yogabook / pathologie / spinal canal stenosis

spinal canal stenosis

Definition of

Narrowing of the spinal canal in the cervical or lumbar spine. The narrowing can be caused by intervertebral discs that press on the anterior longitudinal ligament and thus on the spinal cord or by osteophytes that can narrow the spinal canal itself or the neuroforamina. The lumbar spine is most frequently affected, with L4L5 or L3L4 and, to a lesser extent, the cervical spine. The prognosis is unclear, deterioration is just as possible as improvement, and the symptoms are clearly dependent on the patient’s behaviour.

ICD M48

Cause

– congenital

1. Often degenerative due to osteoarthritis of the spine with narrowing of the joint space, sclerosis, osteophytic marginal growths, which can also protrude into the spinal canal and thus compress nerve roots

– Musculoskeletal system

1. Protrusion or collapse of disc material into the spinal canal(disc prolapse)
2. Often degenerative due to osteoarthritis of the spine with narrowing of the joint space, sclerosis, osteophytic marginal growths, which can also protrude into the spinal canal and thus compress nerve roots
3. Osteoarthritis of thefacet joint also causes osteophytes
4. Congenital narrowing: vertebralbody-facet joint too short; causes symptoms at a young age; symptoms then occur at the age of 30 to 40 years
5. lumbar hyperlordosis
6. Spondylolisthesis
7. Thickening of the lig. flavum

– Dispositional diseases

1. Hormone changes, e.g. Cushing’s disease (cortisone affects the bones)
2. Paget’s disease and other bone diseases with localized bone remodeling

– Other causes

1. Spinal stenosis after spinal surgery (usually due to excessive formation of scar tissue)
2. Synovial cysts
3. Injuries to the vertebral bodies

Predisposing

1. Osteoporosis
2. Weak back muscles
3. Stiff (usually hyperkyphotic) thoracic spine
4. Flexibility deficiencies in the hip joint
5. Hollow back or steep position of the lumbar spine
6. in older people: Intervertebral disc degeneration and dehydration with loss of height, but also from around 30 years of age: disc hernias

Diagnosis

1. MRI. Radiological narrowing does not have to be clinically relevant
2. Clinic
3. Tests and signs: Cook Prediction Rule

Symptoms

1. Symptoms of the lumbar form:
   • Neuroradicular symptoms: back pain with pain radiating into the leg
   • Lumbago or lumboischialgia
   • Intermittent claudication (claudicatio spinalis): limited pain-free walking distance
   • Sensory disturbances when walking that affect the legs or genital area, burning, ants running, feeling cold, „cotton wool under the feet“, impaired sexual function
   • Feeling of weakness in the leg muscles, loss of balance, unsteady gait, stumbles over own legs
   • Bewegungseinschränkungen und Muskelverspannungen im Bereich LWS Muskelverspannungen im Rücken
   • Rapid increase in symptoms when standing or walking, worsening when bending backwards, worsening also when walking downhill and sitting for long periods of time
   • No discomfort in an unordained posture such as cycling or walking uphill, improvement/disappearance of discomfort through preventive movements
   • Cramp-like pain in the calves when walking
2. Symptoms of the cervical form:
   • Pain in the neck, arms, face, hands
   • Paraesthesia in arms, hands
   • Neck pain and muscular tension
   • impaired fine motor skills of the hands
   • Increasing muscle tone in the arms and legs
   • Weakness of the arm muscles
   • if far advanced: paraplegic symptoms

Complications

1. Spondylolisthesis
2. cauda equina symptoms
3. Paraplegic symptoms

Therapy

1. Physiotherapy, back training
2. NSAIDs or opioids if necessary
3. If necessary, muscle relaxants, antidepressants, intermittent corticosteroids
4. Physical therapy, including heat
5. Muscle-relaxing measures: Fango, thermal baths, mud baths
6. Short-term cortisone infiltration to reduce the inflammatory process
7. Psychological pain management training
8. Back training (targeted strengthening training of the back and abdominal muscles, learning back-friendly behavior)
9. Electrotherapy
10. Stepped bed
11. Infiltrations with local anesthetics
12. later orthoses and rollator
13. If necessary, surgical removal of the osteophytic marginal attachments, complication rate 18%
14. Walking distance of less than 5 m, unbearable pain, cauda equinasymptoms are indications for surgery (only 2%)
15. Non-symptomatic spinal canal stenosis is not considered to require treatment, but if symptoms occur, no treatment time should be wasted. If there is no improvement after 12 weeks of conservative therapy with significant symptoms, surgical intervention should be considered. Indications for surgery:
16. Mobilization in the direction of flexion of the lumbar spine, taking into account any contraindications due to disc hernias
17. Stability and balance exercises to promote the local muscles. Training the pelvic floor muscles and transversus abdominis

DD

1. Baastrup’s disease
2. Disc hernia