Spinal stenosis. Diagnostics & Therapy

How is spinal stenosis diagnosed?

A CT scan showing spinal stenosis

A CT scan showing spinal stenosis

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.

Which methods are available to treat spinal stenosis?

We differentiate between conservative (medication and physical therapy) and surgical treatment.

Conservative treatment for spinal stenoses

Injections can help when the symptoms are mild

Injections can help when the symptoms are mild

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 stenoses

Minimally invasive procedures widen the spinal canal

Minimally invasive procedures widen the spinal canal

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.

Rehabilitation

Sitting up straight is important for the back

Sitting up straight is important for the back

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.

Causes & Symptoms

Pelvis

Acquired lumbar spinal stenosis is caused by wear and tear in the disc in old age.

Causes & Symptoms

Specialist Clinics

Specialist Clinics

These specialist clinics and hospitals have qualified physicians and therapists for the treatment of spinal stenosis.

Specialist Clinics

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