Difference to herniated disc

Although the herniated disc and spinal canal stenosis have similar symptoms, the diseases are very different. With a herniated disc the disc itself is affected. When the elastic fibrous ring of the intervertebral disc becomes porous and the gelatinous core emerges from the interior, this is called a herniated disc.

This can cause a narrowing in the spinal canal. However, the cause of spinal canal stenosis is not a herniated disc.However, both diseases can be present. In spinal canal stenosis, the spinal canal running through the vertebrae is affected.

A slipped disc usually occurs acutely. This means that the affected person suddenly feels shooting pain in the area of the herniated disc, while spinal canal stenosis usually develops insidiously and only leads to problems over time. While spinal canal stenosis is rather a disease of old age (exception is a congenital spinal canal stenosis), a herniated disc can already occur in early adulthood.

Although both diseases occur particularly frequently in the lumbar spine, there are also differences there. A herniated disc often occurs between the 4th and 5th lumbar vertebrae or the 5th lumbar and 1st sacral vertebrae. There, the curvature of the spine puts a higher pressure on the intervertebral discs.

Spinal canal stenosis, on the other hand, occurs somewhat higher in the 4th lumbar vertebra or between the 4th and 5th lumbar vertebrae. Based on the typical characteristics and diagnostics, physicians can therefore easily distinguish between spinal canal stenosis and a herniated disc. It is therefore also possible that both diseases occur in parallel, although one disease is usually the determining factor.

Therapy/treatment

The therapy of spinal stenosis depends on many factors. These include, for example, the extent and localization of the stenosis, the patient’s age and general state of health as well as concomitant diseases of the patient and the limitations caused by the spinal canal stenosis. As a rule, the aim is to perform a conservative therapy.

This means that the patient’s suffering is initially alleviated with the help of pain and anti-inflammatory medication. In cases of very severe pain, the so-called infiltration can achieve good results. A thin pain catheter is placed at the point of pain, where medication can then be administered continuously over several days.

Periradicular therapy, in which computer-controlled syringes inject an anesthetic or cortisone preparation near the affected nerve channels, pursues a similar goal. An important component of conservative treatment is physiotherapy. Here, patients learn how to avoid a relieving posture and how to build up the back and abdominal muscles in a targeted manner to relieve the spinal canal.

If the conservative therapy does not lead to the desired success or if the patient’s level of suffering is very high, surgery for spinal canal stenosis may be considered. In this case, the spinal canal is widened in various possible surgical procedures. There are various possibilities of drug therapy for spinal canal stenosis.

Basically, the use of the selected drugs is based on the 3-stage scheme of the World Health Organization: Stage 1 is mild pain, using painkillers and anti-inflammatory drugs such as paracetamol, ibuprofen or diclofenac; stage 2 is moderate pain, with the doctor able to prescribe mild opioid analgesics. This group includes tramadol or the combination of tilidine and naloxone. Stage 3 treats severe pain.

Opioid analgesics of choice here are strongly effective opioid analgesics such as morphine, fentanyl or oxycodone. Injection therapy can also provide relief for spinal stenosis. Here, the physician injects a mixture of lidocaine (a local anesthetic) and cortisone (anti-inflammatory) into the spinal canal.

The injection is either transforaminal (through the nerve exit channel of the spine) or interlaminar (between two adjacent vertebral bodies).

Stage 1 is mild pain, using painkillers and anti-inflammatory drugs such as paracetamol, ibuprofen or diclofenac
Level 2 describes moderate pain, where the doctor may prescribe mild opioid analgesics. This group includes tramadol or the combination of tilidine and naloxone.
Level 3 treats severe pain.
Opioid analgesics such as morphine, fentanyl or oxycodone are the drugs of choice.

In case of spinal canal stenosis, there are various exercises that are used to relieve and mobilize the spine by bending, stretching or extension. Depending on the location of the stenosis, there are specific exercises for the cervical, thoracic and lumbar spine. Cervical spine: A good exercise for spinal canal stenosis in the cervical spine is retraction.

Here, the patient pushes the chin backwards, as if trying to make a double chin. The movement automatically straightens the cervical spine and the neck is stretched. The position is held for 10 seconds and then slowly released.It is important that no rapid movements are made in the cervical spine.

If you are unsure, you can also do the exercise in front of a mirror at the beginning. Thoracic spine: In this exercise, the patient stands on both legs on a balance board or cushion (advanced students can also do the exercise on one leg). The legs are now slightly bent and the back straightened (no hollow back).

Now the arms are stretched upwards over the body for a long time, held there for 2 seconds and then slowly brought down again at the side. 2 times 15 repetitions. Lumbar spine: For this exercise the patient lies on a table in prone position, so that the pelvic bones are flush with the edge of the table and the legs hang loosely from the edge.

If necessary, the patient can hold on to the table with his hands. The weight of the legs now exerts a pull on the lower back, stretching it, thus relieving the strain on the spinal canal. Further exercises can be found in the articles:

Exercises for spinal canal stenosis
Spinal canal stenosis – exercises for at home
Which exercises for spinal canal stenosis

Cervical spine: A good exercise for spinal canal stenosis in the cervical spine is retraction.
Here, the patient pushes the chin backwards, as if trying to make a double chin. The movement automatically straightens the cervical spine and the neck is stretched. The position is held for 10 seconds and then slowly released.

It is important that no quick movements are made at the cervical spine. If you are unsure, you can also do the exercise in front of a mirror at the beginning.
Thoracic spine: In this exercise the patient stands on both legs on a balance board or cushion (advanced students can also do the exercise on one leg). The legs are now slightly bent and the back straightened (no hollow back).
Now the arms are stretched upwards over the body for a long time, held there for 2 seconds and then slowly brought down again at the side. 2 times 15 repetitions.
Lumbar spine: For this exercise the patient lies on a table in prone position, so that the pelvic bones are flush with the edge of the table and the legs hang loosely from the edge. If necessary, the patient can hold on to the table with his hands.
The weight of the legs now exerts a pull on the lower back, stretching it, thus relieving the strain on the spinal canal.

>The question of whether spinal canal stenosis should be operated on must be decided individually for each patient and the benefit-risk ratio must be weighed up. Basically, an attempt is made to avoid the operative risks and to adopt a conservative treatment. However, this is not always possible.

If the patient’s level of suffering is extremely high, paralysis or other serious limitations exist, surgery should be performed. Since there are various surgical procedures for spinal canal stenosis, it is advisable to obtain detailed information and advice beforehand. Despite modern technology, many doctors still recommend stiffening of individual vertebral bodies, which is not always beneficial and can lead to problems later on.

During the operation itself, damage to nerve tracts and blood vessels can occur due to the proximity of the surgical field. In addition, the usual risks of surgery and anesthesia can be added. The operation for spinal canal stenosis is about widening the narrowed spinal canal again.

In contrast to the formerly common laminectomy, in which entire vertebral bodies are removed, the contents of the operation are much gentler today. Since spinal canal stenosis surgery is a very complicated procedure, it is only performed by experienced surgeons at a few locations in Germany. During the operation, the area to be operated on is first exposed in an open surgery or reached with the help of a minimally invasive procedure.

The surgeon then begins to cut open and unfold the vertebral bodies so that he can better reach the narrowed spinal canal. Microsurgical techniques are used to remove the constricted bone and connective tissue structures in the spinal canal. If the spinal canal stenosis is caused by bone growths of individual vertebral bodies, a vertebral implant can also be inserted to replace the altered vertebral body.

Since every patient is different and spinal canal stenosis can vary greatly from one patient to another, the surgeon must prepare himself/herself specifically for each operation in order to ensure the best possible care for the patient.After the operation, the patient will spend a few days in the hospital for monitoring. There the physiotherapeutic post-operative treatment will already begin. This is followed by the outpatient or inpatient rehabilitation measures. Are you looking for information about postoperative treatment of spinal canal stenosis surgery in the lumbar spine? Then read this article: OP spinal canal stenosis lumbar spine – aftercare