Spinal stenosis treatment

Spinal stenosis — a narrowing of the spinal canal. The result is pressure on spinal cord, nerves and blood vessels, causing back pain and nerve damage.

The reason is the age-related wear of the intervertebral discs that develops during life, but it can also be congenital.

Causes of congenital stenosis: chondrodystrophy, achondroplasia, diastematomyelia.

With age, the intervertebral discs lose their strength, as a result of which they become flatter and gradually come closer to each other.

Rarer causes of spinal stenosis:

• Congenital malformations of the spine,
• Excessive scar tissue formation after spinal surgery,
• Vertebral body injuries,
• Bulging or prolapsed intervertebral discs,
• Complication of Cushing’s disease,
• Diseases of the bones,
• Narrowing of the spinal canal at birth for an unknown reason.

Early signs: tingling, weakness and numbness in the legs.

The main symptom is pain, aggravated by walking and standing. When bending forward, spine stretches and pain disappears.

Symptoms of stenosis of the lumbar spine: back pain radiating to legs; weakness of leg muscles; tingling sensation, numbness of legs. In advanced stages — urinary and fecal incontinence, sexual disorder.

Stenosis of the cervical spine: burning neck pain, radiating to shoulders and arms; neck muscle tension; numbness and tingling in hands and arms; violations of fine motor skills; weakness arms muscles.

At initial consultation, the doctor asks in detail about symptoms and presence of concomitant diseases (herniated disc, osteoarthritis, osteoporosis).

This is followed by a neurological examination.

In addition to the mandatory X-ray examination, an MRI is required.

For additional diagnostics, an experienced physician will perform electroneuromyography. This is an electrodiagnostic procedure to measure muscle activity.

Therapy for narrowing the spine in each case is individual and takes into account types of stenosis, factors that cause stenosis, concomitant diseases of spine.

The goal of treatment – to release nerves from a pinched state.

In initial stages, when stenosis is not very pronounced, drug treatment is used. However, due to the cause of disease, this approach quickly reaches its limits.

If spinal stenosis is already running, there are neurological disorders and functional disorders, it’s necessary to carry out surgical treatment.

Surgical options: microsurgical decompression, spondylodesis (an operation to strengthen vertebral bodies), installation of an interspinous implant.

Immediate surgery should be performed when:

• Constant unbearable pain with ineffective painkillers,
• Paralysis or sensory impairment that precludes normal movement,
• Disorders of sexual activity,
• Limiting the maximum walking distance to a few meters.

In such cases, the operation should be performed as soon as possible, in specialized clinics, in order to avoid irreversible damage to the nervous system.

Uncomplicated and temporary complications include:

• Leakage of cerebral fluid from the dural sac (5%),
• Rebleeding (2%),
• Infection (2%).

Severe and irreversible complications develop in 1 in 100 patients. These include heart attacks, nerve injuries, PE, and other rare life-threatening incidents.

8 out of 10 patients immediately feel the effect of operation. Pain is significantly reduced, walking distance is normalized or significantly increased. As a rule, results last for many years.

In 2 out of 10 patients, manifestations of stenosis remain or decrease slightly, after which they recur.

1 in 10 patients will have to reoperation after about 5 years due to further wear of adjacent vertebra or operated segments.