Spinal Stenosis

Spinal Stenosis

Spinal stenosis is a narrowing of the spinal canal, which in most cases is due to degenerative processes in the spinal column. Correspondingly, older people in particular are affected by spinal stenosis.

What is spinal stenosis?

Spinal stenosis is a local narrowing (stenosis) of the spinal canal, which is usually due to wear and tear in the spinal column area. For definition of drug-induced headache in English, please visit acronymmonster.com.

As a result of the narrowing of the spinal canal, the nerves and blood vessels leading through the spinal canal are constricted, causing the symptoms characteristic of spinal stenosis, such as back pain that can radiate into the legs when moving (lumboischialgia), as well as a feeling of weakness and sensory disturbances in the legs, impairment of the bladder – and rectal function or advanced sexual function.

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

Causes

In most cases, spinal stenosis is due to degenerative processes in the spinal column. The intervertebral discs can lose fluidity and height with increasing age, so that the distance between two vertebral bodies (corpus vertebrae) decreases. As a result, they are subjected to greater stress, 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 spinal 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 human body tries to compensate for the resulting displacement of the spinal column segments (spondylolisthesis) with so-called osteophytes (bony extensions on the edge of the bone), which also 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 is accelerated. Furthermore, genetically determined narrowing of the spinal canal, hormonal changes (Cushing’s disease) or diseases of the bone apparatus ( Paget’s disease ) can cause spinal stenosis.

Symptoms, Ailments & Signs

The effects of spinal stenosis are very diverse and do not initially suggest a narrowing of the spinal canal. The features are considered non-specific, especially in the early stages. This includes general back pain radiating into the legs (lumboischialgia). At the same time, patients suffer from restricted movement of the lumbar spine, which is accompanied by severe tension in individual muscle groups.

In the later course, other symptoms such as pronounced abnormal sensations in the legs are added. These manifest in the form of pins and needles, an aggressive burning sensation, or a cotton-like feeling underfoot. At the same time, those affected report an increased sensitivity to cold in the region. Increasing weakness of the leg muscles has a lasting negative impact on gait security.

At the same time, irregularities in going to the toilet due to functional disorders of the bladder and rectum are increasing. The incontinence that occurs makes controlled urination difficult for patients. Furthermore, in some people, spinal stenosis has an unfavorable effect on their sexual function. Typical features of the narrowing of the spinal canal only emerge in later stages and thus facilitate the diagnosis.

Existing complaints such as pain and discomfort decrease significantly in specific body positions. A change in body load from standing to bent activities such as cycling or bending over noticeably relieves patients. The massive change in the level of suffering depending on the posture is referred to in medicine as spinal claudication. If the focus is on intermittent claudication involving constricted blood vessels in the pelvis, the symptoms worsen.

Diagnosis & History

Spinal stenosis is usually diagnosed using imaging techniques. Bony changes in the area of ​​the spine, spondylarthrosis and degenerative changes in the intervertebral discs can be identified using an X-ray. For a direct diagnosis of a spinal stenosis, a computed tomography or magnetic resonance tomography, which allow statements about a narrowing of the spinal canal, is also required.

At the same time, degeneration of the soft tissues (intervertebral discs, nerve roots) can be detected by means of magnetic resonance imaging. 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 relieves the symptoms of those affected by spinal stenosis.

Complications

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

Poor 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. Depending on the severity of the infection, local treatment of the wound and the administration of antibiotics are then required.

If a blood vessel suture comes loose, this can lead to bleeding and the formation of a bruise. Injuries to the blood vessels and circulatory problems can already occur during the procedure. Allergic reactions to the contrast medium are also conceivable. With cervical spinal nerve analgesia, there is a small risk of injury to the pleura that can cause air to enter the chest (pneumothorax).

Epidural-cervical injection can result in infection of the epidural space. Injuries and inflammation of the spinal cord can also occur.

When should you go to the doctor?

Spinal stenosis must always be treated by a doctor. If left untreated, it can lead to severe and serious complications that can have a very negative impact on the patient’s quality of life. For this reason, a doctor must be consulted at the first sign of spinal stenosis in order to prevent further complications and symptoms. The sooner a doctor is consulted, the better the further progression of the disease.

A doctor should be consulted for spinal stenosis if the patient suffers 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 longer period of time. In many cases, abnormal sensations also indicate the disease. Furthermore, some of those affected may also suffer from incontinence, so that a doctor should also be consulted.

Spinal stenosis can be diagnosed by a general practitioner. Further treatment is then carried out by a specialist.

Treatment & Therapy

The therapeutic measures for spinal stenosis depend on the extent of the individual symptoms and the presence of nerve involvement.

If no impairment of the nerves can be determined with the help of diagnostic procedures, the treatment is usually conservative, i.e. no surgical intervention is carried out for the time being. To strengthen the trunk muscles that stabilize the spine, physiotherapy and gait training are used to create a physiologically favorable gait pattern.

In some cases, the lumbar spine is temporarily stabilized with a corset to prevent additional narrowing of the spinal canal. If those affected show 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 combined 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. Depending on the specific symptoms present, different surgical procedures are available.

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

Prevention

Spinal stenosis can be prevented indirectly by avoiding factors that promote degeneration of the spine and intervertebral discs. Activities that put a particularly heavy strain on the spine accelerate the degeneration process. In addition, studies show that nicotine consumption promotes wear and tear on the intervertebral discs. On the other hand, regular exercise, strengthened trunk muscles and avoiding obesity relieve the spine and reduce the risk of spinal stenosis.

Aftercare

In the case of a spinal stenosis, the affected person usually only has limited and only a few measures and options for direct aftercare. It can also not come to an independent healing. The sooner a doctor is consulted for spinal stenosis, the better the further course of this disease is usually.

Those affected are dependent on taking various medications to permanently relieve the symptoms. The person concerned should always ensure that the dosage is correct and that it is taken regularly in order to counteract the symptoms correctly and, above all, permanently. In many cases, the help and care of one’s own family is also very important with this disease, as this can also prevent depression and other mental upsets.

If the symptoms are alleviated by a surgical procedure, the person concerned should definitely rest and not do any physical activities. Life expectancy is usually not reduced by this disease.

You can do that yourself

Spinal stenosis is a clinical picture 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 and by strengthening the abdominal and back muscles. Ideally, all measures taken by the patient are discussed in advance with the treating orthopedist or physiotherapist.

In physiotherapy, the affected person learns exercises that straighten the spine into a physiological and healthy posture and also stabilize it there. These exercises are continued regularly by the patient at home. In fitness sports or rehabilitation sports facilities, there are back courses or a special back school where you learn how to lift and bend properly and where the muscular corset of your back is strengthened.

Heat is an important factor when it comes to self-care for pain. Baths or hot- water bottles loosen the music and contribute to the relief. In most cases, however, a relieving posture is not the right way, as the already tense muscles are put under even more strain. In the case of moderate symptoms, a walk or other form of controlled exercise is often helpful. Getting a good night’s rest is also important: lying relaxed on the right mattress significantly supports the well-being of the patient.

Spinal Stenosis