering has its price: on the one hand, in the event of a herniated disc, the discs can bulge into the spinal canal and reduce the space for the nerves. On the other hand, with increasing age, the intervertebral joints, like other bones and joints, show signs of wear.

Osteoarthritis leads to bony protrusions These bony prominences narrow the spinal canal and reduce the exit ports of the nerves. The spinal canal stenosis is exacerbated when the spine is stretched since the ligamentum flavum is relatively short and thick, narrowing the space inside even more. On the other hand, when the spine is bent forward, for example, when bending over, the ligament is stretched and, therefore, thinner. Therefore, the symptoms subside almost immediately.

 Spinal canal stenosis: symptoms and diagnosis

Spinal canal stenosis occurs primarily in the area of ​​the lumbar spine (LWS) (lumbar spinal canal stenosis), more rarely as cervical spinal canal stenosis of the cervical spine (cervical spine) and very rarely also in the thoracic spine (thoracic spine). The symptoms of spinal canal stenosis arise from the impaired function of the spinal cord nerves due to the narrowing.

The symptoms are typical: Depending on the body position, there is pain in the back and often even more severe pain in the legs. The pain is pronounced when standing and walking but hardly present when bending over and sitting. In addition, there is often a feeling of heaviness or cramps in the legs and numbness in the buttocks, which can extend into the legs.

Those affected with spinal canal stenosis often know all the seating in the area because they can hardly stand to sit up straight. She is, therefore, often bent over while walking. They also often limp (spinal claudication) due to pain or numbness in the leg. Over time, spinal canal stenosis also limits their range of motion and activities in everyday life.

Diagnosing spinal canal stenosis usually does not cause any problems for the doctor due to the typical symptoms. X-rays, computer tomography and magnetic resonance imaging can differentiate other clinical pictures, such as polyneuropathy. An injected contrast medium (myelography) shows the narrowing particularly clearly.

Treat spinal stenosis

Spinal canal stenosis therapy is initially conservative – the measures correspond to those of a herniated disc: physiotherapy exercises, anti-inflammatory painkillers (antiphlogistics) and possibly cortisone injections into the spinal canal. In addition, unique corsets are offered for spinal canal stenosis patients, which support the spine in a position that relieves the spinal canal and the nerves.

If these measures do not sufficiently improve the symptoms of spinal canal stenosis, surgery must be considered for treatment. Minimally invasive measures and classic operations are available depending on the severity of the symptoms. During minimally invasive surgery, implants (so-called spreaders or interspinous spacers) are inserted between the spinous processes using a skin incision and local anaesthesia, which push the vertebrae apart and thus widen the spinal canal. Since the surgical procedure is relatively new, long-term results are still pending.

 

OP: Long-term success is good

In most cases, surgical relief (decompression) of the nerve roots is ultimately essential to treat spinal stenosis. In the past, a complete laminectomy was carried out, meaning that all structures at the back of the spinal canal were removed: not only the thickened ligamentum flavum and the bone protrusions at the joints but also the spinous processes of the vertebrae and the ligamentous connections between them.

However, the resulting instability was problematic, often leading to structural displacements, spondylolisthesis, and renewed symptoms. Therefore, additional stabilization (spondylodesis) was often necessary.

For this reason, the spinous processes and small ligaments are usually preserved in spinal canal stenosis today; only the bony extensions and the thickened ligament flavum are removed. Additional stabilization procedures are only necessary if more significant areas of bone have to be removed. The long-term successes are good – most people affected by spinal canal stenosis are still symptom-free years later.

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