Lumbar spinal stenosis (spinal canal stenosis)

The sensitive spinal cord runs in the spinal canal of the spine. A narrowing (stenosis) in this canal often causes pain when walking and back pain. Find out everything about symptoms, diagnosis and therapy here

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Spinal canal stenosis - briefly explained

The spinal cord pulls through the vertebral bodies in a predetermined "hole". If this spinal canal is narrowed, one speaks of a spinal canal stenosis. The causes of a narrowed vertebral canal can be congenital or acquired; the most common are signs of wear and tear on the vertebral joints (arthrosis of the vertebral joints) and the intervertebral discs. Symptoms of spinal stenosis vary. Characteristic are pain, heaviness and / or sensory disturbances in the legs, which increase when walking (and standing for longer periods), which leads to an increasing reduction in walking distance. The diagnosis is confirmed on the basis of the clinical examination together with imaging procedures (X-ray, MRI). The symptoms of spinal stenosis can often be alleviated with conservative methods (without surgery), but not completely eliminated. The main pillars are drug therapy (including painkillers) and physiotherapy exercises. A corset can also stabilize the spine. If the above measures do not improve the symptoms or if nerve damage is already found, surgical treatment takes place. A decompression operation (relief by removing certain parts of the vertebral segment) with or without additional stabilization of the segment can be considered for this.

What is spinal stenosis?

The vertebral canal (in technical jargon: spinal canal) is located within the spine. The structure of bones and ligaments coats the soft spinal cord and nerves that pull into the legs. The spinal canal thus forms a bony protection. A narrowing (stenosis) of the spinal canal is called a spinal canal stenosis. Usually the spinal canal is narrowed at the level of the lumbar spine (lumbar spinal stenosis).

Lumbar spinal stenosis is a very common disease in older people. In every fifth patient over the age of 60, there is a narrowing of the spinal canal.

© W & B / Martina Ibelherr

Background information - The spinal canal (No. 2 in the picture)

The spinal canal runs within the spine. The figure shows a lumbar vertebra - viewed from above - with the vertebral body, spinal canal, transverse processes, articular surfaces of the vertebral joints and the spinous process. The spinous process points towards the back and is externally visible and palpable. The vertebral body points towards the abdomen.

© W & B / Martina Ibelherr

Background information - The spine

The individual vertebral bodies "stacked on top of each other" form the spine and are connected to one another by small joints. There is a hole in the middle of each vertebral body. Layered on top of each other, the individual holes form the vertebral canal (spinal canal). It forms the protective tunnel for the soft, sensitive spinal cord. The spinal cord is made up of nerve substances that transmit stimuli from the brain to the body. Nerves emerge at certain points in the spine, which then branch out and control the movements of arms and legs, for example. The cartilaginous intervertebral discs are located between the bony vertebral bodies. The intervertebral discs absorb certain movements (for example when jumping) like shock absorbers and allow the spine to bend in different directions.The spine consists of individual sections: cervical spine, thoracic spine, lumbar spine as well as sacrum and coccyx (please click on the magnifying glass to see the entire spine).

Causes: How does lumbar spinal stenosis occur?

Spinal canal stenosis describes an anatomical narrowing of the spinal canal, as a result of which the space for the nerves and vessels located therein becomes less. Causes of this tightness (stenosis) can either be congenital or acquired. In many cases, a combination of several factors leads to spinal stenosis.

Changes due to wear and tear lead to an enlargement of the vertebral joints (arthrosis) with a thickening of the joint capsule and the surrounding ligaments, thereby reducing the diameter of the vertebral canal. Disc protrusions can contribute to further narrowing. The nerves running in the spinal canal are compressed, which causes the typical symptoms.

Most common causes:

  • Signs of wear and tear: ossification of the vertebral bodies and the joints between the vertebrae, thickening of the ligaments and joint capsules, protruding intervertebral discs, slipping of the vertebrae (spondylolisthesis)
  • Idiopathic spinal stenosis: The spinal canal is narrowed from birth for no known cause

Less common causes:

  • Certain inherited bone diseases (such as Paget's disease)
  • Pronounced hollow back (hyperlordosis)

© W & B / Szczesny

Due to age-related wear and / or genetic predisposition, the intervertebral discs lose height and the distance between the vertebral bodies decreases. The height of the segment is reduced, which on the one hand can lead to a bulging of the intervertebral disc itself into the spinal canal (protrusion), on the other hand the ligaments stretched between the vertebrae (vertebral arch ligament, "ligamentum flavum") are no longer taut due to this height reduction . These thrown up ligaments can narrow the spinal canal. The mobility in the affected vertebral segment can also increase. This puts additional strain on the joints between the individual vertebrae (facet joints) and they react with bony attachments. The changes mentioned above can also lead to instability of the segment. The result is a so-called sliding vortex, which is no longer tightly fixed and further narrows the already constricted vertebral canal. This results in compression of the nerve roots in the affected segment.

When standing, the increased curvature of the lumbar spine increases the pressure on the nerves. During physical exertion - simply walking is often enough - the pressure on the nerve roots and their vascular supply increases, so that the typical pain and abnormal sensations that radiate into the legs arise.

Symptoms: what symptoms does spinal stenosis cause?

The symptoms of spinal stenosis vary in their severity. Most of those affected have been suffering from back pain for years, which has gradually worsened and radiates into the legs under strain. The legs then feel heavy and tired. Most of the time, the discomfort occurs while walking. In contrast to similar symptoms in circulatory disorders of the legs (intermittent claudication), the symptoms only improve very slowly after exercise. In addition, it is usually not enough just to stand still, but rather the person concerned has to sit down and walk on a hunched back. This is a typical symptom of lumbar spinal stenosis (spinal claudication). Due to the hunched back when cycling, this is usually still possible for those affected, whereas walking, especially downhill (due to the backward inclination of the spine) usually causes increasing pain in the legs.

Symptoms of paralysis and sensory disturbances are generally rare and are signs of severe constriction. In the worst case, the stenosis leads to a paraplegic syndrome with flaccid paralysis of the legs and problems with urination and defecation.

The above-mentioned symptoms with pain in the legs and reduced walking distance can occur not only with spinal stenosis, but also with many other diseases of the spine, such as a fracture of the vertebral body, herniated disc, nerve diseases (neuropathies), osteoarthritis of the hip (coxarthrosis) ) or circulatory disorders of the legs (PAD, intermittent claudication). It is therefore important to have a detailed medical examination of the symptoms.

Diagnosis: How is spinal stenosis diagnosed?

  • Medical history and physical examination

The symptoms described are groundbreaking for the diagnosis of spinal canal stenosis. As part of the physical examination, the pain can sometimes be provoked by carefully bending the trunk backwards (lordosis). If the pain improves with the opposite movement - leaning the trunk forward with supports on the hands - this provides the doctor with an important clue for the diagnosis.

  • Imaging procedures

The most important examination method is above all magnetic resonance tomography (MRT). In addition to the bony vertebrae, it shows particularly well the "soft tissue structures" such as intervertebral discs, spinal cord, nerve roots and ligaments.

An X-ray of the lumbar spine can show any degenerative changes that have already been made or other causes (for example, a fracture of a vertebral body). Since only the bony structures can be seen in the X-ray image and not the spinal canal itself, magnetic resonance tomography (MRT) remains the most informative method. If an MRI is not possible, for example due to a pacemaker, a lumbar computed tomography (CT scan) may be necessary.

Therapy: How is spinal stenosis treated?

  • Conservative treatment

Treatment of spinal stenosis depends on the severity of the clinical symptoms. In the case of moderate complaints, conservative treatment (without surgery) always takes place first. This puts its main focus on relieving the spine. Physiotherapy exercises, heat treatments and massages temporarily improve the symptoms in many cases. In addition, pain relievers and anti-inflammatory drugs relieve the pain. In principle, it is important to avoid postures in which the lumbar spine is bent into the hollow back. In very serious cases, spinal stenosis surgery is required.

Conservative therapy can alleviate symptoms. Usually medicinal, physiotherapy and physical therapy measures are combined (multimodal therapy concept).

Caution: Of course, all conservative therapeutic measures cannot influence the narrowing of the spinal canal as the cause of the symptoms, but only alleviate the symptoms (usually only temporarily).

  • Operative treatment

The operation of a spinal canal stenosis is a technically demanding procedure that should be reserved for special centers and experienced surgeons. Different surgical techniques are available, which are used depending on the extent and cause of the spinal canal stenosis. The principle of the operation is to relieve ("decompress") the point where the nerves are compressed.

Today, the operations are often minimally invasive (operation through a small window in the skin) as microsurgical or endoscopic intervention (very small access, the surgeon works with an operating microscope (endoscope)). If there is instability or curvature of the spine or the accompanying back pain is in the foreground, an additional stiffening operation may be necessary.

Our advisory expert:

Professor Dr. med. H. Michael Mayer is the chief physician in the spine center of the Schön Klinik München-Harlaching.

Swell:

  • Medical Association Baden-Württemberg, "Common causes of lumbar pain - spinal stenosis and herniated disc. Online: https://www.aerztekammer-bw.de/10aerzte/20fortbildung/20praxis/90allgemeinmedizin/1701.pdf (accessed on June 3, 2019)
  • German Society for Neurology, "Lumbale Radikulopathie", as of January 2018. Online: https://www.dgn.org/leitlinien/3516-ll-030-058-2018-lumbale-radikulopathie (accessed on June 3, 2019)
  • German Society for Orthopedics and Orthopedic Surgery (DGOU), "Specific Kreuzschmerz", p. 19 ff "Spinal canal stenosis", as of December 2017. Online: https://www.awmf.org/uploads/tx_szleitlinien/033-051l_S2k_Spezischer_Kreuzschmerz_2018-02. pdf (accessed June 3, 2019)
  • Levin K. Lumbar spinal stenosis: Pathophysiology, clinical features, and diagnosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (accessed June 3, 2019)

Important NOTE:
This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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