Spinal Stenosis: Causes, Symptoms & Treatment

Spinal stenosis is a predominantly degenerative condition that can develop in the cervical spine, particularly the lumbar spine. Although spinal stenosis is now the most common reason for lumbar spine surgery, conservative measures are the main focus of treatment.

What is spinal stenosis?

Back pain associated with spinal stenosis is a classic complaint. Spinal stenosis is the narrowing of the spinal canal formed by the vertebrae and extending from the first cervical vertebra to the sacrum. The narrowing is predominantly due to wear and tear, which is why it is becoming increasingly important against the background of the increasing life expectancy of the population and the increasing demands of even older patients for quality of life, mobility and flexibility. The increasing quality of diagnostics, above all imaging procedures such as magnetic resonance imaging and computer tomography, is also contributing to the fact that the diagnosis is being made more frequently. The lumbar spine is most frequently affected, and in particular the floor between the third and fourth as well as the fourth and fifth lumbar vertebrae. Spinal stenosis can also develop in the cervical spine, but is less common here.

Causes

The development of spinal stenosis due to chronic degenerative changes in the spine is a complicated and lengthy process that is influenced by several factors. Wear of an intervertebral disc can cause it to bulge into the spinal canal and already lead to narrowing. However, disc wear also leads to a decrease in the height of the distance between adjacent vertebral bodies, which can exacerbate the narrowing and lead to osteoarthritis of the vertebral joints. Arthrosis of the vertebral joints has a variety of consequences, such as swelling of the joint capsule, bony attachments and cysts may develop, as well as instability between the vertebral bodies. All of this can additionally cause distress to the spinal cord by compressing nerve roots, the spinal cord membranes and vessels. Spinal stenosis does not have to be limited to one location in the spine; it can be localized to multiple spinal levels at the same time.

Symptoms, complaints, and signs

Narrowing of the spinal canal does not cause symptoms until it is severe enough to press on blood vessels, nerves, and the spinal cord. The symptoms that occur depend on the section of the spine in which the stenosis is located. In most cases, the symptoms are more severe when the patient is in an upright posture, because this increases the pressure on the affected area. Bending the back, on the other hand, leads to relief and the symptoms subside. If the narrowing is in the lumbar spine, pain occurs in the lower back and may radiate to the legs. Walking is painful, and sufferers usually only manage short distances. The back also hurts when standing. Sitting, on the other hand, provides relief, since a bent posture is assumed. Muscle tension often occurs in the lumbar region. In addition, numbness, tingling and sensory disturbances can occur. In the further course, paralysis can develop. Incontinence and a disturbance of sexual functions are also possible. If the narrowing is in the neck area, it becomes noticeable with neck pain that can radiate into the arms. Fine motor skills of the hands may be disturbed, as well as the ability to perceive arms and hands. Furthermore, the muscle tension of arms and legs may increase. If the stenosis progresses further, the same symptoms as in paraplegia may appear.

Diagnosis and progression

Spinal stenosis in the lumbar spine causes unilateral or bilateral back pain that may increase in intensity over years, radiating to the buttocks, groin, and legs. If the problem exists in the cervical spine, there is typically neck pain that radiates to the shoulders and arms, numbness and problems with fine motor skills develop in the hands, and gait unsteadiness and a tendency to fall may also occur.However, all of these complaints are not typical of stenosis; rather, they can also occur in numerous other spinal diseases, such as an isolated herniated disc, inflammatory and neurological diseases, and vertebral body fractures that develop insidiously in the lumbar spine as part of osteoporosis. X-rays including so-called functional images, magnetic resonance imaging and computer tomography contribute to the clarification. In case of ambiguity, special neurological examinations, vascular diagnostics and also laboratory tests may be required to clarify a possible spinal stenosis.

Complications

Spinal stenosis primarily leads to very severe pain. This occurs mainly when walking or sitting for a long time and can have a very negative effect on the patient’s quality of life. The pain can also occur at night in the form of pain at rest and can lead to sleep problems. Most of those affected also suffer from depression and irritability. Sometimes, pain in the legs also becomes noticeable, which can be accompanied by significant restrictions in movement. As a result, many patients are dependent on the help of other people. The legs often feel heavy. Furthermore, the disease also leads to disturbances in sensitivity or paralysis in the legs. The pain often spreads to the back and can lead to restrictions there as well. The treatment of spinal stenosis is always based on the symptoms. Usually, no complications occur. The pain can be relieved with the help of painkillers. However, long-term use of painkillers can damage the stomach. Furthermore, sufferers rely on various exercises and therapies to alleviate the discomfort. The patient’s life expectancy is not reduced by the condition.

When should you see a doctor?

Spinal stenosis can manifest itself suddenly or slowly with a variety of symptoms. Seeing a doctor is therefore advisable for several reasons. It is important to see a doctor early whenever spinal stenosis causes sudden onset pain with severe characteristics. Also paralysis and numbness should be clarified promptly with the doctor. Immediate visit to the doctor is obligatory if there is no control over rectum or bladder. The primary care physician can be seen as the first point of contact. A neurologist or orthopedist who is already treating the patient is also a suitable contact. In cases of severe pain and at night, the emergency room of the nearest hospital can also be visited. There are also cases in which the doctor does not need to be consulted immediately for spinal stenosis and resulting complaints. This applies to cases where diagnostics have already been completed and the reason for the stenosis, for example a disc problem, is already known. Then the doctor is always consulted when unusual complaints are added or known pain as well as sensory disturbances have become more severe. The desire for a referral to a physiotherapist can also be a reason for a visit to the doctor, if the patient has already had the experience that physiotherapy can alleviate his known complaints. Pain therapists are seen when the pain or burning is difficult to control.

Treatment and therapy

The primary goals in treating spinal stenosis are to reduce pain and improve mobility. As a rule, conservative measures represent the initial treatment concept consisting of physiotherapy, physical and manual therapy, bracing, posture training and, of course, medicinal pain therapy, which may be supported by acupuncture. Surgery is only necessary if conservative measures, which have been consistently continued for 12 weeks, have not led to any significant success and the complaints are undoubtedly due to spinal stenosis. However, there is an absolute indication for surgery if there are increasing symptoms of paralysis due to compression of the spinal cord or a nerve root. The principle of the operation consists of a so-called decompression, in which the spinal canal is surgically widened again, thus relieving the spinal cord and nerve roots.Various surgical techniques are available for this purpose, from which the most suitable procedure can be selected individually for each patient. Depending on the surgical technique, however, there may be foreseeable instability between the vertebral bodies, so that not only the spinal stenosis is eliminated in the same surgical session, but the operated spinal segment must also be stabilized.

Prevention

The development of spinal stenosis can be conditionally prevented by preventive measures. Generally recommended is a back-friendly lifestyle with the goal of ensuring a strong back at times. Plenty of exercise prevents back problems and can usually be easily integrated into everyday life: Stairs instead of elevator, shopping on foot, regular walks and sports. Additional targeted and, above all, regular back training is recommended.

Aftercare

During surgical therapy for spinal stenosis, patients usually stay in the hospital for four to five days. They are allowed to get up and go to the bathroom a few hours after surgery if the procedure is unremarkable. In the following days, the newly operated patients learn back-friendly behavior such as standing up, lifting or bending over with the help of a physiotherapist. They should move as normally as possible. If necessary, aids such as a support corset or a rollator can be used to support the patient. Physiotherapy and individual pain therapy round off the aftercare in the hospital. After the hospital stay, follow-up treatment takes place. In mild cases of spinal stenosis, patients should take advantage of physiotherapy with exercises to strengthen the back and abdominal muscles. Daily walks of slowly increasing duration and distance are also part of rehabilitation at home. In the case of more severe forms, outpatient or inpatient treatment in a rehabilitation clinic is recommended after the hospital. This lasts approximately three to four weeks and can be extended further if necessary. In the first three months after the operation, patients should take it easy as far as possible and not lift any weights over ten kilograms. In addition, movements and exercises that cause pain should be avoided. A checkup with a back specialist is also necessary one and three months after surgery.

What you can do yourself

Spinal stenosis must first be clearly diagnosed by a physician in order to rule out other causes of discomfort. Once this is done, the patient can bring about relief with self-help in everyday life and quite often achieve the quality of life that makes surgery avoidable. However, the measures should ideally be discussed with the attending physician such as the orthopedist. Strengthening the trunk muscles is an important factor in reducing symptoms. Physiotherapists teach efficient exercises for this purpose, which the patient can continue at home on a regular basis. There are also courses in fitness studios that specifically target the health of the back. The back school, which is often also offered by health insurance companies, also provides tips for back-friendly behavior in everyday life, such as the correct way to bend or lift. It is important to relieve pressure on the spine. Patients with spinal canal stenosis should repeatedly use the step position and ensure that they sleep in a back-friendly position on an optimal mattress. In the case of pain, baths or even the classic hot water bottle often help to loosen the tense muscles. Massages with a hedgehog ball also often help. In most cases, however, restraint is counterproductive. It can lead to further tension. Exercise, on the other hand, is important for mobility and often helps reduce discomfort.