Spinal stenosis can be a very painful condition that usually occurs in the cervical and lumbar spine. Worldwide, 103 million people are affected. Sufficient therapy is necessary to alleviate the symptoms in the long term.

 

What is spinal canal stenosis?

In the case of spinal canal stenosis, the spinal canal through which the spinal cord runs with all its nerve fibres is narrowed. Depending on the location of the narrowing, various nerve roots are irritated and the transmission of information is impaired. This results in various symptoms such as pain, numbness, loss of strength and neurological deficits in the affected extremities. Spinal canal stenosis occurs most frequently in the cervical and lumbar spine. It rarely occurs in the thoracic spine.

 

 

Who gets spinal stenosis and why?

As a rule, spinal canal stenosis occurs in older people from the age of 50 and can be recognised in an MRI. However, it can be asymptomatic and is therefore often an incidental finding. Not every spinal canal stenosis is painful. Spinal canal stenosis can be congenital or acquired. Congenital spinal canal stenosis can be caused by certain anatomical misalignments. However, this only occurs in 9% of cases. In the case of acquired spinal canal stenosis, degenerative processes, herniated discs or trauma may be to blame. The degenerative process of the spine, in which the spinal column degenerates, i.e. ages, is the most common cause. However, it is not possible to predict whether symptoms will develop. Degeneration leads to remodelling processes in the spine, which can result in bone growths that narrow the space of the spinal canal and thus irritate the nerve root. This disrupts the transmission of stimuli. If you stand on a garden hose, less water comes out at the end, as you can imagine when the transmission of nerve impulses is impaired.

 

 

What symptoms can occur?

The pain differs depending on whether the cervical or lumbar spine is affected and how severe the narrowing of the spinal canal is.

Spinal canal stenosis of the cervical spine:

• Neck pain & headaches: Those affected often suffer from severe neck pain, which can even lead to headaches. The pain can also radiate into the arms.
• Motor deficits: Motor impairments may occur, making it difficult to lift a cup, for example.
• Numbness & tingling: in the arms, hands and/or fingers

 

Spinal canal stenosis lumbar spine:

• Back pain: Affected persons experience a localised pain in the lower back. This can also radiate into the legs.
• Motor deficits: Reduced strength can lead to limitations when walking or standing.
• Numbness & tingling: in the legs, feet and/or toes
• Change in bladder or bowel control: In advanced cases, there may be problems with bladder and bowel control.

 

 

 

What is done in the case of spinal canal stenosis?

Spinal canal stenosis can be diagnosed based on the symptoms of the affected person and various tests. However, an MRI provides a very precise image. The severity of the spinal canal stenosis can also be diagnosed. In older people, this is often an incidental finding, with patients usually not experiencing any symptoms.

Depending on the severity and symptoms, surgery is an option. However, conservative therapy is usually the first choice. This involves the use of medication in the form of painkillers and physiotherapy. It is important that a lifestyle adjustment is made and that patients understand the importance of exercise for their recovery.

Optimal physiotherapy treatment consists of manual therapy and movement therapy. In manual therapy, movement restrictions are improved, pain is relieved and attempts are made to create space in the spine. However, this can only have a long-term effect if movement therapy is carried out. This involves strengthening exercises, nerve mobilisation, endurance exercises such as cycling and mobilisation exercises. This combination with manual therapy can alleviate the symptoms in the long term.

In severe cases, surgery or PRT injections are sometimes unavoidable. Treatment with PRT injections is an effective pain therapy. Injections are administered to the affected nerve roots under X-ray control. This procedure relieves the pain considerably and can be combined well with exercise therapy.

During surgery using a minimally invasive procedure, the spinal canal is widened, resulting in decompression (pressure relief). This procedure is only used in cases of very severe pain and walking impairments. Nevertheless, rehabilitation with physiotherapy is required afterwards in order to promote participation in everyday life and restore function.

It is always advisable to opt for conservative treatment first, as surgery always involves an intervention in the body.

 

Sources:

• Ammendolia, C., Hofkirchner, C., Plener, J., Bussières, A., Schneider, M. J., Young, J. J., Furlan, A. D., Stuber, K., Ahmed, A., Cancelliere, C., Adeboyejo, A., Ornelas, J. (2022). Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review.
• Kasch, R., Truthmann, J., Hancock, M. J., Maher, C. G., Otto, M., Nell, C., Reichwein, N., Bülow,
• Katz, J. N., Zimmerman, Z. E., Mass, H., Makhni, M. C. (2022). Diagnosis and management of lumbar spinal stenosis: a review.
• Raja, A., Hoang, S., Patel, P., Mesfin, F. B. (2017). Spinal stenosis.
• Kasch, R., Truthmann, J., Hancock, M. J., Maher, C. G., Otto, M., Nell, C., Reichwein, N., Bülow, R., Chenot, J. F., Hofer, A., Wassilew, G., Schmidt, C. O. (2022). Association of lumbar MRI findings with current and future back pain in a population-based cohort study.