Spinal stenosis

Spinal stenosis describes a disease of the spine that occurs due to one or more narrowing of the spinal canal (spinal canal).

The spinal canal is a bony canal bounded by the vertebrae and vertebral arches and contains the spinal cord, which, like the brain, is part of the human central nervous system (CNS). The spinal nerves arise from the spinal cord and emerge from the spinal canal through the intervertebral foramina. They contain nerves that, on the one hand, transmit sensory information from the periphery of the body to the brain and, on the other hand, are responsible for controlling muscle functions.

If, in old age, largely normal signs of wear and tear occur in the spinal column, e.g. bony attachments (spondylophytes) or arthrosis of the facet joints, narrowing can occur in the spinal canal itself or in the intervertebral holes. Compression of the spinal cord or spinal nerves is the result. In the majority of cases, the lumbar spine is affected, as this has to withstand a particularly high pressure in the course of life and is thus subject to the most wear-related changes.

Signs of spinal stenosis may include:

• Back pain during stress, e.g. when walking
• Radiation of pain into the legs
• Shortened walking distance
• Sensory disturbances in the legs, e.g. numbness, signs of paralysis
• Improvement of discomfort when bending forward, e.g. cycling

Common complaints of spinal stenosis are back pain that occurs when walking and can radiate into the legs. Typically, patients have to stop walking after a certain distance because of the pain they experience. After standing for some time, the symptoms improve and they can continue walking again. Thus, there is a considerable reduction in the walking distance, in extreme cases only a few meters are possible. This phenomenon is called claudication intermittens spinalis.

Concomitantly, the compression of the nerves may result in paraesthesia, e.g. numbness, or paralysis of the legs.

A similar symptomatology can be caused by peripheral arterial occlusive disease (pAVK). In pAVD, the cause of leg pain is the occlusion of arterial vessels and the accompanying reduced blood flow. An important distinguishing feature of spinal stenosis from pAVD is the improvement in symptoms when the upper body is bent forward, for example, when riding a bicycle. In this posture, the space between the vertebrae is increased and thus the nerves are relieved.

The cervical spine is affected by spinal stenosis much less frequently than the lumbar spine. This can be manifested by neck pain radiating into the arms.

Causes of spinal stenosis include:

• Facet joint arthrosis
• Bone attachments (spondylophytes)
• Herniated disc (prolapse)

In the majority of cases, spinal stenosis is caused by age-related wear and tear of thespine, which affects almost everyone in the course of their lives. Mostly people beyond the age of 60 are affected.

These typical signs of wear and tear in old age include facet joint arthrosis, the formation of bony attachments (spondylophytes) and changes in the intervertebral discs.

In the case of facet joint arthrosis, the articular cartilage of the intervertebral joints (facet joints) degenerates due to age-related wear or certain diseases. As a result, the joint surfaces can no longer interact optimally with each other during movements. This results in restricted movement and back pain, typically when bending backwards. As part of this process, new bone formations (spondylophytes) can also develop, narrowing the spinal canal and/or intervertebral holes and compressing nerves.

With age, changes also occur in the intervertebral discs, including a loss of disc height. If disc tissue escapes into the spinal canal, a herniated disc (prolapse), spinal stenosis and compression of nerves may result.

Our spine specialist Priv.-Doz. Dr. Pestka will ask you about your complaints in a detailed consultation. The chronological course, severity and triggers of your complaints are of particular importance. This is followed by a physical examination of the spine and a neurological examination.

The gold standard for diagnosing spinal stenosis is magnetic resonance imaging (MRI), which provides a good assessment of narrowing of the spinal cord and its causes, such as a herniated disc.

If necessary, further imaging, such as X-rays, follows. In the X-ray, the focus is on visualizing bony structures, e.g. the condition of the facet joints or bony attachments (spondylophytes).
If there is still uncertainty regarding the correct diagnosis, pain-relieving medication can be injected into the area of the facet joints. Any pain relief that occurs indicates facet joint osteoarthritis.

Conservative therapy:

The following conservative therapies are available:

• Drug therapy: analgesics
• Physiotherapy
• Back School
• Facet blockade, facet joint denervation

Conservative treatment of spinal stenosis is a multimodal therapy consisting of medicinal, physiotherapeutic and interventional approaches.

Painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) can be used to relieve back pain and inhibit inflammatory reactions.

Physiotherapy helps to strengthen the trunk muscles through strengthening exercises and can also reduce muscular tension in the lumbar spine through stretching exercises. Basic principles of back-friendly behavior in everyday life should be taught in a back school.

In the case of facet joint arthrosis, a facet block can contribute to significant pain relief. This involves pain treatment of the intervertebral joints (facet joints) and their immediate surroundings. Drugs are injected into the facet joints in a controlled manner using an imaging procedure such as ultrasound or X-ray. Since facet joints of different heights of the spine are often affected, several injections may be necessary.

An alternative is facet joint denervation. With the help of high temperatures, the nerves responsible for pain sensation in this region are interrupted.

Operation:

If the symptoms do not improve sufficiently despite conservative therapy, or if there is a risk of nerve damage, surgical therapy is indicated. The operations differ depending on the underlying cause.

In the case of bony attachments (spondylophytes), these are removed through a small skin incision on the back, a procedure called microsurgical decompression.

Our spine specialists at Orthozentrum Freiburg will be happy to advise you further.

Everything at a glance:

• Operation time: 1-1.5 h
• Anesthesia: General anesthesia
• Clinic stay: inpatient
• Fit for work: after approx. 6 weeks
• Return to sports (RTS): after approx. 3 months, depending on sport

Already on the first day after the operation, walking is possible under physiotherapeutic guidance. Patients usually remain in the hospital for about a week. After discharge, the wound should be checked and the sutures removed by the orthopedist or general practitioner after 10-14 days.

Ideally, the hospital stay is followed by rehabilitation.