Spinal stenosis: modern tactics of treatment
Spinal stenosis: causes, symptoms, treatment
Spinal stenosis is a degenerative pathologic process characterized by decreasing of the diameter of the vertebral canal occupied by the spinal cord.
Classification of the disease
The mechanism of spinal stenosis may be congenital or acquired.
Birth due to anatomical features and manifests itself in the form of:
- shortening the arc of the vertebrae;
- achondroplasia (increasing the thickness of the vertebral arch, reducing the height of his body and shortening the legs);
- cartilage and fibrous diastematomyelia.
The major causes of acquired(secondary) stenosis are:
- deforming spondylosis, manifested in the form of hypertrophy of the intervertebral joints and of marginal osteophytes;
- ossification of intervertebral discs;
- degenerative spondylolisthesis;
- the nature of rheumatoid hyperostosis (Forestier disease);
- Bechterew’s disease;
- hypertrophic growth and ossification of the yellow ligament;
- iatrogenic stenosis — subarachnoid adhesions and scarring occurring in the postoperative period.
According to the degree of disease progression:
- narrowing of the channel to 12 mm — relative stenosis
- narrowing of the channel up to 10 mm and less — absolute stenosis
In the region of distribution:
- Central stenosis
- lateral stenosis
The most common cause of acquired spinal stenosis, osteochondrosis of the spine.
What are the main symptoms of the disease?
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Most often spinal stenosis occurs in the lumbar spine.
The disease manifests itself, especially lower back pain, which often radiates to the legs. There are also weakness and a feeling of heaviness in the lower back and legs. Usually these symptoms first occur only after a long load, and after a short rest go.
Spinal stenosis at the level of the cervical is less common, but, due to the fact that in this Department the spinal canal itself is narrow, and its greater contraction manifests itself instantly..
The stenosis and compression of the spinal cord at this level often lead to the development of myelopathy — a serious neurological disease, in which the background is constantly increased muscle tone observed weakness in the limbs and often disrupted pelvic organs.
Diagnosis begins with a careful study of the complaints and clarify the location and nature of pain and its Association with physical activity, as well as specification of other symptoms that occur in diseases of the peripheral nervous system: decreased sensitivity, weakness etc.
Then conducted a physical examination, which determined a provisional diagnosis and Refine the plan for further examinations to clarify the diagnosis.
Most often stenosis of the spine for the purpose of additional surveys are conducted radiography and magnetic resonance imaging of the spine, and sometimes additionally performed CT scan.
As is customary to treat spinal stenosis?
At a moderate severity of symptoms preferably conservative treatment.
This treatment includes primarily drug therapy combined with physiotherapy techniques and massage. Medical treatment involves the prescription of non-steroidal anti-inflammatory drugs, painkillers and means of improving blood circulation.
In some cases when a persistent pain syndrome is used epidural glucocorticoids.
It is, however take into account that steroid drugs have many side effects, so this method of treatment only when other methods of conservative treatment proved ineffective.
In cases when the pain becomes unbearable, disrupted pelvic organs, pain in the legs becomes permanent or weakness in the legs gradually increases, the question arises about the need for surgery.
Given that in most cases, the disease is age, and in elderly patients, surgery is not always desirable and possible, it is necessary to weigh carefully all factors to take into account the overall health and possible risk of surgery.
Often, spinal canal stenosis combined with instability and herniated discs, which also affects the choice of operation.
The main goal of surgical intervention is decompression of the spinal cord, so the most commonly performed decompressive laminectomy, and in some cases, the installation of the stabilizing system or systems interspinal fixation.
When combined stenosis with a herniated disc requires a microdiscectomy, which is wider than decompressive laminectomy, resection of bone structures, which cause narrowing of the spinal canal.