Conditions Spinal stenosis

Spinal stenosis is a narrowing (stenosis) of the spinal canal. Depending on how narrow the canal is, the spinal cord and nerve roots can be damaged.

The spine is made up of several interconnected vertebrae. Vertebrae have a hole in the middle – the vertebral foramen. Together, the vertebral foramen form the spinal canal, through which the spinal cord runs, and the roots of the spinal cord nerves (spinal nerves) branch off from this.

Spinal stenosis most commonly affects the lumbar spine in the lower back although, in rarer cases, it can also affect the cervical spine in the neck. It develops slowly over several years. If the lumbar spine is affected, doctors refer to this as lumbar spinal stenosis and talk of cervical spinal stenosis if it’s in the neck area.

Lots of older people have spinal stenosis, caused by wear and tear.

This does not always cause problems. Sometimes, however, the narrowing of the spinal canal causes symptoms such as pain, impaired sensation or paralysis. This then requires treatment.

Often, spinal stenosis does not cause any symptoms. Symptoms only occur when the spinal canal is so severely narrowed that nerves, nerve roots or blood vessels are compressed.

The symptoms are also dependent on whether it is the cervical spine (neck) or the lumbar spine (lower back) that is affected.

When the spinal canal in the cervical spine is narrowed, neck pain radiating to the arms usually occurs. The person may also experience dizziness. If the spinal cord is damaged by the narrowing, it can also cause impaired sensation or numbness in hands, arms and legs over time. These symptoms can be very changeable at first.

Narrowing of the spinal canal in the lumbar spine area often manifests itself as chronic pain in the lower back, some of which radiates to the buttocks and legs. Prolonged standing or walking usually intensifies the pain. They usually improve when sitting or bending forwards. Sometimes, there is also impaired sensation and paralysis in the legs.

The most common cause of spinal stenosis is signs of wear and tear of the spine, such as on intervertebral discs and the zygapophyseal joints (small vertebral joints). The wear and tear is usually age-related. 

It is rare for spinal stenosis to be present at birth. Accident or fall-related injuries to the spine can also lead to stenosis if a broken piece of bone is pushed into the spinal canal. Other rare causes of spinal stenosis include previous surgical procedures, metabolic disorders, bone disease, infections or tumors.

There are no exact numbers of how many people have spinal stenosis.

As wear and tear is a common cause for the narrowing, the likelihood increases with age.

In the over-65 age group, spinal stenosis is the most common reason for surgery on the spine.

To diagnose spinal stenosis, you first of all need to have an in-depth conversation with your doctor about your existing symptoms and an intensive physical examination.

Doctors check for the following in particular:

• whether and which sensory disturbances are present
• whether and where paralysis is present
• how flexible you are and how good your reflexes are
• to what extent and in what form your gait is impaired
• whether pain occurs as a result of damaged nerve roots

To confirm the diagnosis, doctors usually use magnetic resonance imaging (MRI). This imaging procedure helps identify where and how severely the spinal canal is narrowed. In some cases, an x-ray scan is performed while the patient is standing up.

Various treatment options are available depending on the cause and severity of spinal stenosis. They range from exercises to the administration of medication and surgery.

If causes such as an infection or tumors can be ruled out and there are no signs of spinal cord damage, conservative therapy usually suffices. This includes all non-surgical treatments such as:

• Movement exercises in the pain-free region and muscle training
• Taking non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants
• Infiltration: this is where a local anesthetic and an anti-inflammatory drug like cortisone are injected near to the spine.

Above all, it is important for patients to remain mobile. This is crucial for maintaining or rebuilding the muscles that stabilize the spine.  

If conservative treatment measures are not effective enough or the spinal cord or nerve roots have been damaged, surgery may be necessary. This particularly applies if paralysis is present.

Surgery usually involves the removal of bony parts of one or more vertebral joints and the vertebral arch to widen the spinal canal and reduce pressure on the nerves. This procedure is also called decompression.

If the spine is unstable, the neighboring vertebral bodies can also be connected to each other. Surgery should be followed by physiotherapy to improve mobility and reduce pain.

Surgery should generally only take place if it is absolutely necessary. Studies suggest that 10 to 24 of every 100 spinal stenosis operations on the lower back result in complications that sometimes lead to permanent physical impairments.

Spinal stenosis can progress in very different ways. In 50 to 70 percent of those affected, the symptoms can be improved through conservative treatments such as physiotherapy and medication. However, 20 to 40 percent of people who initially receive conservative treatment still end up having surgery within the next 10 years.