Therapy | Spinal canal stenosis in the lumbar spine

Therapy

Both surgical and conservative, i.e. non-surgical treatment options are used to treat spinal canal stenoses of the lumbar spine. There are various approaches to the conservative treatment of spinal canal stenosis of the lumbar spine, which will be summarized here in brief In most cases, the focus is on a versatile approach. Before a surgical intervention is considered, all conservative measures should be tried first.

Pain therapy is an important cornerstone of conservative treatment of spinal stenosis of the lumbar spine. Pain reduction is important to improve the patient’s well-being and quality of life. One possibility is the drug-based pain therapy.

Here, a step-by-step scheme of the World Health Organization (WHO) can be used, which prescribes certain drug groups and their dosage depending on the patient’s symptoms. Acupuncture is another therapy option for pain. Although the benefits of acupuncture are controversial, it is used occasionally.

Pain therapy is important for the patient for various reasons. With a good pain therapy one tries to prevent the development of chronic pain in the context of a pain memory. In addition, usually only a largely pain-free patient can carry out other therapy options, such as sports exercises or physiotherapy.

A good pain relief thus enables the patient to cooperate well. Movement therapy and muscle-relaxing procedures as well as posture training are also important for patients with spinal canal stenosis of the lumbar spine. Another important therapeutic approach is physical therapy.

This makes use of different therapeutic modalities such as heat therapy or electrotherapy. They are intended to help relax the muscles and relieve pain. There are many exercises that can help with back problems.

You can do exercises under the guidance of a physiotherapist or physiotherapist. However, simple exercises can also be done well at home. However, they are by no means a substitute for adequate therapy and should rather be seen as a supporting measure.

Especially exercises in a slightly bent position help to expand the spinal canal and thus reduce the strain on the bruised nerve root and spinal cord. The following is a list of some simple exercises that can provide relief, especially in the case of lumbar spinal canal stenosis. In addition to such stretching exercises, certain sports are also gentle on patients with spinal canal stenosis.

These include sports that are associated with a slight forward tilt of the trunk. A very good example of this is cycling, which many patients with spinal canal stenosis find much easier than running.Other back-friendly sports for people with spinal canal stenosis are Nordic walking or rowing. In addition to the aforementioned procedures, there are also psychological and psychotherapeutic approaches to pain management.

The focus is on learning skills to reduce pain and achieve relaxation. Often different approaches are combined in so-called back schools. These represent a kind of comprehensive therapy concept in which back-friendly behavior is to be learned.

Targeted strength training of the back and abdominal muscles is also often combined with other therapeutic approaches. Finally, there is also the possibility of treatment with local anesthetics (local anesthesia). These are injected by an experienced doctor near the nerve root exit points of the spine.

They are used for local anesthesia. A similar therapeutic approach is the infiltration of the intervertebral joints. In this form of therapy, a local anesthetic, usually mixed with cortisone, is injected into the joint capsule of the intervertebral joints (facets).

In order to hit the right area, the infiltration is carried out under visual control with a CT.

  • 1. “cat’s hump”: For these exercises you should lay a mat or a light blanket on the floor. Now kneel on the floor and come into the four-footed position.

    Your hands and knees touch the floor. Now take a deep breath and make a “cat hump”. The head hangs down loosely.

    Hold this position for a few breaths. Then let the back sag loosely. Repeat the exercises 10 to 15 times, several times a day.

  • 2.

    kneel again on the ground and sit down loosely with the buttocks on your calves. Now bend your upper body forward and lay it down on the floor. Stretch your arms away from you.

    Try to stay on your calves with your buttocks. Repeat the exercises 10 to 15 times.

  • 3rd step position: For this exercise you lie on the floor in a supine position. Then place your lower legs on a stool so that the upper and lower legs form a right angle.

    To strengthen the abdominal muscles you can now pull the upper body towards the knees in small movements. The arms stretch them forward. Repeat the exercises 15 to 30 times.

  • 4.

    lie flat on your back. Now pull your knees towards your chest and embrace it with your arms. Pull the head to the knees as well.

    Make yourself very “round”. Stay in this position for a few breaths.

In addition to conservative treatment, surgical therapy is also an important pillar in the treatment of spinal stenosis of the lumbar spine. The risks of the operation must always be carefully weighed, so that a surgical intervention is usually only considered if conservative measures have not achieved sufficient improvement.

There are many different surgical procedures that can be used for spinal canal stenosis of the lumbar spine. There are two main objectives, namely the relief and stabilization of the spinal canal or spinal column. To ensure relief of the spinal canal, the excess bone tissue that constricts the spinal canal is removed.

Depending on the extent to which bone is removed, a distinction is made between different surgical procedures:

  • 1. laminectomy: During this procedure, special bony structures of the vertebrae, especially the vertebral arches, are removed to create space and eliminate the constriction. Hemilaminectomy is a similar procedure, in which only half of the vertebral arch is removed.

    Nowadays, however, these procedures are almost exclusively performed in a modified form, as they can cause instability of the spinal column.

  • 2nd windowing: A windowing is a type of modified laminectomy. It is a microsurgical technique in which some material of the spinal column is removed through very small accesses, usually on both sides. The procedure does not follow a uniform technique.

    The structures that are removed in the course of windowing include parts of the intervertebral joints and the vertebral ligaments. In contrast to laminectomy or hemilaminectomy, the spinous processes and the vertebral arches are spared. Therefore, the risk of spinal instability after the procedure is lower than with a pure laminectomy or hemilaminectomy.

  • 3.

    interspinous spacers: This procedure is a kind of mixed option between conservative and surgical therapy. It is suitable for patients with milder symptoms. Interspinous spacers or interspinous implants can be thought of as a kind of placeholder placed between the extensions of two vertebrae.

    In this way an expansion of the space is achieved.

  • 4. stabilizing procedures: As already discussed at the beginning of this section, in addition to relieving the pressure on the spinal canal and nerve roots, stabilizing the spine is very important for the success of the therapy. A distinction is made between a fixed fusion of a spinal section and dynamic fixation, in which individual vertebral bodies are splinted and thus stabilized by a rod system.

Surgery is always a burden for the patient, even if it is a minor procedure.

In general, surgical procedures for the treatment of spinal stenosis of the lumbar spine are performed using the keyhole technique (minimally invasive), i.e. with the smallest possible accesses and wounds. They are therefore much gentler than operations with large surgical wounds and scars. Immediately after the operation, it is imperative that the wound is protected in order to ensure good healing.

However, showering is usually possible on the first day after the operation with a special shower plaster. In the first 6 to 12 weeks after the operation, lifting heavy loads as well as rotational movements of the spine or other strains should be avoided. Sports activities should only be resumed after consultation with a doctor.

Depending on the surgical procedure used, full loading of the spine can only be guaranteed after half a year or even a year. However, everyday activities can be performed without any problems. After such an operation, follow-up treatment in the form of physiotherapy, back training or physiotherapy should be started as early as possible.

This should be started after 6 weeks at the latest. This also depends on the success of the operation and the general condition of the patient. This type of post-operative treatment is particularly important for the mobility and functionality of the spine and shows good effects in patients with spinal stenosis of the lumbar spine.

Osteopathy is also occasionally used in the treatment of spinal canal stenosis of the lumbar spine. After a confirmed medical diagnosis, in some cases a conservative therapeutic attempt is made with osteopathic measures. These are, for example, mobilizations of the spinal sections. Amongst other things, hand grips are used to relax the muscles and unblock various joints. However, caution is advised in cases of severe discomfort and instability of the spinal column, as osteopathic hand movements can occasionally cause damage to the spinal column.