Causes

A spinal canal stenosis is not a sudden event in the spine. On the contrary, it develops after a creeping process that usually goes unnoticed and undetected for years. It is a slow, wear-related, degenerative remodelling of the bony structure of the spine.

Not all degenerative changes in the spine cause complaints; on the contrary, they occur in almost all people in old age. Ultimately, they are therefore something natural that occurs with age. Whether complaints develop or not depends strongly on the extent of the change, the basic stability of the spine, the general condition of the person and, above all, the stress to which the spine is subjected, for example, through sports or work.

But what exactly are degenerative processes? And how can they be imagined? A degenerative change is a kind of wear and tear or decay of tissue, which is usually accompanied by a functional limitation of the affected area, e.g. a joint.

Various changes are found in the context of spinal canal stenosis of the lumbar spine. An important process to be mentioned in this context is the development of bony attachments. These are also known as osteophytic attachments or spondylophytes.

These are bony attachments that occur at various locations of the vertebral bodies and the bony extensions of the vertebrae. Since these extensions are space-consuming and occur in places where there is no room for them, other structures may become constricted. In spinal canal stenosis, bony attachments constrict important nerve roots at their exit points in the intervertebral holes (Foramina intervertebralia) and the spinal cord in the spinal canal.

Furthermore, arthrosis-like changes in the intervertebral joints are a consequence of wear and tear. The intervertebral joints are the joints that connect the vertebrae with each other, also known as facet joints. In the course of degenerative wear, the intervertebral discs also lose height.This loss of height and elasticity of the intervertebral discs leads to a higher load on the individual vertebral bodies.

In addition, the important ligamentous apparatus of the spine also loses elasticity, since it is no longer taut due to the loss of height. A possible consequence can be a so-called spondylolisthesis, in which the vertebral bodies slide against each other. Ultimately, all these degenerative changes result in narrowing at various points of the spine.

Strong back muscles can help to stabilize the spine and cushion forces and loads. People whose back muscles are not well trained are more likely to develop complaints. In addition to wear-related changes in the spine, there are other primary diseases that can trigger spinal stenosis of the lumbar spine.

However, these are very rare. One example of such a disease is Paget’s disease (ostitis deformans), which is a bone disease that promotes the occurrence of bony attachments to the lumbar spine. Hormonal imbalances, such as Cushing’s syndrome, in which elevated cortisone levels in the blood are present, can also cause spinal stenosis. Finally, spinal canal stenosis of the lumbar spine can also occur as a complication in the course of spinal surgery.