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Spinal stenosis animation
What are the symptoms of spinal stenosis ?
What different kinds of spinal stenosis do exist?
What causes a spinal stenosis ?
Central stenosis
Lateral recess stenosis
Foraminal stenosis
How is a spinal stenosis treated ?
Spinal stenosis (lateral recess stenosis) animation
What are the symptoms of spinal stenosis ?
Clinical complaints are determined by the location of the narrowing (and therefore slow progressive nerve pinching).
1. In case of central canal stenosis or spinal stenosis, there is typically a dull pain or radiation from the back to both legs after walking for a while. This reduces the walking distance. In order for these complaints to disappear, it is necessary to stand still for a while. Bending forward also helps. Walking is therefore always interrupted by an obligatory rest break, one steps with intervals. It is called neurogenic claudication. As the narrowing of the canal increases, the distance that can be covered in one go becomes shorter and shorter.
Usually there is no (significant) back pain in case of canal narrowing. The central canal is large, which means that it takes years for there to be sufficient bone growth to constrict the spinal canal significantly. As a result, the disorders of the spinal canal occur only slowly and gradually. Some people experience the need to stop because of heavy pressure or pain in the lower back, symptoms that typically disappear at a rest interval. When the back is bent forward, the diameter of the canal increases, just as you would get the kink out of a garden impact. As a result, it is also typical that leaning forward makes walking easier. Sometimes people automatically lean forward while walking. Steps that allow you to lean forward are also better. That is why it is better to walk uphill or with a shopping trolley to lean on. Cycling also works fine because of the same bent posture.
“CENTRAL stenosis: “NEUROGENIC CLAUDICATION” slowly progressing gait disorders, disabling leg pain that occurs when walking and disappears when stopping.
LATERAL recess stenosis: “SCIATICA” more sudden appearance with constant unilateral leg pain.”
Gradually people are able to walk less and less far, which results in them not being able to leave their houses. Progressively the self-reliance decreases due to very difficult walking.
2. With lateral recess stenosis there are often complaints similar to those of a disc herniation. These sciatica symptoms can be as severe, there is also pain when resting, a sudden onset was notices and symptoms only present in one leg. Also here the back pain is more at the background or long lasting. There is irradiation on one side to the buttocks, thigh, calf and sometimes up to the foot with sometimes sensory disturbances in addition to pain.
What causes spinal stenosis?
“THREE TYPES OF STENOSIS:
Central (canal)
Lateral recess
Foraminal (nerve opening) ”
1. Spinal stenosis is usually caused by wear and tear on the back due to aging. The complaints are therefore more common over the age of fifty. Due to wear and tear on the intervertebral disc and/or on the small joints (facets) of the back, the spinal canal of the lower back slowly 'grows' closed, as it were. Sometimes this is accompanied by a vertebral shift ('spondylolysthesis'), which makes the narrowing even stronger. Because of all this, the lower back nerves are slowly compressed in a space that is too narrow. This narrowing will slowly increase over many years, which means that the nerves have time to adjust, so there is usually no pain at rest.
Often, due to minimal trauma, a local swelling has occurred in an already narrow lateral recess. This swelling disturbs the precarious balance of a net-not pinched nerve. The nerve has no place in reserve to move through the narrowed space and pinches itself against the walls of the canal.
Roughly three types of constrictions may be present, whether or not in combination. In case of lateral canal stenosis ('lateral recessive stenosis') there is an important narrowing only on one side of the main canal, there is only radiation to that side. In central canal stenosis ('central spinal stenosis'), the entire tube of the canal is blocked and there will therefore be complaints in both legs.
At the vertebrae there are two lateral openings on each side where the left and right nerve branches off to the leg. If one of these openings is narrowed (foraminalestenosis), the exiting nerve is squeezed. Since only one nerve is crushed, symptoms are similar to those of a herniated disc.
In some rare cases spinal stenosis can be congenital. However, the symptoms also occur later in life.
What different sorts of spinal stenosis do exist?
there are three different places where narrowing can occur.
Central spinal stenosis
Lateral recess stenosis
Foraminal stenosis
1. Central spinal stenosIS:
There are two distinct central canal stenosis:
Tissue (mainly bone) growth. This is what is classically called "spinal stenosis".
Spinal displacement. "spondylolysthesis."
In "classic" spinal stenosis, the full diameter of the spinal cord canal is reduced due to wear and tear of the spinal cord due to aging. the narrowing is caused by a combination of bone growth in the spinal cord canal, bulging disc and thickened vertebral ligaments.
Central canal stenosis in which both sides of the spinal cord are narrowed round about. The narrowing is often caused by a combination of bone growth, bulging disc and thickened ligaments IN the spinal canal. There are complaints in both legs
2. Lateral reces stenosis:
The "lateral recess" is the lateral border of the spinal canal. A separate nerve that has just branched off from the spinal cord transverses this area. In this space on the side of the spinal canal this nerve runs towards the nerve opening (neuroforamen). When lateral recess diameter is reduced due to bone growth and sometimes disc bulging, pressure is applied to the nerve with sciatica symptoms in the ipsilateral leg.
In a lateral recess stenosis, the "lateral groove", in which nerves run, is constricted by colorectal growth, sometimes combined with discus bulging. One-sided radiation is created in the course of the pinched nerve.
In the spondylolysthesis, upper and lower vertebrae are shifted (usually only a few millimeters) opposite each other. This shift means that the bone rings of both vertebrae are no longer exactly above each other. What still overlaps of these two channel rings is the remaining narrowed spinal canal.
3. Foraminal stenosis
A foraminal stenosis is the nerve opening, the "neuroforamen" diminished by imaginary growths. The nerve that passes through this opening (the "exiting" nerve) is pinched when constricted and gives radiating pains.
The neuroforamen is a relatively small tunnel on both sides of each vertebra link. It is the exit port through which the exiting nerve leaves the spinal canal on its way to the legs. This nerve opening is already relatively small in itself, which means that a relatively limited constriction can already exert considerable pressure on the nerve.
How is spinal stenosis treated?
From a scientific point of view, there are only two therapies that have been proven to help with bone narrowing.
The use of a walker.
Operative decompression.
When bending the back forward, the diameter of the spinal canal slightly increases. Therefore, people with a canal stenosis also have a natural tendency to lean forward. However, this is an awkward and tiring posture for the body. The walker makes your arms support theirs while still allowing you to step with your back slightly bent. In this way, you can increase the diameter of the spinal cord canal (to a limited extent) without straining the torso muscles.
“Only thing that helps: using a rolator OR surgical decompression”
Sometimes epidural infiltrations are given in case of spinal stenosis. This has no proven effect on curing spinal stenosis. This can be explained since the cause (mainly) by bone overgrowth, and bone does not disappear by injections. For this reason, the reimbursement of epidural infiltrations for spinal stenosis treatment has been abolished in Belgium.
Channel narrowing with complaints in the legs is treated in our department in the least invasive way possible by means of a full-endoscopic decompression of the spinal canal or an endoscopic widening of the neuroforamen.