Spinal stenosis
and Sabine Schrör, medical journalist and Martina Feichter, medical editor and biologistRicarda Schwarz studied medicine in Würzburg, where she also completed her doctorate. After a wide range of tasks in practical medical training (PJ) in Flensburg, Hamburg and New Zealand, she is now working in neuroradiology and radiology at the Tübingen University Hospital.
More about the expertsSabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.
More about the expertsMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
More about the experts All content is checked by medical journalists.
In spinal canal stenosis (spinal stenosis, spinal stenosis, vertebral canal stenosis), the canal in the spine through which the spinal cord runs is narrowed. The resulting pressure on the spinal cord, nerves and blood vessels can cause back pain and permanent nerve damage. Usually a narrowing of the spinal canal arises as a result of aging processes.Here you can read interesting facts about the causes, symptoms and treatment options of spinal canal stenosis.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. M48M51M99
Brief overview
- Causes: Mostly wear (degeneration) of the spine. More rarely, congenital constrictions (hollow back, malformations of the spine), spinal operations, protruding or herniated discs, hormonal changes, bone diseases such as Paget's disease.
- Symptoms: Often asymptomatic at first. Later, often unspecific complaints such as back pain radiating to the legs (lumbar sciatica), reduced mobility of the lumbar spine and muscle tension in the lower back. In severe spinal stenosis, sensory disturbances and weakness in the legs, limping (claudatio spinalis), bladder and / or rectal disorders, impaired sexual function. Very rarely paraplegic syndrome with paralysis of the legs and problems with bowel movements and / or urination.
- Diagnostics: Using the characteristic symptoms in connection with imaging procedures (magnetic resonance imaging, computed tomography).
- Treatment: mostly conservative therapy with a combination of physiotherapy, back training, heat therapy, electrotherapy, support corset (orthosis), pain management training and pain therapy. Surgery is rarely necessary to relieve the spinal canal.
- Course and prognosis: usually very slow course even without therapy. With consistent conservative therapy, the typical complaints can usually be treated and alleviated well.
Spinal canal stenosis: causes
The most common cause of spinal stenosis is wear and tear (degeneration) of the spine: over time, the intervertebral discs between the vertebral bodies lose fluid. As a result, they become flatter and are less able to cushion movement-related pressure - the vertebral bodies are therefore more heavily loaded and then press on the vertebral canal (spinal canal).
Due to the shrunken intervertebral discs, the ligaments along the spine are also less taut and lose their elasticity. This can make the entire structure of the spine latently unstable. The vertebral bodies can shift against each other (vertebral sliding, spondylolisthesis) and compress the vertebral canal.
Well-trained back muscles stabilize the spine so that you are free of symptoms despite spinal stenosis. In contrast, patients with poorly developed back muscles often develop typical symptoms of stenosis. Because when the muscles cannot support the unstable spine, the body forms new bone structures on the vertebral bodies to stabilize the spine. These newly formed bony structures are called osteophytes. Not only can they make spinal canal narrowing worse, they can also cause it.
This happens with spinal stenosis
Arthrosis of the vertebral joints (facet joints) can also lead to new bone formation and thus promote spinal stenosis.
Rarer causes of spinal canal stenosis are:
- Congenital malformations such as a strong hollow back, sliding vertebrae (spondylolisthesis), chondrodystrophy (disorders in the conversion of cartilage to bone tissue in the embryonic age). In such cases, the symptoms appear at the age of 30 to 40 years.
- Spinal surgery (the excessive formation of scar tissue can narrow the spinal canal)
- Injuries to the vertebral bodies
- Bulging or prolapse of disc material into the spinal canal
- hormonal changes that affect the bone substance and the stability of the vertebral bodies (e.g. Cushing's disease)
- Bone diseases (such as Paget's disease): This results in a locally limited remodeling and cultivation of bones. In this disease, spinal stenosis occurs more often in the lumbar spine than in the cervical spine.
- constricted spinal canal from birth of unknown cause (idiopathic spinal stenosis)
Spinal canal stenosis: symptoms
Spinal canal stenosis usually occurs in the lumbar vertebra area (lumbar spinal canal stenosis). It does not necessarily lead to discomfort. These only occur when the spinal canal is so narrowed that nerves or blood vessels are compressed. Which complaints are specifically, when and how severe they occur, depends on several factors. These include the severity of the disease, the patient's posture and the level of physical strain.
At the onset of the disease, the symptoms are not very characteristic and varied. These unspecific complaints include:
- Back pain in the lumbar region (lumbago), which usually radiates into the legs on one side (lumbar sciatica)
- decreased mobility in the lumbar region
- Muscle tension in the lumbar region
If the stenosis continues, the following symptoms are possible:
- Sensory disturbances in the legs
- Parasitic sensations in the legs, e.g. burning, pins and needles, feeling cold, feeling cotton wool under the feet
- Feeling weak in the leg muscles
- pain-related limping (spinal claudication)
- Bladder and / or rectal disorders (problems with bowel movements and urination or incontinence)
- impaired sexual function
It is typical of the disease that the symptoms usually improve significantly when sitting or in other positions in which the trunk is bent forward (for example when cycling, bending over and walking uphill).
The limping in spinal stenosis (claudication) must be differentiated from the temporary limping due to circulatory disorders in "intermittent claudication" (PAD). The latter is called intermittent claudication.
Spinal canal stenosis very rarely leads to a so-called paraplegic syndrome: Both legs are paralyzed and problems with bowel movements and urination occur.
Sometimes the narrowing of the spinal canal does not affect the lumbar spine but the cervical area (cervical spinal stenosis). Those affected often have neck pain that radiates into the arms. Over time, sensory disorders in the legs, rectal and bladder disorders can develop here as well.
Spinal canal stenosis: treatment
In most cases, spinal stenosis can be treated well with conservative therapy methods. Surgical intervention is rarely necessary (in very severe cases).
Conservative treatment
The conservative forms of therapy for spinal stenosis include:
- Physiotherapy (exercise therapy, baths, muscle-relaxing treatments, etc.) to relieve and stabilize the spine
- Heat therapy to relax the back muscles
- Electrotherapy for pain relief and muscle relaxation
- Support corsets (orthoses) to relieve the spine
- Back school (targeted strengthening training for the back and abdominal muscles, tips for back-friendly postures, behavioral tips)
- Psychological pain management training
- Pain therapy
Usually several of the measures mentioned are combined with one another. One then speaks of a modular therapy concept.
Medication
Effective pain management is a cornerstone of conservative stenosis therapy. Different active ingredients are used depending on the intensity of the pain. Non-opioid pain relievers such as ibuprofen, paracetamol or diclofenac can help with mild pain. They have an analgesic and anti-inflammatory effect (the latter is only very slight with paracetamol). For moderate pain, light opioids are used, often in combination with light (non-opioid) pain relievers. Severe pain, on the other hand, is treated with strong opioids.
Some pain relievers can irritate the stomach lining if taken for a long time. That is why doctors often prescribe so-called proton pump inhibitors. These drugs act as "stomach protection" and ensure that the body produces less stomach acid.
In addition to the classic pain relievers, the doctor can prescribe light antidepressants. In low doses, they can help with chronic pain.
Muscle relaxing drugs can sometimes help with spinal stenosis. In the case of very severe pain, high-dose cortisone therapy may be an option: Cortisone makes the soft tissues that press on the spinal canal swell. So there is a little more space in the canal.
The various active ingredients with analgesic, anti-inflammatory, local anesthetic and / or decongestant effects can often not only be administered by mouth (as tablets, capsules, etc.). In many cases, it can also be injected directly into the affected area of the narrowing of the spinal canal. This injection therapy is particularly indicated when a nerve root is severely inflamed. The combination of anti-inflammatory active ingredients such as cortisone and pain relievers fights inflammation and at the same time alleviates pain-related symptoms. If, on the other hand, the pain comes from the small vertebral joints, local injections with pain relievers can help.
In studies on injection therapy, instead of real drugs, patients were given ineffective substances (placebo), often simple table salt. Despite this dummy treatment, many patients had less pain afterwards. The researchers discovered that the placebo injections released the body's own "pain relievers" (endorphins).
surgery
Conservative therapy helps almost all patients with spinal stenosis. Surgery is rarely necessary - usually when important nerves fail. In addition, an operation can be carried out if conservative treatment fails or the patient is suffering from severe stress and is clearly restricted in his everyday life.
Surgical intervention always aims to relieve the area where the spinal cord is being squeezed. Various methods are available for this:
- The pressure relief (decompression) of the constricted nerves is the method of choice. For this, the vertebral arch at the stenosis site is removed on one side or on both sides together with the spinous process (hemi- / laminectomy). Sometimes only parts of the vertebral arch are removed (microdecompression).
- Fusion (spondylodesis): Individual vertebrae are connected and stiffened with material from the iliac crest or with screws. This prevents them from sliding into one another and narrowing the spinal canal.
- Interspinous implants connect the spinous processes of the vertebral bodies and thus prevent the spine from tilting forwards or backwards in the affected area.
The doctor decides which method is most suitable in each individual case. All three procedures can usually be performed minimally invasive or microsurgical. This means that the doctor does not have to make a big cut to reach the affected region. Several small incisions are sufficient, through which the surgeon inserts a tiny camera with a light source and the fine surgical instruments.
There are certain risks associated with every operation. For example, nerves can be damaged during the procedure. In addition, the "skin" around the spinal cord can be injured so that spinal cord fluid escapes (liquor fistula). Before operating on spinal stenosis, the doctor will therefore carefully weigh the expected benefits and potential risks against each other.
Spinal canal stenosis: examinations and diagnosis
In the initial consultation (anamnesis), the doctor asks the patient in detail about their symptoms and known previous or underlying diseases (herniated disc, osteoarthritis, osteoporosis, etc.). This is followed by a physical examination: Among other things, the doctor can ask the patient to bend the upper body far back and then forwards. If there is spinal stenosis, the back hurts when leaning back, while symptoms disappear when the trunk is bent.
Imaging methods provide further information. Experts recommend magnetic resonance imaging (magnetic resonance imaging, MRI) without contrast media. It can show nerves, intervertebral discs, blood vessels and other structures in great detail in slice images.
Alternatively, the spine can be visualized using a computed tomography with contrast agent. However, this so-called Myelo-CT exposes the patient to a certain amount of radiation.
Not every narrowing of the spinal canal that is visible on an MRI or other imaging procedures actually causes symptoms!
In addition, the doctor can X-ray the patient while standing and in certain postures (functional images).
Electrophysiological examinations can also be used to clarify spinal stenosis. These include, for example, electromyography (EMG) and so-called evoked potentials. These methods help assess nerve function.
Spinal canal stenosis: course and prognosis
Even if left untreated, spinal stenosis usually progresses very slowly. Depending on the cause, the disease can also develop very differently. The pain caused by the pressure on the nerve tracts can remain constant, decrease with certain movements or over time, or come and go constantly. Sometimes symptoms even decrease with age, when the spine becomes less flexible. Because then the nerves are stimulated less often, so movement-dependent pain occurs less often.
In some cases, however, spinal canal stenosis is acute: if, for example, intervertebral disc tissue is displaced (protrusion, prolapse), capsule swelling occurs in osteoarthritis, or fluid accumulates near the nerve tracts, the symptoms of spinal canal stenosis can suddenly worsen. One side of the body is often particularly affected.
Overall, spinal stenosis can be treated well in most cases with conservative therapy methods, so that those affected can live relatively free of discomfort.
Additional information
Guidelines:
- Guideline "Lumbar spinal stenosis" of the German Society for Orthopedics and Orthopedic Surgery and the Professional Association of Doctors for Orthopedics
