Therapy

Spinal canal stenoses can be treated both surgically and conservatively, i.e. non-surgically, by physiotherapy and other treatment options. In case of spinal canal stenosis, various therapeutic approaches are available in order to achieve an alleviation of the symptoms for those affected. First of all, all conservative measures are exhausted before a surgical intervention is considered.

The therapy follows a versatile approach. An important component of the conservative therapy of spinal stenosis in the cervical spine is the adequate drug-based pain therapy. This is based on a defined step-by-step scheme that adapts the class of pain medication to the patient’s symptoms.

There are several reasons for pain therapy. On the one hand, it is important to alleviate the complaints of the patients, on the other hand, it is essential for a good therapy success to prevent a pain memory from forming and the pain from becoming chronic.In addition, further cooperation of the patient, e.g. for posture training or physiotherapy, can usually only be made possible through pain therapy. The latter represents another very important component of the conservative therapy of spinal stenosis.

Here the focus is on movement therapy and muscle relaxing procedures. Some simple exercises for home use are listed below: Furthermore, physical therapy approaches such as heat therapy for relaxation and pain relief or electrotherapy (also for pain reduction) are used. With regard to pain reduction, acupuncture is also used.

Acute relief of the pain can also be achieved by a support or back corset. A further approach is the so-called back school, where patients learn various techniques for a back-friendly behavior and specifically strengthen and invigorate their back and abdominal muscles. In order to achieve a reduction in pain and to improve the pain for the patients, treatment with local anesthetics (local anesthesia) is possible.

These are injected near the nerve root exit points on the spine and are intended to numb the pain locally. Do you suspect that you suffer from a cervical spine syndrome? Please also carry out our self-test “Cervical spine syndrome”:

1st exercise: For this exercise, stand in front of a mirror.
Now push your chin back as if you were making a double chin. If you make the neck very long, you relieve the compressed structures. Hold this position for 10 seconds and release it slowly.

Do not make any abrupt movements. Repeat the exercise as desired.
2nd variation of the 1st exercise: Grasp the chin with your index finger and thumb and push it back a little further. Do not make any levering movements.
Pay attention to a gentle motion sequence. Hold the position for 10 seconds and release it again.
3rd Exercise: Come into the supine position and relax your muscles. Now try to press your chin on your chest as if you were pressing your cervical spine into the ground.
Try to relax while doing this. Hold this position for a few seconds and then gently release. Repeat the exercise as desired.
4th Exercise: Slight shoulder rotations can help to improve the pain in the cervical spine and shoulder girdle.
Let the shoulders rotate alternately, as it feels good for you.

There are a variety of different surgical procedures that are used to treat spinal canal stenosis. Whether surgery is appropriate or not depends on the severity and nature of the symptoms, as well as the success or failure of conservative measures. The necessity of surgery should always be carefully weighed up, considering the advantages and disadvantages for the patient.

If conservative measures do not bring success and there are always pronounced or even worsening symptoms, surgery may be appropriate. Patients with symptoms of paralysis in particular can benefit from surgery. The various procedures are designed to relieve pressure on the nerve roots and spinal cord.

The following is a compact overview of the most important surgical procedures for treating spinal canal stenosis:

Laminectomy: In this procedure, parts of vertebral bodies, the so-called vertebral arches, are generously removed in order to achieve a relief of the spinal cord and the nerves emerging from it. The disadvantage is that the spinal column may become unstable after the operation
Windowing: In windowing, microscopically small holes are made in the area of the vertebral arch and only some material is removed to remove the narrowing.
Stabilization: In some patients, the spine is so unstable that it needs to be stabilized, for example to prevent spondylolisthesis. A distinction is made between fixed fusion, in which vertebral bodies are firmly connected, and dynamic stabilization, in which several vertebral bodies are merely fixed together.

As with any operation, surgical procedures for the treatment of spinal stenosis in the cervical spine can also involve certain risks.

A distinction is made between general surgical risks and specific risks resulting from the operation.In general, there is a certain risk of infection during an operation because the body is opened and material is inserted. This risk of infection is kept as low as possible by the sterile work in the operating room. Even after the operation, an infection of the surgical wound can occur.

This risk is also very small, as the operations are performed with keyhole technology, so no large scars are left. In addition, nerves, ligaments, blood vessels and tendons can be injured during the operation. There are also risks associated with the anesthesia, which are necessary for the procedures.

During anaesthesia, cardiovascular disturbances such as sudden drops in blood pressure or cardiac arrhythmia can occur, which are intercepted by the anaesthetist with circulation-supporting medication. Allergic reactions to the anesthetics used may occur. In addition, problems with ventilation may occur.

After the anaesthesia nausea and vomiting are possible. Confusion is also possible, especially in older patients. Relief operations and interventions to stabilize the spinal column in the case of spinal stenosis of the cervical spine can injure surrounding structures such as ligaments, nerves or blood vessels.

The spinal cord is located in the immediate vicinity, which in principle can be injured. However, the risk is very low. This can lead to paralysis, numbness or postoperative pain.

Furthermore, after spinal surgery, the spinal column can become unstable. This risk is also minimized by stabilizing procedures (see above). During the operation, scar tissue can form, which can also cause pain in the region.