Conservative therapy
The therapy of spinal stenosis is usually conservative. In cases of severe nerve damage, uncontrollable, disabling pain and circumscribed disease findings, surgical therapy measures for spinal canal stenosis can help. Since there is no causal therapy for an advanced degenerative spinal disease, pain and physiotherapy is the main focus of treatment.
This includes: In advanced cases, precise diagnostics, the exploration of the optimal therapy for spinal canal stenosis and adequate pain therapy are only possible during an inpatient stay. Infiltrations (injections), which are injected directly into the spinal canal (epidural/peridural), have the greatest non-invasive pain therapy effect.
- Medication-based pain therapy (NSAIDs, opiates etc.
)
- Pain Patch
- Implanted pain pumps
- Physical pain therapy (current therapy, ultrasound, heat etc. )
- Infiltration therapy (nerve blocks, periradicular therapy, trigger point infiltrations)
- Psychotherapy
- Mobilising, stabilising physiotherapy
- Back school
- Entlordosierendes bodice
Sacral blockages or sacral infiltrations are suitable for spinal canal stenosis, which occurs predominantly in the lower area of the lumbar spine. In this therapy of spinal canal stenosis, a mixture of local anesthetic and cortisone is injected into the spinal canal via the sacral canal.
The access is located in the course of the gluteal fold above the arch-shaped transition to the coccyx. Imaging of the spinal canal stenosis is not necessary for sacral infiltration. One orients oneself by the anatomical landmarks.
Under sterile conditions, 20-30 ml of a local anesthetic and cortisone are then injected into the spinal canal. The patient is then asked not to walk around for some time (1-2 hours) because the local anesthetic can sometimes cause numbness and weakness in the legs, which can lead to a risk of falling. After the anaesthetic has worn off, this effect disappears again.
The pain therapeutic effect is good and, due to the applied cortisone, also persistent. Sometimes a temporary increase in pain can occur due to the increase in volume and pressure in the spinal canal. As a harmless side effect of cortisone, a reddening of the face may occur, which disappears after a few days.
Epidural infiltration therapy is suitable for spinal canal stenosis affecting the upper parts of the lumbar spine. With sacral infiltration, usually only a height up to about the 4th lumbar vertebral body is reached in pain therapy. With epidural infiltration one is very flexible regarding the height of the infiltration.
The approach corresponds to that of the anesthetists in spinal cord anaesthesia. With a long needle, the spinal canal space is searched for according to the principle of “loss of resistance” and a mixture of local anesthetic and cortisone is injected, as in sacral infiltration. The pain therapeutic effect corresponds to that of sacral infiltration. If the administration of medication is to be repeated several times, a catheter system (tube system) can be connected so that access to the spinal canal is maintained.