Spinal canal stenosis of the lumbar spine

Patients often complain of severe back pain, which can often radiate into one or both legs (lumboischialgia). These radiating pains are usually described as shooting and stabbing. A further characteristic is an often limited walking distance.

Depending on the extent of the constriction, patients report that their legs begin to hurt after (a few) 100 meters and they experience an unpleasant tingling or numbness that prevents them from walking any further. This phenomenon is called claudication spinalis. A characteristic feature of claudication in spinal stenosis is that the pain improves when the patient bends forward (reclination).

(Whereas an improvement of the symptoms caused by reclination cannot be observed in intermittent claudication – colloquially also described as “window dressing”. This is caused by a reduced arterial blood supply to the lower extremity in peripheral arterial occlusive disease, and thus has completely different causes, but similar symptoms). The improvement through prevention can be explained by the fact that the spinal canal widens a little bit in this case and thus a slight relief of the spinal cord is achieved.

Thus, affected patients usually prefer a forward bent sitting position to lying down, which in pronounced cases can lead to them trying to sleep even when sitting. More about this:

Spinal canal stenosis of the lumbar spine
Symptoms of spinal canal stenosis

In principle, spinal canal stenosis is first approached conservatively (i.e. non-surgically). The aim is not to remove the underlying cause, but to treat the consequences.

The measures include relief of the spinal cord, for example by means of stepped bed positioning or – if the patient is still mobile – movement such as cycling. Painkillers are used medicinally, especially those from the group of non-steroidal anti-inflammatory drugs (NSAIDs), including substances such as ibuprofen, diclofenac, piroxicam and celecoxib (Celebrex®). In addition, an early start to physiotherapy plays an important role in the treatment of muscular tension and in learning to behave in a way that is appropriate for the back.

Syringes containing local anesthetics for temporary anesthesia, injected directly into the affected area, can also provide temporary relief. Surgical intervention should be considered if the patient still has significant symptoms after conservative treatment, i.e. if the disease is refractory to therapy. But also – or especially – if neurological deficits such as paralysis or major sensitivity disorders occur, surgery should be considered urgently.

The aim of the operation is to relieve the spinal cord by removing or splitting bony or ligamentous (belonging to the ligamentous apparatus) parts of the spinal column. This procedure is called microsurgical decompression. Microsurgical because it uses a surgical microscope, which makes it possible to make only very small skin incisions. If the narrowness extends over several vertebrae, the operation must be performed open (i.e. with a larger skin incision).