Why is the channel narrowing?
Over the years, the intervertebral discs dehydrate and settle, the load is redistributed to the small joints of the spine, they become enlarged and deformed. The ligamentum flavum thickens and bulges into the lumen of the canal. Sometimes the vertebra moves forward relative to the neighboring one, narrowing the space even more. In some people, the canal is initially narrow from birth, and then age-related changes give rise to symptoms earlier. Less commonly, the cause is the consequences of injuries, operations, tumors or metabolic diseases.
- Age-related changes in discs and joints
- Thickening of the ligamentum flavum
- Spondylolisthesis - displacement of a vertebra
- Congenitally narrow spinal canal
- Large disc herniation
- Consequences of injuries and operations
- Rare causes: tumors, Paget's disease
Symptoms: lumbar and cervical stenosis
With lumbar stenosis, the main symptom is neurogenic intermittent claudication: after a certain distance, heaviness, burning, numbness and weakness appear in the legs, forcing you to stop. Leaning forward, squatting, or leaning on a shopping cart provides relief because bending widens the canal. Therefore, such patients tolerate cycling more easily than walking. With cervical stenosis, the spinal cord itself is compressed: fine motor skills are impaired, gait becomes uncertain, and stiffness appears in the legs.
- Heaviness, numbness and weakness in the legs when walking
- Relief when bending forward and sitting
- Reducing pain-free walking distance
- Lower back pain radiating to the buttocks and thighs
- Hand clumsiness, difficulty fastening buttons with cervical stenosis
- Unsteadiness of gait, stiffness in legs
- In severe cases, urinary problems
Diagnostics
The diagnosis is based on a combination of typical complaints and imaging findings, because narrowing of the canal is also found in people without symptoms. MRI is the method of choice: it shows nerve structures, the condition of discs and ligaments. CT better reflects bone changes and is used when MRI is not possible. ENMG helps to distinguish root lesions from polyneuropathy. Be sure to evaluate the pulsation of the arteries in the legs and, if necessary, perform an ultrasound of the vessels so as not to miss the vascular cause of lameness.
- Neurological examination with assessment of gait and reflexes
- MRI of the lumbar or cervical spine
- CT for contraindications to MRI
- Electroneuromyography
- Doppler ultrasound of the arteries of the lower extremities to exclude vascular claudication
- X-ray with functional tests if instability is suspected
Conservative treatment
Most patients start with non-surgical treatment. The basis is physical therapy: bending exercises, strengthening the abdominal and back muscles, endurance training on an exercise bike, which is better tolerated than walking. Gradually increase the distance using short stops. The doctor selects painkillers taking into account age and concomitant diseases; in case of severe radicular pain, epidural and paravertebral blockades are used, which provide temporary relief. Losing weight and quitting smoking, which impairs tissue nutrition, are important. Complete rest does not help and leads to detraining.
- Physical therapy with emphasis on flexion
- Exercise bike and swimming instead of long walking
- Gradual increase in distance with stops
- Painkillers in short courses as prescribed by a doctor
- Blockades for severe radicular pain
- Weight loss, smoking cessation
- Scandinavian poles and walking support
When is surgery needed?
Surgical treatment is discussed if conservative therapy does not help for several months, walking distance continues to decrease, weakness and numbness increase, and quality of life suffers significantly. Urgent intervention is required for cauda equina syndrome with difficulty urinating and numbness of the perineum, as well as for progressive damage to the spinal cord in the cervical region. The essence of the operation is decompression: removal of structures that compress the nerves; in case of instability, it is supplemented with stabilization. The decision is made by the neurosurgeon together with the patient, assessing age, concomitant diseases and expectations.
- Ineffectiveness of conservative treatment for several months
- Progressive weakness in the legs
- Drastic reduction in walking distance
- Cauda equina syndrome - emergency surgery
- Myelopathy with cervical stenosis
- Decompression, with stabilization if necessary
- Rehabilitation after surgery is mandatory