Spinal stenosis – causes, symptoms, treatment

What is a spinal stenosis?

Inside the spine, there is the spinal canal. The spinal canal is something very important for our body: It protects the spinal cord and the nerve roots that exit through it. The structures of vertebral bodies, intervertebral discs, ligaments surround and protect the soft spinal cord and the nerves that run into the arms and legs. Spinal canal size varies according to age and gender. Just to be clear: Commonly in the cervical spine it has a diameter of 25 mm and in the lumbar spine of 30 mm.

An abnormal narrowing (reduction of the size) of the spinal canal is called spinal stenosis. In spinal stenosis, the spinal canal narrows by deposition of calcification or bone attachments and/or thickening of the ligaments. Spinal stenosis was well described first from the French Anatomist Antoine Portal in 1803.

Often, parallel to the spinal stenosis, there is also a narrowing of the points from which nerves come out (Neural foramen stenosis - NFS). The term "intermittent claudication" has arisen because sufferers have pain due to the lack of oxygen after a physical activity like walking or standing. To hide the pain and make sure that other people do not notice it, for example while shopping, people pretend to stare at the shop windows until the pain disappears. To distinguish between intermittent claudication by peripheral artery disease and spinal stenosis is examination of blood supply of limbs useful. However in cases of peripheral artery disease the foot is cyanotic and cold and the artery pulse is decreased. Spinal canal stenosis, which causes pressure on the spinal cord, nerves and blood vessels, can not only cause back pain but also permanent damage to the nerves.

Women are commonly more affected than men

About 80% of all people in Germany occasionally suffer from back pain, 40% from permanent pain. Nearly 10% of people have a spinal stenosis, but about 20% of all people over the age of 60, present radiographic signs of spinal stenosis. Women are affected more frequently than men (1 out of 3). Approximately 60,000 patients with spinal stenosis have to be hospitalized every year. A distinction must be made between innate and acquired spinal stenosis. The innate is a rare form of constriction.

Causes of the spinal canal stenosis

What causes spinal canal stenosis? In the course of the aging process, almost all people experience a creeping narrowing of the spinal canal. The narrowing of the spinal canal is more common in the lumbar area of our spine and less in the cervical area. With increasing age, the disc tissue has less water content and as a result, the intervertebral discs become flatter, break faster and more unstable. These changes lead to the formation of reactive bone spurs and the protrusion of some ligaments into the spinal canal. In this way, a slowly progressing constriction of the spinal canal arises. Secondary Spinal canal narrowing is seen when tumor growing in the canal or in the presence of disc hernia or protrusions.

Common symptoms of spinal stenosis

In cases of spinal stenosis patients suffer mainly from pain in the legs often accompanied by heaviness and cramps). Some sufferers are also affected by back pain. Very often, symptoms occur especially when walking and/or standing. By bending the body forward or sitting down, symptoms disappear or decrease, because the spinal canal expands itself through this posture and temporarily relieves pressure from the nerves in the spinal cord. Normally, patients affected by spinal stenosis in the lumbar spine complain also from numbness, tingling, weakness, and heaviness in the leg. It can also cause weakness, restricted mobility, sleep disorders, bladder and erectile dysfunction. Narrowing of the spinal canal of the cervical spine causes arm pain and discomfort. Subsequently also weakness of the arms, insecurity in the movements, unsteady gait, atrophy of extremities and other complaints, as in cervical myelopathy. This type of stenosis severely limits the life of those affected and reduces the quality of life.

Normal spinal canal

Spinal stenosis

Diagnosis of spinal stenosis

As we know, treatments take place only once specialist conducted a precise medical history (in-depth interview with the patient), physical and neurological examination and additional radiological examinations. Magnetic resonance imaging (MRI) is used for diagnostic purposes because an MRI scan can depict nerves, intervertebral discs, blood vessels and other structures in detail even a slight but wide protrusion of the intervertebral discs can be seen. In computer tomography (CT), bone changes can also be displayed very well. Because of the exposure to radiation, this assay method is predominantly replaced by magnetic resonance imaging. An X-ray of the lumbar spine is necessary in a bent and a stretched position in order to simultaneously detect or exclude any instability of the spine, the so-called spondylolisthesis. With a diameter of the spinal canal of fewer than 15 millimeters, we speak of relative spinal stenosis and with a diameter of fewer than 10 millimeters - of absolute spinal stenosis.

Treatment and therapy of spinal stenosis

Once a careful and accurate diagnosis has been made we proceed to choose the best therapy treatment and tailor it for every patient. These treatments include first of all the prescription of painkillers, injections, exercises, manual therapy, etc. However, in some cases, if conservative therapies are not feasible due to individual findings or if the stenosis or discomfort or failure worsens it is advisable to forego them and find a new solution.

In patients with clear symptoms, a wait-and-see attitude does not make sense, because they are increasingly weakened by the limitations. Surgery is a routine procedure with a low complication rate and it should be considered by the specialist and the patient as the treatment choice.

If conservative spinal stenosis therapies do not show sufficient effect, or if there are abnormal sensations, loss of strength, and bladder dysfunction, then microsurgery can be helpful because it will relieve the trapped nerves by removing the calcifications and thickened structures. Which means that the spinal canal and neuroforamina will be extended in order to give more space to the nerves. A spinal fusion will be taken into consideration only if there is also instability of the spine.

In contrast to conventional surgical procedures, a small incision of about 3 centimeters in length per segment is sufficient in microsurgery. This significantly reduces the risk of subsequent scarring.

Recognize it early

Good news for those afraid of spinal stenosis: It is just a creeping process that can, in many cases, be stopped by special trainings. Physicians and physiotherapists recommend always to ride a bicycle because it would give more space to your nerves.

The microsurgical extension of the spinal canal creates more space, and so the neural structures can recover or regenerate. Now you can reinforce and stabilize your back muscles in order to prevent the new development of new narrowing.

Dr. med. Munther Sabarini

Dr. med. Munther Sabarini
Specialist in Neurosurgery

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

If you decide to undertake your therapy and/or surgery in Berlin, we would want to make your stay as pleasant as possible. In our clinic, you are at the center of our attention! You can expect state-of-the-art equipment in all areas - from the operating room to the patient bedroom.

The latest, gentle, minimally invasive treatment procedures are the focus of our clinic. Together we try to find a suitable treatment for your complaints. The actual therapy takes place only after a detailed discussion with the patient, examinations and the diagnostics.

For us, as important as medical care, it is the commitment we take to guarantee our patients a high level of personal care that can, in turn, ensure them a comfortable stay.

During the period of inpatient stay our team of nurses will take care of you 24 hours a day. They also offer services in several foreign languages, including English, Russian, Polish, Turkish, Spanish, Italian, Arabic, Bulgarian and French. We care not only about your safety but also your needs, respecting traditions and religions.

Our team is made up of a group of highly qualified specialists who work together to guarantee you a quick recovery.