Spinal stenosis. Diagnostics & therapy
How a spinal stenosis is diagnosed and treated?
An aching back, numbness in the legs or restrictions when walking: The symptoms of spinal stenosis can be varied. To identify the narrowing of the spinal canal as a cause of symptoms, a thorough diagnosis of the spine is first necessary. If a spinal stenosis was detected, the type of treatment depends on the severity of narrowing and occurring symptoms.
Not always a surgical therapy for spinal stenosis is needed. A not far advanced narrowing of the spinal canal not often can be stabilized by conservative treatment measures such as physical therapy or muscle building workout. Only with a strong narrowing of the spinal canal, a surgical expansion is inevitable.
Diagnostics, therapy & treatment of spinal stenosis.
Diagnostics. How a spinal stenosis is recognized
How is spinal stenosis diagnosed?
Specialist orthopaedic, neurological or neurosurgical examination is indicated when the listed symptoms occur. Magnetic resonance imaging (MRI) is the imaging method of first choice: This examination is free of radiation and the spinal canal and the neural structures found within, such as the spinal cord and the nerve roots, can be excellently seen. This examination cannot be carried out on patients with cardiac pacemakers or those suffering from claustrophobia. Computer tomography (CT) is a reasonable alternative for these patients. In individual cases, the testing of nerve conduction velocity in the spinal cord (evoked potentials) or in the nerves (electromyography or EMG) may be helpful.
Therapy. Treatment of the spinal stenosis
Which methods are available to treat spinal stenosis?
We differentiate between conservative (medication and physical therapy) and surgical treatment.
Conservative treatment for spinal stenosis.
Conservative treatment cannot eliminate the causes of symptoms, i.e., the narrowing of the spinal canal. The aim is to relieve the pain caused by the degenerative processes in the spinal column by giving patients medication, e.g., non-steroidal anti-inflammatories such as Diclofenac, Ibuprofen, Paracetamol, amongst others. In addition to this, physical therapy treatment can ease painful muscle tension and encourage back-friendly behaviour.
Computer-guided injections (periradicular therapy = PRT) can be very effective in individual cases. In this treatment, local anaesthetic and cortisone are injected into the affected nerve root. These drugs can also be injected into the spinal canal in the direct vicinity of the tissues surrounding the spinal cord (single shot peridural anaesthesia or SSPDA) and ease symptoms for several months. Conservative treatment is always recommendable when symptoms are minor or when the patient´s general condition does not permit surgical treatment.
Surgical treatment for spinal stenoses.
International studies have proven that surgical treatment of spinal stenosis is the most effective alternative.
What types of surgery are available for spinal stenosis?
The cervical spine region can be accessed from two points of entry: From the front, i.e., through the throat, reaching the cervical spine via a predetermined "anatomical path". One or more discs, one or more vertebral bodies and the bone spurs pressing on the spinal cord are removed and replaced with an implant. In this operation, the normal width of the spinal canal is restored first of all and is followed by cervical spine stabilisation.
Other techniques to widen the spinal canal.
From the back, i.e., through the neck, so that several vertebral arches can be sawn open and "swung open": the diameter of the spinal canal is also widened with this technique. In most cases, the different surgical techniques are not freely interchangeable and are carried out depending on the individual examination results. The operations are carried out under a general anaesthetic and with the help of microscopes so that the stress for the patient remains within reasonable limits. You can get up on the evening of the operation and remain an inpatient for up to 4 days.
Minimally invasive procedures for spinal stenosis.
Spinal stenosis in the lumbar spine can be corrected using so-called minimally invasive procedures. Both sides of the spinal canal can be widened via an approx. 25 mm long incision in the skin. This procedure can be carried out over a maximum of 4 levels. The advantage of this gentle surgical technique is that elderly patients can also be operated on. Usually patients can already walk further on the first day after the operation.
Treatment of slipped vertebrae.
If a slipped vertebra has caused spinal stenosis, surgery corrects the narrowing of the spinal canal and stabilises the spinal column. Titanium screws are placed in the appropriate vertebral bodies and fixated using titanium rods. The disc is additionally removed and replaced with an artificial implant filled with bone.
Getting back to every day life again.
Outpatient or inpatient follow-up rehabilitation follows procedures for cervical and lumbar spinal stenosis. The option of follow-up rehabilitation will be discussed with the patient on the first day following surgery. A member of our social services team will organise this. The aim of the follow-up rehabilitation is to treat any neurological deficits, i.e., paralyses, with training and to familiarise the patient with forms of behaviour that are gentle on the neck and back. This should be beneficial for the loads applied to the back during work and when away from work.
The vertebral bodies, discs and ligaments form a canal that is designed to protect the spinal cord and the nerve roots exiting it.
Prevention & Medical Advice
Can I prevent a spinal stenosis? When should I go to the doctor in case of complaints? We provide advice and assistance in everyday life.
These specialist clinics and hospitals have qualified physicians and therapists for the treatment of spinal stenosis and diseases of the spine.