Spinal stenosis

The concept of spinal stenosis ( spinal stenosis or spinal stenosis ) refers to a narrowing of the spinal canal. It is more common in older people and mostly in the lumbar spine. The segments most affected are between third and fourth and between the fourth and fifth lumbar vertebrae.

Causes

Due to the upright posture of humans the lower lumbar spine is mechanically highly loaded. Degenerative changes are age-and stress- dependent and widely used in mild forms. It is not so much the question of whether they develop, but more the question of how quickly progresses the narrowing and whether it causes clinical symptoms.

As part of the normal aging process, lose the intervertebral discs of height and it comes to osteochondritis intervertebralis: on the one hand to the protrusions of the intervertebral disc, on the other hand to the bony outgrowths on the vertebral bodies ( spondylophytes ). Next arise arthritis of the small facet joints ( spondylarthritis ). This combination creates an hourglass- narrowing of the spinal canal.

The stenosis may have various shapes. Occasionally, a relatively intact intervertebral disc shifts in the intervertebral space and " slips " to the side. Thus, the spinal canal is pressed from one side and it comes to more obvious symptoms.

Clinical features and diagnosis

The clinical findings are uncharacteristic first. Dysfunction and pain or irritation of the sciatic nerve can be caused by very different pathological changes of the lumbar spine. Typical of the spinal stenosis is the symptom of spinal claudication. The patient complains of pulling pain at the front or back of the legs when he went a short distance. The pain improve if he sits down or prevents the upper body. These early conversations give first indications. You will be so taken that the spinal canal is relatively wide through the bending and reduces the irritation of the nerve structures. If the patients are in extreme cases only able to walk less than 100 m, further diagnostics and therapy are required. The normal X-ray diagnosis is already showing the first evidence of the proof can be done by MRI scan.

The stenosis is often more progressive and progresses at a different rate. After a few years, however, there is usually no deterioration more. Neurological deficits are rare.

Therapy

Accompanying the entire available range of pain management can be used. This is often alone is necessary to enable a targeted training work in the first place. The emphasis of treatment is on physical measures, relaxation exercises, electrotherapy and not on the use of painkillers. However, depending on the clinical picture suggests, this treatment is not always on.

Immediate relief, especially in the elderly, is possible with relieving or stabilizing hull bandages / corset fabric. This disc can be relieved.

As part of a surgical decompression of the spinal canal can be extended again, in mild cases is to insert a placeholder ( interspinous spacer) between the spinous processes for the expansion of the spinal canal and exit channels of the nervous sense.

Alternatively, a reinforcement can be made ​​with the disc in question is removed and by two small plates ( cages ) to be replaced, which serve as placeholders. In addition, the affected segment with screws and rods is stiffened. When medically assisted occurs after about 4 to 6 months a sufficient ossification of the vertebrae (bone bridges), which can produce up to 95 % of normal exercise capacity. The two vertebrae are then secured together, which does not result in a few vertebrae to form a functional limitation. Tobacco use can delay this process, which is why at least several months of abstinence may be prescribed. Postoperatively, physiotherapy treatment is indicated, which is often used for acclimatization of later only to be carried out exercises that can significantly influence the further course ( in other vertebrae ).

Are becoming increasingly important also motion-preserving surgical procedures such as the flexible spinal stabilization. This is a dynamic implant, which stabilizes the spine and at the same time receives the motion in the operated vertebral segment. Unlike the stiffening the new surgical method also protects neighboring segments against wear, so that occur less frequently after the procedure back pain.

Economic Importance

The economic importance of various diseases of the spine is very high. In most early retirement, the spine more or less directly the cause for retirement dar. In this group of diseases accounts for most job losses.

Not least because of the economic importance of spinal stenosis and other back problems has grown up around this topic, a whole industry. A variety of so-called rehabilitation clinics, physiotherapists and orthopedic surgeons provide services to "improve the crooked back ", which are partly taken from the cash register. In addition, a large private market of " treatments " which often does not exist or insufficient proven medical benefit.

Criticism

A radiological spinal stenosis secured not an indicator of the extent of the pain.