Spinal canal stenosis is a predominantly degenerative disease that can develop in the cervical spine and especially the lumbar spine. Even though spinal canal stenosis is now the most common reason for surgery on the lumbar spine, conservative measures are the focus of treatment.
What is spinal canal stenosis?
Spinal canal stenosis is the narrowing of the spinal cord canal, which is formed by the vertebral bodies and extends from the first cervical vertebra to the sacrum. For what does the abbreviation atfp stand for, please visit usvsukenglish.com.
The narrowing is mainly due to wear and tear, which is why it is becoming increasingly important against the background of the increasing life expectancy of the population and the increasing demands of older patients in terms of quality of life, mobility and flexibility. The increasing quality of diagnostics, especially imaging methods such as magnetic resonance imaging and computed tomography, contributes to the fact that the diagnosis is being made more and more frequently.
The lumbar spine is most commonly affected, particularly the level between the third and fourth and fourth and fifth lumbar vertebrae. Spinal stenosis can also develop in the cervical spine, although it is less common here.
The development of spinal canal stenosis due to chronic degenerative changes in the spine is a complicated and lengthy process that is influenced by various factors.
When an intervertebral disc wears down, it can bulge into the spinal canal and already lead to narrowing. However, intervertebral disc wear also leads to a reduction in height of the distance between adjacent vertebral bodies, which can exacerbate the narrowing and lead to arthrosis of the vertebral joints.
Osteoarthritis of the vertebral joints has a variety of consequences, such as swelling of the joint capsule, bony attachments and cysts and instability between the vertebral bodies can develop. All of this can also cause distress to the spinal cord by compressing nerve roots, spinal cord membranes and vessels.
A spinal canal stenosis does not have to be limited to just one part of the spine, it can be localized at several levels of the spine at the same time.
Symptoms, Ailments & Signs
The narrowing of the spinal canal only causes symptoms when it is so severe that it puts pressure on blood vessels, nerves and the spinal cord. The symptoms that occur depend on the section of the spine in which the stenosis is located. The symptoms usually get worse when you stand upright, because this increases the pressure on the affected area.
Bending the back, on the other hand, provides relief and the symptoms subside. If the narrowing is in the area of the lumbar spine, pain occurs in the lower back, which can radiate into the legs. Running is painful, and those affected usually only manage short distances. Your back hurts even when you stand up. Sitting, on the other hand, provides relief because it involves adopting a hunched posture. Often there is muscle tension in the lumbar region.
Numbness, tingling and sensory disturbances can also occur. As the disease progresses, paralysis can develop. Incontinence and sexual dysfunction are also possible. If the constriction is in the neck area, it becomes noticeable with neck pain that can radiate into the arms.
The fine motor skills of the hands can be impaired, as can the perception of the arms and hands. The muscle tension in the arms and legs can also increase. If the stenosis progresses, the same symptoms can appear as in paraplegia.
Diagnosis & History
A spinal canal stenosis in the area of the lumbar spine causes back pain on one or both sides, which increases in intensity over the years and can radiate into the buttocks, groins and legs. If the problem is in the cervical spine, there is typically neck pain that radiates into the shoulders and arms, sensory disturbances and problems with fine motor skills develop in the hands, but unsteady gait and a tendency to fall can also occur.
However, none of these symptoms are typical of a stenosis, rather they can also occur in numerous other spinal diseases such as an isolated herniated disc, inflammatory and neurological diseases, vertebral body fractures that gradually develop as part of osteoporosis in the lumbar spine.
X-rays including so-called functional images, magnetic resonance imaging and computed tomography contribute to the clarification. If anything is unclear, special neurological examinations, vascular diagnostics and laboratory tests to clarify a possible spinal canal stenosis may be necessary.
Spinal canal stenosis primarily leads to very severe pain. These occur primarily when walking or sitting for long periods of time and can have a very negative effect on the patient’s quality of life. The pain can also occur at night in the form of rest pain and lead to sleeping problems.
Most sufferers also suffer from depression and irritability. Sometimes there is also pain in the legs, which can be accompanied by significant restrictions in movement. As a result, many patients are dependent on the help of other people. Legs often feel heavy.
The disease also leads to sensory disturbances or paralysis in the legs. The pain often spreads to the back and can also lead to limitations there. The treatment of spinal canal stenosis is always based on the symptoms. Usually there are no complications.
The pain can be relieved with the help of painkillers. However, long-term use of painkillers can damage the stomach. Furthermore, those affected are dependent on various exercises and therapies to reduce the symptoms. The patient’s life expectancy is not reduced by the disease.
When should you go to the doctor?
Spinal canal stenosis can manifest itself suddenly or slowly with various symptoms. Going to the doctor is therefore advisable for various reasons. It is always important to see a doctor at an early stage if the spinal canal stenosis suddenly causes shooting pain with strong characteristics. Paralysis and numbness should also be checked with a doctor as soon as possible. Immediately to the doctor is mandatory if you can no longer control your rectum or bladder. The family doctor can be the first point of contact. A neurologist or orthopaedist who is already treating you is also a suitable contact person. In the event of severe pain and at night, the emergency outpatient department of the nearest clinic can also be visited.
There are also cases in which the doctor does not have to be consulted immediately for spinal canal stenosis and the resulting symptoms. This applies to cases in which a diagnosis has already been completed and the reason for the stenosis, for example a problem in the intervertebral disc, is already known. Then the doctor is always consulted when unusual symptoms occur or known pain and sensory disturbances have become stronger. The desire to be referred to a physiotherapist can also be a reason for a doctor’s visit if the patient has previously experienced that physiotherapy can alleviate the known symptoms. Pain therapists are consulted when the pain or burning is difficult to control.
Treatment & Therapy
The primary goals in treating spinal canal stenosis are pain reduction and improved mobility. As a rule, conservative measures represent the initial treatment concept consisting of physiotherapy, physical and manual therapy, corsetry, posture training and, of course, drug- based pain therapy, which can possibly be supported by acupuncture.
An operation is only necessary if conservative measures, which have been consistently continued for 12 weeks, have not led to any significant success and the symptoms are undoubtedly a spinal canal stenosis. However, there is an absolute indication for surgery if the compression of the spinal cord or a nerve root leads to increasing symptoms of paralysis.
The principle of the operation consists of a so-called decompression, in which the spinal canal is surgically expanded again, which relieves the spinal cord and nerve roots. Various surgical techniques are available for this purpose, from which the appropriate procedure can be selected individually for each patient.
Depending on the surgical technique, foreseeable instability between the vertebral bodies can occur, so that not only is the spinal canal stenosis eliminated in the same surgical session, but the operated section of the spine must also be stabilized.
The development of spinal canal stenosis can be prevented to a certain extent by taking preventive measures. A back-friendly lifestyle with the aim of ensuring a strong back at times is generally recommended. A lot of exercise prevents back problems and can usually be easily integrated into everyday life: take the stairs instead of the elevator, do shopping on foot, take regular walks and exercise. Additional targeted and, above all, regular back training is recommended.
In the surgical treatment of spinal canal stenosis, patients usually stay in the hospital for four to five days. If the course is normal, you can get up and go to the toilet a few hours after the operation. In the days that follow, the newly operated patients learn back-friendly behavior such as standing up, lifting or bending over with the help of a physiotherapist.
They should move as normally as possible. If necessary, aids such as a support corset or a walker can be used as support. Physiotherapy and individual pain therapy round off the aftercare in the hospital. Follow-up treatment follows the hospital stay. In mild cases of spinal canal stenosis, those affected should take advantage of physiotherapy with exercises to strengthen the back and abdominal muscles.
Daily walks with slowly increasing duration and distance are also part of rehabilitation at home. In the case of more severe forms, outpatient or inpatient treatment in a rehabilitation clinic is recommended after leaving the hospital. This lasts about three to four weeks and can be extended further if necessary.
In the first three months after the operation, patients should rest as much as possible and not lift weights over ten kilograms. In addition, movements and exercises that cause pain should be avoided. A check-up by a back specialist is also necessary one and three months after the operation.
You can do that yourself
The spinal canal stenosis must first be clearly diagnosed by the doctor in order to rule out other causes for the symptoms. When this is done, the patient can bring about relief with self-help in everyday life and often achieve the quality of life that makes surgery avoidable. However, the measures should ideally be discussed with the doctor treating you, such as the orthopaedist.
Strengthening the core muscles is an important factor in reducing discomfort. Efficient exercises are learned in physiotherapy, which are then regularly continued by those affected at home. There are also courses in the fitness studio that are specifically aimed at back health. The back school, which is often offered by health insurance companies, also gives tips for back-friendly behavior in everyday life, such as bending down or lifting correctly.
It is important to relieve the spine. Here it is advisable for patients with spinal canal stenosis to take up the stepped position from time to time and to ensure that the sleeping position on the optimal mattress is right for their back. In the case of pain, baths or the classic hot -water bottle often help to relax tense muscles. Massages with the hedgehog ball also often help.
In most cases, however, gentle behavior is counterproductive. It can lead to further tension. Exercise, on the other hand, is important for mobility and often helps to reduce symptoms.