Spinal canal stenosis 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 occurrence of the disease in time, to conduct a comprehensive diagnosis and treatment to prevent the appearance of dangerous symptoms and complications.
Features of the disease
Stenosis of the spinal canal - 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 intervals.
Pressure on the spinal cord or nerve endings can lead to pain, as well as impaired sensitivity in the lower extremities. With pressure in the neck, symptoms may appear in the arms and legs.
Most often spinal stenosis occurs after 50 years, and equally often in women and men. However, the disease can also occur at a younger age in the presence of congenital malformations or spinal injuries.
Main classification
There are several different classifications of spinal canal 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 influence of various negative factors on the structure of the spine. By the severity of narrowing of the spine, such forms are distinguished as:
- lateral;
- relative;
- absolute;
- degenerative.
Lateral stenosis of the spinal canal is diagnosed if its lumen narrows to approximately 3 mm or less. With such a pathology, urgent surgery is often required to prevent the death of a large area of the spinal cord due to 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 completely by accident during the diagnosis for the presence of other diseases of the spine. You can improve well-being at this stage without surgery, using only conservative methods of therapy.
Absolute stenosis of the spinal canal is diagnosed when its diameter decreases to 4-10 mm. With prolonged preservation of compression of the nerve endings, an increase in neurological disorders is observed.
Degenerative stenosis is one of the most common varieties of the disease. Violation occurs with ankylosis, osteochondrosis, adhesions, impaired posture. This form is characterized by a progressive course and often requires surgery.
Causes of occurrence
Many patients are interested in whether the narrow spinal canal is 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 channel decreases. The study is carried out by introducing contrast and performing an x-ray.
Among the main causes that provoke such a disease, it is necessary to highlight such as:
- intervertebral hernia;
- fatty benign formation;
- deposition of calcium salts;
- 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, with the fixation of the vertebrae with metal structures.
The most common cause of stenosis is degenerative changes in the spine. A fairly common situation is the simultaneous development of a congenital and acquired form of the disease.
The main reason is the occurrence of degenerative processes that occur as a result of aging. However, they can be during the course of inflammation or morphological changes. As the body ages, ligaments thicken and calcify. There is also proliferation in the joints and vertebrae.
When one part of the spine suffers, an increase in the load on the intact region also occurs.
Quite often, the disease appears with spondylolisthesis. This disease is characterized by the fact that one vertebra crawls in relation to another. It occurs due to degenerative changes or injuries. Sometimes it is congenital.
The main symptoms
Spinal stenosis can cause disability, as there is a malfunction of the 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;
- the appearance of puffiness in the area of damage;
- violation of the blood supply to internal organs;
- hypoxia of the brain.
All of these signs of critical stenosis of the spinal canal lead to disability. If a drug treatment or surgery is not performed, the consequences can be very dangerous.
Symptoms of the disease can be paroxysmal and persistent. The first occur with an exacerbation of the disease or the presence of pathologies of the internal organs. These include signs such as:
- lameness;
- convulsive syndrome;
- violation of the sensitivity of the limbs;
- uncontrolled urination and defecation;
- limitation of limb mobility.
The constant symptoms of the disease include the following:
- muscle contractions;
- vegetative-vascular dystonia;
- thoracalgia, lumbalgia;
- myelopathy
Four degrees of disease severity are distinguished depending on the severity of symptoms. The first is characterized by the fact that there is a sharp pain in the calf muscles, therefore, lameness appears periodically when walking. In the second degree, moderate gait disturbance with the onset of soreness is observed.
The third stage is characterized by the presence of a rather pronounced pain syndrome. Movement without assistance becomes simply impossible. With the fourth degree, severe manifestations of lameness with severe soreness are noted.
The main symptoms of stenosis of the spinal canal of the cervical can be as follows:
- motor impairment;
- impaired shoulder muscle function;
- signs of tension;
- the appearance of soreness;
- headache;
- paresthesia in the neck.
The main cause will be an acute hernia or fracture of the vertebra. With stenosis of the spinal canal of the cervical spine, 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.
Thoracic stenosis is rare. Basically, nerve roots are damaged in this section, which manifests itself in the form of muscle atrophy, pain in the affected area, discomfort from the internal organs.
Spinal stenosis in the lumbar region is mainly associated with protrusion of the intervertebral disc. Pain in this case is quite well expressed. The pain is localized mainly in the lumbar region, as well as in the lower extremities. A characteristic manifestation of stenosis of the spinal canal of the lumbar region 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 of the bladder and anus.
Combined spinal stenosis refers to rapidly progressing diseases. If it was not possible to stop an acute attack, then after a while he returns again.
Diagnostics
Diagnosis of stenosis of the spinal canal of the cervical, thoracic and lumbar spine begins with a medical history and complaints, examination and filling out the history 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 a decrease in the height of the intervertebral disc, sclerosis of the ligaments, and the presence of osteophytes. This type of study reveals bone structures. After radiography, other spinal diseases can be ruled out.
MRI can help determine 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.
Treatment features
Often, treatment of spinal canal stenosis is performed using conservative techniques. For this, medications, non-traditional therapies, as well as physiotherapy are used.
In especially severe cases, surgery is required, as this will avoid the development of dangerous complications. After this, a long rehabilitation is required, which will help normalize general well-being.
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, Xefocam, and Revmoxicam are prescribed. There are various forms of such drugs: tablets, injections, capsules, gels, ointments, plasters. That is why they can be used both internally and locally.
In addition, muscle relaxants are prescribed, in particular, such as Midokalm, Sirdalud. They are used to eliminate severe muscle tension. B vitamins have a positive effect on the nervous system, and also have an analgesic effect. These include: Milgamma, Neurovitan, Combipilene.
Treatment of stenosis of the spinal canal in the lumbar is carried out with the help of plasters and ointments, which have analgesic and anti-inflammatory effects. In particular, they appoint Voltaren, Finalgon, Dolobene.
With severe soreness, a sacral or epidural blockade, which is injected directly into the spine, has a good effect. Complex therapy is often used.
It is strictly forbidden to choose 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 stenosis of the spinal canal should be comprehensive and necessarily involves the additional use of alternative medicine. To do this, apply natural ointments, infusions, compresses, rubbing. Smear the affected area with honey, cover with a napkin, apply 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 the flowers of elderberry, chamomile, St. John's wort and apply it for the night. A massage with honey is considered a good remedy. You need to do it with sharp rubbing movements until the pain completely disappears.
Take 40-50 g of frankincense, add 50 g of apple cider vinegar. Apply the finished product to a woolen cloth and apply to the back for 3 days. A cold garlic compress helps well. To do this, wet a towel in the infusion of garlic and lemon juice. Leave on for 20 minutes. Dampen the towel again and place it on your back. Do this procedure until the pain completely passes.
Using unconventional techniques, it is worth remembering that in this way the disease cannot be completely cured. That is why a doctor’s consultation and complex therapy are required.
Physiotherapy
If a moderate pain syndrome is observed and the well-being does not worsen, then a set of procedures with a rehabilitation doctor may be required. If you choose the right individual program of physical exercises, they will help improve posture, increase strength, reduce pain and increase flexibility of the spine.
The rehabilitation doctor will select an individual set of exercises, as well as adjust movements 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.
Exercises need to be selected individually, since each person has an individual illness. The main task of gymnastics will be the elimination of 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 overall well-being.
To strengthen the lumbar spine, you need to spread a small mat, lie on your back. Bend your knees and place them shoulder-width apart. Stops should remain motionless on a rug. Take a deep breath, count to five, exhale. Repeat 10 times.
It is convenient to lie on your back on a hard surface, spread your arms to the sides. Take a deep breath 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 some time, you can feel better. A person will be able to lead a more active and mobile lifestyle.
Physiotherapeutic Techniques
Additionally, the doctor may prescribe physiotherapeutic procedures, which include:
- electrophoresis;
- laser therapy;
- magnetotherapy;
- balneotherapy;
- ultrasound exposure.
After stabilization, a massage course can be prescribed, as well as an extension procedure.
Operation
With stenosis of the spinal canal at the level of the cervical, thoracic and lumbar spine, surgery can be prescribed. It is required to eliminate compression. Surgical intervention is performed with a small skin incision. After gaining access to the interbranch space, it is removed, and then suturing of the soft tissues and eliminating protrusion of the intervertebral discs are performed.
Both extensive open surgeries and endoscopic procedures with minimal tissue incisions are currently underway. Among all the techniques for performing the operation, the most common are:
- decompression laminectomy;
- microsurgical decompression;
- stabilizing operations;
- excision of a hernia.
Decompression laminectomy implies excision of a part of the vertebral arch, intervertebral joints, and spinous processes. This allows you to expand the affected area and eliminate compression of the roots of the spinal cord. This is the earliest treatment and it is characterized by the fact that it is quite traumatic.
Stabilizing operations are mainly performed with spinal stenosis in the lumbar region and are required to strengthen the supporting function of the spine. For this, special metal plates are used with which they strengthen the spine after performing decompression laminectomy.
Microsurgical decompression and installation of systems for dynamic fixation ensures the strengthening of the spine after eliminating stenosis. At the same time, the ability to normal flexion and extension of the spine is preserved.
If the disease was triggered by a disc herniation, then operations to remove it are good. The doctor determines the type and extent of intervention separately for each patient, depending on the causes and clinical features of the course of the disease. Often, the operation provides a complete recovery.
Rehabilitation period
After the operation, you need to recover as soon as possible and get rid of the pain syndrome. Properly choose a rehabilitation program will help only a qualified specialist. To achieve positive results, reflexology and physiotherapy are used.
The main goal of such rehabilitation therapy will be to prevent relapse. Immediately after surgery, the patient needs rest. When the wounds are fresh and every movement is painful, the doctor may recommend wearing a fixative corset. At first, it may be necessary to use ice, which reduces blood flow, constricts blood vessels, and helps eliminate muscle spasm, pain and inflammation.
Thermal treatments promote vasodilation. This contributes to the introduction of medications that reduce pain and accelerate the healing process. Ultrasound can reach tissues no deeper than 6 cm deep. At the same time, blood supply to the problem area improves, oxygen delivery to tissues affected by inflammation improves.
Electrical stimulation is performed to normalize the conductivity of nerve tissue. It helps reduce discomfort, as well as eliminate spasm. Massage relaxes muscles, reduces soreness and normalizes painful manifestations.
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Possible complications
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The manifestation of symptoms will largely depend on the nature and level of damage. The consequences can be very different - from complete recovery to loss of sensation 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 subjected 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.