Stenosis of the spinal canal is a disease of the spine, the main feature of which is the narrowing of the spinal canal. In this case, the back of the brain and its nerve endings are pinched by bone and muscle structures.
It is necessary to recognize the onset of the disease in time, conduct a comprehensive diagnosis and treatment in order to prevent the appearance of dangerous symptoms and complications.
Features of the disease
Stenosis of the spinal canal is a narrowing of the free space, which leads to increased pressure on the roots of the spinal cord. This violation usually provokes a narrowing of one or more areas of the spinal column. Pathology can affect a small part of the spine or spread over significant gaps.
Pressure on the spinal cord or nerve endings can lead to pain and sensory disturbances in the lower extremities. With pressure in the neck, symptoms maymanifest in arms and legs.
The most common spinal stenosis occurs after 50 years, and equally common in women and men. However, the disease can also occur at a younger age in the presence of congenital anomalies or spinal injuries.
Main classification
There are several different classifications of spinal stenosis. The primary form of the disease is rare. It occurs when exposed to congenital factors. Secondary stenosis of the spinal canal occurs due to the impact of various negative factors on the structures of the spine. According to the severity of the narrowing of the spine, such forms are distinguished as:
- lateral;
- relative;
- absolute;
- degenerative.
Lateral spinal stenosis is diagnosed when the lumen narrows to about 3 mm or less. With such a course of pathology, an urgent operation is often required to prevent the death of a large area of the spinal cord due to its damage.
Relative stenosis of the spinal canal is diagnosed when the diameter of the canal narrows to 10-12 mm. Often, with such a slight narrowing, no obvious clinical manifestations are observed. It is possible to determine such a violation quite by accident when diagnosing for the presence of other diseases of the spine. It is possible to improve well-being at this stage without surgery, using only conservative methods of therapy.
Absolute spinal stenosis is diagnosed when its diameter is reduced to4-10 mm. With prolonged preservation of compression of nerve endings, an increase in neurological disorders is observed.
Degenerative stenosis is one of the most common types of disease. Violation occurs with ankylosis, osteochondrosis, adhesive processes, impaired posture. This form is progressive and often requires surgery.
Causes of occurrence
Many patients are interested in whether a narrow spinal canal is a stenosis or not, for what reasons this disease can occur and what signs are characteristic of it. The disease is diagnosed when the width of the canal decreases. The study is carried out by introducing contrast and taking an x-ray.
Among the main causes that provoke such a disease, it is necessary to highlight such as:
- intervertebral hernia;
- fat benign formation;
- deposition of calcium s alts;
- degenerative processes in the spine;
- injuries;
- epiduritis.
In addition, the disease occurs very often during surgery in the spine, as a result of the formation of adhesions in the postoperative period, when the vertebrae are fixed with metal structures.
The most common cause of stenosis is degenerative changes in the spine. A fairly common situation is the simultaneous development of congenital and acquired forms of the disease.
The main reason is the occurrence of degenerative processes that occur as a result of agingorganism. However, they can be in the course of inflammation or morphological changes. As the body ages, the ligaments thicken and calcify. There is also growth in the joints and vertebrae.
When one part of the spine is affected, there is also an increase in the load on the intact area.
Quite often a disease occurs with spondylolisthesis. This disease is characterized by the fact that one vertebra slips in relation to another. It occurs due to degenerative changes or injuries. Sometimes it is congenital.
Main symptoms
Stenosis of the spinal canal can cause disability, as there is a violation of the functioning of internal organs. Among the main signs of the occurrence of such a disease, it should be noted such as:
- compression leads to soft tissue pathologies;
- appearance of puffiness in the damaged area;
- impaired blood supply to internal organs;
- brain hypoxia.
All these signs of critical spinal stenosis lead to disability. If medical treatment or surgery is not carried out, the consequences can be very dangerous.
Symptoms of the disease can be paroxysmal and permanent. The first occur with an exacerbation of the disease or the presence of pathologies of the internal organs. These should include signs such as:
- limping;
- convulsive syndrome;
- sensitivity disorderlimbs;
- uncontrolled urination and defecation;
- limited limb mobility.
The permanent symptoms of the disease include the following:
- muscle contractions;
- vegetative-vascular dystonia;
- thoracalgia, lumbalgia;
- myelopathy.
Depending on the severity of symptoms, there are four degrees of severity of the disease. The first is characterized by the fact that there is a sharp pain in the calf muscles, so lameness appears periodically when walking. In the second degree, there is a moderate gait disturbance with the onset of soreness.
The third stage is characterized by the presence of a rather pronounced pain syndrome. Movement without assistance becomes simply impossible. At the fourth degree, severe manifestations of lameness with severe soreness are noted.
The main symptoms of cervical spinal stenosis can be:
- motor disorders;
- impaired shoulder muscle function;
- signs of tension;
- appearance of soreness;
- headaches;
- paresthesia in the neck.
The main cause will be an acute hernia or fracture of a vertebra. With stenosis of the spinal canal of the cervical region, complete paralysis may occur, as well as the absence of temperature and pain sensitivity of the affected area. There is also weakness in the hands, impaired reflexes.
Stenosis in the thoracic region is quite rare. Mainly in this departmentnerve roots are damaged, which manifests itself in the form of muscle atrophy, pain in the affected area, discomfort from the internal organs.
Stenosis of the spinal incandescence in the lumbar region is mainly associated with protrusion of the intervertebral disc. The pain syndrome is quite well expressed. The pain is localized mainly in the lumbar region, as well as the lower extremities. A characteristic manifestation of stenosis of the spinal canal of the lumbar spine will be the flow of pain from the buttocks to the foot.
Among the main signs, it is also necessary to highlight rapid fatigue when walking, muscle atrophy, as well as deterioration in the functioning of the bladder and anus.
Combined spinal stenosis is a rapidly progressing disease. If it was not possible to stop an acute attack, then after a while it returns again.
Diagnostics
Diagnosis of stenosis of the spinal canal of the cervical, thoracic and lumbar begins with the collection of anamnesis and complaints, examination and filling in the history of the course of the disease. Then the doctor prescribes a number of diagnostic procedures, in particular, such as:
- MRI, CT;
- radiography;
- discography;
- venospondylography.
If the doctor suspects the presence of degenerative changes in the spine, the doctor prescribes an X-ray, which can confirm the decrease in the height of the intervertebral disc, sclerosis of the ligaments, the presence of osteophytes. This type of study shows bone structures. After x-rays are taken, other spinal diseases can be ruled out.
MRI will help identify stenosis and hernia. Tomography allows layer-by-layer visualization of the bone structures of the spine. Often this type of diagnosis is combined with contrasting of the epidural space.
Features of treatment
Spinal stenosis is often treated with conservative techniques. To do this, medications, non-traditional therapies, as well as physiotherapy are used.
In especially severe cases, an operation is required, as this will avoid the development of dangerous complications. After that, a long rehabilitation is required, which will help to normalize the general state of he alth.
Drug therapy
Drug treatment of spinal stenosis involves the use of the following groups of drugs:
- anti-inflammatory drugs;
- painkillers;
- decongestants.
Anti-inflammatory drugs form the basis of conservative therapy. They help eliminate soreness, inflammation, reduce swelling in the area of nerve endings. In particular, such drugs as Ibuprofen, Diclofenac, Ksefokam, Revmoksikam are prescribed. There are various forms of such drugs: tablets, injections, capsules, gels, ointments, patches. That is why they can be used both internally and locally.
Additionally, muscle relaxants are prescribed, in particular, such as Mydocalm, Sirdalud. They are used to eliminate the expressedmuscle tension. B vitamins have a positive effect on the nervous system, and also have an analgesic effect. These include: Milgamma, Neurovitan, Kombipilen.
Stenosis of the spinal canal in the lumbar region is treated with patches and ointments that have analgesic and anti-inflammatory effects. In particular, they appoint Voltaren, Finalgon, Dolobene.
With severe pain, sacral or epidural blockades, which are inserted directly into the spine, have a good effect. Complex therapy is often used.
It is strictly forbidden to select medications on your own, as this can provoke a deterioration in well-being and lead to the development of complications.
Folk remedies
Treatment of discogenic spinal stenosis should be comprehensive and necessarily involves the additional use of alternative medicine. For this, natural ointments, infusions, compresses, rubbing are used. Spread the affected area with honey, cover with a napkin, put 3 mustard plasters on top and wrap with cellophane.
Grate radish and horseradish, add sour cream until gruel and mix. Apply as a compress. Make an infusion of elderflower, chamomile, St. John's wort and apply it at night. Massage with honey is considered a good remedy. You need to do it with sharp rubbing movements until the pain disappears completely.
Take 40-50 g frankincense, add 50 g apple cider vinegar. Apply the finished product to a woolen cloth and apply to the back for 3 days. A cold compress of garlic helps. To do this, soak a towel in an infusion of garlic and lemon juice. Leave for 20 minutes. Wet the towel again and apply it to your back. Do this procedure until the pain is completely gone.
When using non-traditional methods, it is worth remembering that in this way it will not be possible to completely cure the disease. That is why it is mandatory to consult a doctor and complex therapy.
Therapeutic exercise
If there is a moderate pain syndrome and the state of he alth does not worsen, then a complex of procedures with a rehabilitation doctor may be required. A well-chosen personalized exercise program can help improve posture, increase strength, reduce pain, and increase spinal flexibility.
The doctor-rehabilitologist will select an individual set of exercises, as well as adjust movements in such a way as to reduce the load on the spine. Properly selected gymnastics will help strengthen the muscles of the arms, neck and back, and the cardiovascular system.
Exercise must be selected individually, since each person has an individual disease. The main task of gymnastics will be to eliminate the symptoms of the disease. At the same time, there is an increase in the strength and flexibility of the spine, as well as the normalization of general well-being.
To strengthen the lumbar you need to spread a small rug, lie on your back. Bend your knees and place them shoulder-width apart. Feetmust remain motionless on the mat. Take a deep breath, count to five, exhale. Repeat 10 times.
Comfortably lie on your back on a hard surface, spread your arms to the sides. Inhale deeply and exhale. Raise your legs, pressing your knees to your chest, stay in this position for as long as possible. Then lower your legs and relax. Repeat 10 times.
After a while, you can feel better. A person will be able to lead a more active and mobile lifestyle.
Physiotherapy techniques
Additionally, the doctor may prescribe physiotherapeutic procedures, which include:
- electrophoresis;
- laser therapy;
- magnetotherapy;
- balneotherapy;
- ultrasonic treatment.
After stabilization of the condition, a course of massage can be prescribed, as well as traction procedures.
Operating
In case of stenosis of the spinal canal at the level of the cervical, thoracic and lumbar regions, surgery may be prescribed. It is required to eliminate compression. Surgery is performed with a small skin incision. After gaining access to the interarticular space, it is removed, and then the soft tissues are sutured and the protrusion of the intervertebral discs is eliminated.
Now both extensive open surgeries and endoscopic intervention with minimal tissue incision are being performed. Among all the methods of performing the operation, the most common are:
- decompression laminectomy;
- microsurgicaldecompression;
- stabilizing operations;
- hernia excision.
Decompression laminectomy involves the excision of a part of the vertebral arch, intervertebral joints, spinous processes. This allows you to expand the affected area and eliminate compression of the roots of the spinal cord. This is the earliest method of treatment and it is characterized by the fact that it is quite traumatic.
Stabilizing surgeries are mainly performed for stenosis of the spinal canal in the lumbar region and are required to strengthen the supporting function of the spine. For this, special metal plates are used to strengthen the spine after decompression laminectomy.
Microsurgical decompression and installation of systems for dynamic fixation provides strengthening of the spine after the stenosis is eliminated. At the same time, the ability of normal flexion and extension of the spine is preserved.
If the disease was provoked by a disc herniation, then operations to remove it help well. The doctor determines the type and scope of intervention separately for each patient, depending on the causes and clinical features of the course of the disease. Surgery often ensures a full recovery.
Rehabilitation period
After the operation, you need to recover as soon as possible and get rid of the pain syndrome. Only a qualified specialist will help you choose the right rehabilitation program. To achieve positive results, reflexology is used andphysiotherapy.
The main goal of this restorative therapy will be to prevent relapse. The patient needs to rest immediately after the operation. When the wounds are fresh and every movement causes pain, the doctor may recommend wearing a fixing corset. At first, ice may be required, which reduces blood flow, constricts blood vessels, and helps eliminate muscle spasm, pain and inflammation.
Thermal procedures promote vasodilation. This facilitates the administration of medications that reduce pain and speed up the healing process. Ultrasound can reach tissues no more than 6 cm deep. This improves blood circulation in the problem area, improves oxygen delivery to tissues affected by inflammation.
Electrical stimulation is carried out to normalize the conductivity of the nervous tissue. It helps to reduce discomfort as well as eliminate spasm. Massage relaxes muscles, reduces soreness and normalizes painful manifestations.
Stretching and developing the joints can be quite uncomfortable, but they are required to normalize well-being.
Possible Complications
Spinal stenosis carries a great danger with its direct effect on the spinal cord. A slight narrowing of the lumen of the spinal canal will only affect the area between the membranes, but will not provoke neurological symptoms. This leads to a disruption of the nervous system.
The manifestation of symptoms will largely depend on the nature and leveldamage. The consequences can be very different - from complete recovery to loss of sensitivity and motor ability.
With timely assistance, the prognosis is quite favorable. However, spinal cord injury significantly reduces the chances of a successful recovery.
Prophylaxis
To prevent the occurrence of stenosis, you need to be exposed to constant intense and static loads as little as possible, you can not lift heavy objects. Be sure to strengthen the muscles of the back, as well as perform exercises to increase the mobility of the spine.
