Spinal canal stenosis
The clinical findings are first of all a non-characteristic dysfunction and pain or also irritations of the sciatic nerves which can be caused by different pathogen alterations of the lumbar spine. Typical for a spinal stenosis is the symptom of Claudicatio spinalis. The patient is complaining about a dragging pain at the front and the back of the legs after walking for a short while. The pain gets better when the patient is sitting down again or bends the upper body forward. The spinal canal is widened relatively by bending forward and the irritation of the nerve structures is decreased. In extreme cases, when patients are only in the position to walk less than 100 metres, further diagnostic measures and medical therapy is necessary. The standard x-ray diagnostic normally shows no concrete indications for the disease, more often the magnetic resonance imaging (MRT) is the first choice when it comes to diagnosing by means of imaging techniques and can be supplemented with a lumbar myelography with a postmyelographic CT (pm-CT).
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Due to the human constitution the lumbar spine is burdened extremely. Degenerative processes are therefore very common. It is less the question if they are going to develop than rather how fast the processes are developing.
An instability that is leading to a sliding vertebra is deforming the spinal canal and the canal becomes elongated. While the transverse section normally remembers to a “Napoleon’s hat”, the canal becomes slimmer and sharpener. The mechanical stress in the segment is causing the formation of bracing reactions, the spondylophyts or spontaneous fusions that are also thickened and presumably also a body’s reaction to the instability, the “yellow belt” (Ligamentum flavum). The area that is available for the dural sleeve becomes smaller so that the nerve root irritations or damages to the nerves roots are occurring. weiter zur Therapie...
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An instability that is leading to a sliding vertebra is deforming the spinal canal and the canal becomes elongated. While the transverse section normally remembers to a “Napoleon’s hat”, the canal becomes slimmer and sharpener. The mechanical stress in the segment is causing the formation of bracing reactions, the spondylophyts or spontaneous fusions that are also thickened and presumably also a body’s reaction to the instability, the “yellow belt” (Ligamentum flavum). The area that is available for the dural sleeve becomes smaller so that the nerve root irritations or damages to the nerves roots are occurring. weiter zur Therapie...
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In many cases the reason for these alterations can be found in the mechanical instability. The musculature of the spine can be stabilized by the respective gymnastics and exercises and therefore the instability and its consequences can be improved. Collateral the whole range of pain therapy methods can be applied. However, this is often necessary in order to make well-aimed medical gymnastics possible. The main focus of the medical therapy lies on the physical measures, relaxation exercises, electrotherapy and professional accupunture and not on pain medication. In case all the therapy measures fail or a persistence of the complaints is diagnosed in the end the operative enlargement of the spinal canal is necessary. With this the respective nerve segments are released from the bone pressure. The medical therapy of the spinal canal stenosis is mostly conservative. Serious nerve damages, uncontrollable, invalid-making pains and the circumscribed findings can be treated by operative measures.
As there is no causally determined therapy for a progressed degenerative spine disease the pain therapy and physiotherapy are standing in the foreground.
As to that belong:
• Medication pain therapy (NSAR, opiate …)
• Pain patch
• Implantable pain-control pump
• Physical pain therapy (juice therapy, ultrasonics, heat …)
• Infiltration therapy (regional nerve blockade, periradicular therapy, trigger point infiltrations)
• Psychotherapy
• Mobilizing and stabilizing physical therapy
• Back school and behavioural therapy
• Special medical corsets
An exact diagnostic, trying to get the bottom of the problems and the optimal medical therapy and a sufficient paint therapy are in advanced cases only possible in the course of an inpatient treatment.
The biggest non-invasive pain-therapeutic effects have infiltrations of medications (injections), which are injected directly (epidural/peridural) in to the vertebral canal.
Epidural infiltrations
For a spinal canal stenosis that is already affecting the upper parts of the lumbar spine an epidural infiltration is indicated. By means of a sacral infiltration normally only the area up to approximately the 4th lumbar vertebral body can be treated with pain medications. With an epidural infiltration one is very flexible with regards to the height of the infiltration. The meatus is the same like with a spinal anaesthesia.
By means of a long needle it is searched for the respective vertebral canal according to the principle “loss of resistence” and a mixture of local anaesthetics and cortisone is injected with a sacral infiltration. The pain therapeutic effect corresponds with the sacral infiltration. If the medication shall be applied repeatedly a catheter system (tube system) can be connected in order to maintain the aperture to the vertebral canal.
Surgical treatment
The surgical treatment is only reserved for very severe cases of a spinal canal stenosis, Reason for a surgical treatment can be:
• Intolerable pain, not controllable by conservative treatment measures
• Neurological defunctionalization symptom
• Incapability to walk/invalidity
• Circumscribed spinal canal stenosis
• young patient
The most suitable therapy measure would be the circumscribed spinal canal stenosis by means of an open microsurgical decompression.
Microsurgery means an open surgery with a very small skin incision, the use of a special operation microscope as well as the use of special bended instrument.
Microscopically enlarged the parts responsible for the spinal canal stenosis/nerve root stenosis are removed and the spinal canal is released and decompressed (part of the vertebral arch, parts of the ligamentum flavum, parts of the vertebral joint). The operation trauma is confined to the most necessary.
Advantages of the microsurgical procedure are:
• Slight operation trauma due to this less loss of blood and less scar formation
• Early-stage mobilization and rehabilitation measures are possible
• Less damages to nerves and vessels
• Obtaining the stability of the locomotor system by insertion of dynamic implants (DIAM, X-Stop, Wallis, Aperius)
Dynamic implants like the X-Stop System and the DIAM-System give the chance to release the constrained nerve roots without opening up the spinal canal and at the same time revise the awkward movement dynamic.
The mobilization is mostly regained on the evening of the operation, the pain in the back and in the legs eases considerably after a short period of time.
When it comes to a long hauled spinal canal stenosis over the area of several vertebral body stages the incision must be made larger according to a open operation. For single decompression steps the operation microscope is brought into the process.
If at the same time a distinctive instability of the vertebral body exists in addition the instable vertebral body stages need to be stabilized. This can be made in different ways, if necessary an operation from two sides with a procedure from the front and from the back (abdominal and from behind). Sometimes an operation only from behind is sufficient. The result is a stiffening of the spine (spondylodesis). zurück zur Definition
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As there is no causally determined therapy for a progressed degenerative spine disease the pain therapy and physiotherapy are standing in the foreground.
As to that belong:
• Medication pain therapy (NSAR, opiate …)
• Pain patch
• Implantable pain-control pump
• Physical pain therapy (juice therapy, ultrasonics, heat …)
• Infiltration therapy (regional nerve blockade, periradicular therapy, trigger point infiltrations)
• Psychotherapy
• Mobilizing and stabilizing physical therapy
• Back school and behavioural therapy
• Special medical corsets
An exact diagnostic, trying to get the bottom of the problems and the optimal medical therapy and a sufficient paint therapy are in advanced cases only possible in the course of an inpatient treatment.
The biggest non-invasive pain-therapeutic effects have infiltrations of medications (injections), which are injected directly (epidural/peridural) in to the vertebral canal.
Epidural infiltrations
For a spinal canal stenosis that is already affecting the upper parts of the lumbar spine an epidural infiltration is indicated. By means of a sacral infiltration normally only the area up to approximately the 4th lumbar vertebral body can be treated with pain medications. With an epidural infiltration one is very flexible with regards to the height of the infiltration. The meatus is the same like with a spinal anaesthesia.
By means of a long needle it is searched for the respective vertebral canal according to the principle “loss of resistence” and a mixture of local anaesthetics and cortisone is injected with a sacral infiltration. The pain therapeutic effect corresponds with the sacral infiltration. If the medication shall be applied repeatedly a catheter system (tube system) can be connected in order to maintain the aperture to the vertebral canal.
Surgical treatment
The surgical treatment is only reserved for very severe cases of a spinal canal stenosis, Reason for a surgical treatment can be:
• Intolerable pain, not controllable by conservative treatment measures
• Neurological defunctionalization symptom
• Incapability to walk/invalidity
• Circumscribed spinal canal stenosis
• young patient
The most suitable therapy measure would be the circumscribed spinal canal stenosis by means of an open microsurgical decompression.
Microsurgery means an open surgery with a very small skin incision, the use of a special operation microscope as well as the use of special bended instrument.
Microscopically enlarged the parts responsible for the spinal canal stenosis/nerve root stenosis are removed and the spinal canal is released and decompressed (part of the vertebral arch, parts of the ligamentum flavum, parts of the vertebral joint). The operation trauma is confined to the most necessary.
Advantages of the microsurgical procedure are:
• Slight operation trauma due to this less loss of blood and less scar formation
• Early-stage mobilization and rehabilitation measures are possible
• Less damages to nerves and vessels
• Obtaining the stability of the locomotor system by insertion of dynamic implants (DIAM, X-Stop, Wallis, Aperius)
Dynamic implants like the X-Stop System and the DIAM-System give the chance to release the constrained nerve roots without opening up the spinal canal and at the same time revise the awkward movement dynamic.
The mobilization is mostly regained on the evening of the operation, the pain in the back and in the legs eases considerably after a short period of time.
When it comes to a long hauled spinal canal stenosis over the area of several vertebral body stages the incision must be made larger according to a open operation. For single decompression steps the operation microscope is brought into the process.
If at the same time a distinctive instability of the vertebral body exists in addition the instable vertebral body stages need to be stabilized. This can be made in different ways, if necessary an operation from two sides with a procedure from the front and from the back (abdominal and from behind). Sometimes an operation only from behind is sufficient. The result is a stiffening of the spine (spondylodesis). zurück zur Definition
zurück zur Entstehung...
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