Causes of spinal stenosis
Stenosis of the lumbar spine is typically caused by degenerative changes. Degenerative changes result from “wear and tear” of the spine and include the flattening of intervertebral discs, the thickening of important ligaments and also the formation of bony attachments, e.g. at the intervertebral joints. Stenosis in the lumbar spine is common. Approximately 11% of older adults suffer from symptoms of spinal stenosis. Acute spinal stenosis, which can be caused by a large herniated disc, is less common.
Symptoms
The typical symptoms of lumbar spinal stenosis are back pain that radiates down the buttocks into one or both legs. In some cases, this pain is accompanied by numbness and tingling in the legs or feet. In the case of manifest spinal canal stenosis, the pain increases when standing or walking for long distances. The symptoms can sometimes be relieved in a sitting position and by bending forward. Unfortunately, spinal stenosis usually progresses over time and the symptoms increase, which can then lead to a reduction in everyday activities and quality of life.
Diagnosis
Spinal stenosis is generally diagnosed on the basis of the reported symptoms and the results of a specialist examination. Imaging methods, such as an MRI examination, can help to confirm the diagnosis.
Treatment
Conservative management
The treatment of spinal stenosis includes physiotherapy, targeted training and, if necessary, the administration of medication such as non-steroidal anti-inflammatory drugs (NSAIDs) in addition to individual adjustments to everyday life.
Epidural steroid infiltration
Epidural steroid infiltrations (cortisone injections) are another therapeutic option. Epidural steroid infiltration is carried out under X-ray control in the area of spinal canal narrowing. The effects of epidural steroid infiltrations depend on various individual factors. Ideally, there is a lasting, significant reduction in symptoms. In many cases, however, epidural steroid infiltration only brings about a temporary improvement in symptoms and is rarely effective for longer than three weeks.
Surgery
Another important therapeutic option is surgery. This involves removing troublesome bone parts, thickened ligaments and, if necessary, intervertebral disc tissue, so that the spinal cord and spinal nerves are relieved. Surgery for spinal stenosis typically reduces pain problems and also improves strength in the legs. However, not all affected patients can benefit from a surgical procedure. Careful consideration of the indications is therefore essential. All non-surgical measures should be exhausted before surgery is considered.
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