Spinal canal stenosis refers to a narrowing of the spinal canal (in the region of the lumbar spine) through which the spinal cord passes. This nerve bottleneck puts pressure on the spinal cord, nerves and blood vessels hence pain when standing and walking are some of the typical symptoms. In a worst case scenario, permanent nerve damage is the result. Natural ageing processes are the most common cause of a constricted spinal canal. However, fewer than ten per cent of the patients with a constricted spinal canal require an operation.
What causes spinal canal stenosis?
With advancing age, the spine wears out (degeneration), at different rates depending on predisposition and strain. The intervertebral discs also lose fluid with increasing age and shrink into each other a little. As the intervertebral discs serve as a kind of buffer between the vertebral bodies, these reductions mean that even the ligaments along the spine lose their elastic force. As a result, the spine becomes more unstable and the vertebral bodies can slide against each other (known as spondylolisthesis). Altogether this leads not only to more severe strain on the vertebral bodies but, above all, on the vertebral joints or the protective cartilage surfaces there. The body reacts to the damaged cartilage by widening the osseous parts: The bones under the cartilage become compressed and sclerosed. Osseous accretions are formed on the vertebral joints that can constrict the spinal canal: This creates a spinal canal stenosis (lumbal spinal canal stenosis).
Usually, various factors are jointly responsible for triggering spinal stenosis, so extensive diagnosis is essential. Causes can be:
- Genetic predisposition
- Degenerative changes (natural aging processes)
- Lack of exercise
- Injuries of the vertebral bodies
- Vertebral body fractures
- Spinal disc herniation
- Spinal canal stenosis after intervertebral disc surgery owing to post-operative scar tissue
- Pronounced vertebral joint osteoarthritis with resulting osseous constriction
- Spondylolisthesis with displacement of two vertebral bodies towards each other and the resulting osseous constriction
- Thickened “yellow ligaments” (ligamenta flava): These ligaments stabilise the spine and increase in thickness in the event of intervertebral disc wear
- Deviations in the spine position such as kyphosis (excessive extension of the spine backwards) or scoliosis (lateral curvature of the spinal column)
- Malpositions that arise from spinal injuries
- Hormonal changes such as Morbus Cushing
- Bone diseases such as Paget’s disease
What are the symptoms of spinal canal stenosis?
People who have stenosis of the spinal canal rarely suffer exclusively from back pain. Their symptoms are often non-specific and develop over months in several stages:
Symptoms of constriction of the spinal canal in two stages:
- A tense back
- Back pain that usually radiates down into the leg
- Mobility of the lumbar spine is limited
Symptoms in the more advanced stage:
- Patients suffer from instability when walking (ataxia)
- Pain-free walking becomes increasingly difficult
- Leg muscles feel weak
- Standing for a long time leads to local pain which can radiate down to the leg and buttock region
- Local and radiating pain when lying flat on the back
- Abnormal sensations in the legs (tingling, burning, formication, sensation of coldness)
- Bladder or bowel disorders (problems defecating or urinating)
- Sufferers have impaired sexual function
The pain is normally much easier to cope with if the patient bends forward as happens when you sit down, stoop, climb a hill or ride a bike. Conversely, the pain when walking down hill is particularly severe. Similarly to “window-shopper’s disease”, patients with stenosis of the spinal canal are always looking for an opportunity to sit down when they are walking. In the supermarket, they look forward to the saviour: their shopping trolley which they can lean over to reduce the constriction. This lessens the pain.
Cases such as these are known as claudicatio intermittens – i.e. from different pain conditions that temporarily diminish (intermittently). Spinal canal stenosis is known as claudicatio intermittens spinalis owing to the constricted spinal canal. However, it is important to distinguish this from peripheral occlusive disease, which can also lead to symptoms of claudicatio intermittens, for example. Here the cause is not constricted nerves but constricted blood vessels in the pelvis or thighs. The diagnostic difference between spinal canal stenosis and peripheral occlusive disease is, therefore, the easily felt pulse in the feet, which is significantly weaker in peripheral occlusive disease.
How is spinal canal stenosis treated?
Lumbal spinal canal stenosis can be treated with conservative, minimally-invasive or surgical therapies. Our focus is always to take advantage of the possibilities of conservative treatment before we recommend minimally-invasive or surgical treatment (see info box).
Conservative therapy for spinal canal constriction:
- Relieving posture (avoid long standing and sitting)
- Heat therapy
- Drug therapy
- Orthoses (support corset)
- Back health classes (targeted training to strengthen the back and stomach muscles)
- Video catheter
- Endoscopic surgery
- Microsurgical interventions
If these treatment options do not achieve success or if the spinal canal stenosis is far advanced and the symptoms are very severe, we have further state-of-the-art and gentle procedures at our disposal with which we can give you rapid and effective help:
Examination and treatment with a video catheter
With the video catheter, we examine, treat and remove not only inflammation and constrictions in the spinal canal but also adhesions and scars, using direct visualisation. To do this we pass a catheter (thickness of only 1.4 mm) via the sacrum into the spinal canal, guide it to the painful zone and inject highly effective drugs into the area. The disruptive soft tissue thereby shrinks.
Under general anaesthetic, we pass a thin endoscope as far as the spine. Muscles, ligaments and tendons do not need to be separated during this procedure, meaning that no scars develop which could trigger back pain again. With the help of micro-instruments, we remove the osseous tissue that constricts the spine in cases of spinal canal stenosis. The tip of the endoscope can be guided with precision in all directions.
For pronounced spinal canal stenosis, we remove the ingrown tissue with a microsurgical operative technique. To do this we make a small cut to pass a thin titanium sleeve as far as the spine. Through this sleeve we remove bone parts or thickened ligament tissue, using an operation microscope for visualisation. The spine remains unaffected and the stability of the spine is fully maintained.
Spondylodesis – vertebral fusion surgery – is the final option if all other minimally-invasive and conservative measures do not lead to improvement. In this procedure screws are inserted into two or more vertebral bodies and connected with each other via rods or metal plates, thereby stabilising the spine. The intervertebral disc is removed in the operation and replaced by an implant made of titanium or plastic known as a “cage”. This creates the required distance between the vertebral bodies until they have connected osseously to each other.
Patient opinion on treatment of spinal canal constriction
Helga N. (57) suffered from severe pain for many years which ultimately made it impossible for her to work in her occupation as a geriatric nurse. Dr med. Reinhard Schneiderhan was able to help the patient with a combination treatment of a heat probe and a spinal catheter. In her destiny report “Ten Years of Suffering and Hopelessness” in the magazine “Freizeit Total”, you can read about Helga N.’s experiences and suffering (in German).
Your advantage with us: customised treatment concept
You enjoy several advantages in our four medical care centres: As an interdisciplinary centre of excellence, we consider patients holistically and not only from the perspective of the respective medical discipline. Our doctors work together on an interdisciplinary basis and undergo continual further training at an international level, in order to offer you the best possible state-of-the-art treatment. We also spare you unnecessary follow-up appointments because all the examinations you need will normally be carried out on the same day at our premises. This means that you receive a treatment concept tailored to your needs as fast as possible. By the way, we also regard an operation as the very last resort and only contemplate this if the possibilities of minimally-invasive or conservative therapies do not bring any relief.
How to prevent spinal canal stenosis
The motto: “Being protected is half the battle” also counts in the prevention of spinal canal stenosis. A healthy diet, regular physical exercise and targeted training of the back and torso muscles are the most effective means of prevention. If the back muscles are well trained, the spine can cope with loads much more easily and poor posture is also minimised.