Spinal stenosis
Spinal canal stenosis occurs as a result of overgrowth of the spinal canal, which is an enclosed space within the spine that houses the spinal cord and nerve roots. As a result of degenerative changes (most often), narrowings can occur, in which the above-mentioned nerve elements are excessively compressed.
Causes of stenosis:
The main cause of stenosis is degenerative changes. As we age, the intervertebral discs flatten and protrude into the spinal canal. Because discs are natural shock absorbers, increasing force begins to affect surrounding structures, such as intervertebral joints, which enlarge. The yellow ligament, which protects the contents of the canal, with a standard thickness of up to 2 mm can overgrow to a thickness of more than 1 cm.
It is much less common for spinal canal stenosis to result from other conditions, such as trauma or cancer.
Symptoms of stenosis
Stenosis most commonly occurs in the lumbar and cervical sections, it is far less common for it to affect the thoracic section.
The most common symptoms of cervical spinal stenosis:
- Symptoms of spinal cord compression
- impaired hand function, especially when performing precision tasks such as buttoning
- gait disturbances, especially when walking down stairs
- urinary disorders
- Symptoms of nerve root compression
- brachial neuritis (pain radiating to the hand)
- superficial sensory disturbances in the arm / hand
- Symptoms resulting from disk damage, sometimes from instability
- neck pains
- less frequently, headache
The most common symptoms of lumbar spinal stenosis:
- Resulting from pressure on the roots:
- so called neurogenic claudication – a classic symptom. After walking a certain distance, e.g. 100 m, a sick person has to stop because of numbness in the legs. After stopping and mostly leaning forward, you can continue walking after a short pause
- pain radiating from the spine / buttock to the leg
- urinary disorders
- in extreme cases paresis of the limbs, e.g. foot / feet drop
- Related to discopathy and intervertebral joint damage
- lumbar backaches
- backaches
Diagnosis
The diagnosis of stenosis is based on a detailed history and imaging studies. The gold standard for diagnostic imaging is magnetic resonance imaging (MRI), as it is necessary to visualise soft tissue structures of the spinal canal such as nerve roots and the fluid collection. They are faintly visible on a computed tomography (CT) scan, while they are not visible on an X-ray.
Treatment of stenosis
Treatment of spinal canal tightness is both conservative and surgical. During conservative treatment, pharmacotherapy based mainly on the use of nonsteroidal analgesics and anti-inflammatory drugs is used. While physiotherapy is often an effective treatment for discopathy with sciatica, its role is very limited for stenosis. This is because symptoms appear when the narrowing of the spinal canal is already very advanced, when the pressure on the nerve elements is very intense.
The most effective treatment for symptomatic stenosis is surgical decompression, which is the release of pressure on the nerve elements. At Vratislavia Medica Hospital we perform procedures for decompression of spinal canal narrowing using minimally invasive techniques. One of these is laminotomy. This procedure involves making a small incision in the skin and, under the guidance of an operating microscope, removing the tissue that is pressing on the nerve fibres. A procedure performed using the minimally invasive technique has many benefits for the patient. Surgical damage to the muscles is very slight, blood loss is minimal and the structure of the spine remains intact – so patients get up on the day of surgery and are discharged home the next day fully fit.
Surgical techniques for stenosis
Laminectomy (classic method) | Laminotomy (minimally invasive method) | Endoscopic decompression | |
|---|---|---|---|
Invasiveness | High | Low | Very low |
Efficacy in advanced stenosis | High | High | Medium |
Blood loss | Medium-high | Low | Low |
Muscle damage | Little | Little | Very little |
Verticalization | After 2-3 days | On the day of surgery | On the day of surgery |
Important!
If you are experiencing pain in your spine and/or numbness in your limbs, don’t underestimate the problem and come in for a consultation with a neurosurgeon who will suggest a form of treatment suitable for you.
Available treatment methods:
