Stenosis of the lumbar spine: symptoms and treatment

Stenosis of the vertebral canal of the lumbar spine is a pathological condition in which the size of the canal is reduced. The narrowing of the lumen leads to compression of the structures located in the canal, the roots of the spinal cord. Symptoms of the disease are determined by which roots are subjected to compression. The disease is slowly progressive. Treatment can be conservative and operative. The latter is prescribed in case of ineffectiveness of drug treatment. From this article you can learn about the causes, symptoms, diagnosis and treatment of stenosis of the spinal canal of the lumbar spine.

General information

Normally the anteroposterior size (sagittal) of the vertebral canal at the lumbar level is 15-25 mm, transverse - 26-30 mm. At this level, the human spinal cord ends and the so-called ponytail (a group of roots of the spinal cord in the form of a bundle) is located. Reduction of the sagittal size to 12 mm is called relative stenosis, which means the following: clinical manifestations of constriction may or may not be present. When the anteroposterior dimension is 10 mm or less, then this is an absolute stenosis always having clinical signs.

From the point of view of anatomy, there are three types of stenosis of the spinal canal at the lumbar level:

• central: reduction of anteroposterior size;
• lateral: narrowing in the region of the intervertebral opening, that is, the place where the spine nerve root exits from the vertebral canal between two adjacent vertebrae. Lateral stenosis is the reduction in the size of the intervertebral foramen to 4 mm;
• combined: decrease in all sizes.

Causes of stenosis

Stenosis of the lumbar spine may be congenital or acquired.

Congenital (idiopathic) stenosis is caused by the peculiarities of the structure of the vertebrae: an increase in the thickness arc of the vertebra, shortening of the arch, lowering of the body height, shortening of the leg and the like changes.

Acquired stenosis is much more common. It can be caused by:

• degenerative processes in the spine: osteochondrosis of the lumbar spine, deforming spondylosis, arthrosis of the intervertebral joints, degenerative spondylolisthesis (displacement of one vertebra in relation to the other), protrusion (protrusion) and herniation of intervertebral discs, calcification and, accordingly, thickening of ligaments the spine;
• injuries;
• iatrogenic causes (as a result of medical interventions): after laminectomy (removal of part of the arch of the vertebra), arthrodesis or spondylodesis (fixation joints or vertebrae, respectively, with the help of additional devices, for example, metal structures) as a result of the formation of adhesions and postoperative Scars;
• other diseases: Pagetta's disease, Bechterew's disease (ankylosing spondylitis), rheumatoid arthritis, lumbar spine, acromegaly and others.

Degenerative changes in the spine are the most common cause of stenosis of the lumbar spinal canal.

Quite common is the situation when the patient has both a congenital and acquired narrowing of the spinal canal.

In the development of symptoms of stenosis of the vertebral canal of the lumbar spine, in addition to the narrowing, the role violation of the blood supply to the roots of the spinal nerves, resulting from the vasoconstriction, venous disturbance outflow.

Symptoms

Stenosis of the spinal canal at the lumbar level is a fairly common disease, because with In the age of each (!) a person develops the processes of aging of the spine, manifested by degenerative changes. More often the stenosis manifests itself after 50 years, more susceptible to the disease of a man.

The most characteristic signs of stenosis of the lumbar spinal canal are the following:

• Neurogenic (caudogenic) intermittent claudication is a feeling of pain, numbness, weakness in the legs, which occurs only when walking. The pain is usually bilateral, has no clear localization (that is, if the episodes are repeated, it can be noted in another place) is sometimes not even described to patients as a pain, but as a difficultly delineated unpleasant sensation that does not allow move. Pain and weakness in the legs make the patient stop, sit down, and sometimes lie down on the street. The pain disappears in the position of easy bending of the legs in the hip and knee joints with a slight tilt of the trunk forward. In the sitting position, such feelings do not arise, even when a person performs physical exertion (for example, riding a bicycle). Sometimes patients with stenosis of the spinal canal of the lumbar spine involuntarily move in a slightly bent posture (monkey posture), since it allows walking without gain pain syndrome;
• pains in the lower back, sacrum, coccyx may be diverse, but more often blunt and aching, do not depend on the position of the body, can "give" to the legs;
• Pain in the legs is usually bilateral, the so-called "radicular". This term means a special localization of the pain sensation (or its distribution) - the lamp-like, that is, along the length of the leg in the form of a band. "Lampas" can pass along the front, side, back surface of the foot. Since stenosis usually squeezes several roots of the spinal cord, then the "lamp" can be wide. Compression of the roots causes the so-called tension symptoms - Lassega, Wasserman, which are caused by the passive lifting of the straightened leg in a different posture;
• violation of sensitivity in the legs: a sense of touch is lost, the difference between sharp and blunt is not caught Sometimes, with closed eyes, it is difficult for a patient to describe the position of the toes that the doctor gave them (for example, he bent or straightened). Similar changes can be in the groin, in the genital area;
• tingling sensation, crawling crawling, burning sensation in the legs and similar sensations;
• violation of the function of the pelvic organs: a change in urination by the type of delay or vice versa incontinence, imperative urge to urinate (that is, requiring immediate satisfaction), a violation of potency, defecation;
• decrease or absence of knee, Achilles, plantar reflexes;
• krampi (painful cramps) in the muscles of the legs, especially after a little physical exertion, involuntary twitching of individual muscle beams without pain;
• weakness (paresis) in the legs: this may concern individual movements (for example, it is difficult for a patient to stand on socks or walk on the heels), and can wear generalized, full-legged, character;
• weight loss (thinning) of the legs due to dystrophic changes in the muscles that occur with prolonged compression of the nerve roots.

Violation of the pelvic organs, paresis in the legs and weight loss of the lower limbs are late symptoms of stenosis of the vertebral canal of the lumbar spine. Usually, in the presence of such changes, the patient is already shown surgical treatment.

Diagnostics

The diagnosis of stenosis of the vertebral canal of the lumbar spine is based on clinical symptoms (especially neurogenic intermittent claudication), data neurologic examination (changes in sensitivity, reflexes, the presence of tension symptoms, paresis, weight loss of limbs) and data of additional methods survey.

Of the additional methods of examination, the most informative are the radiography of the lumbosacral spine, computed tomography (CT), and magnetic resonance imaging (MRI). These methods make it possible to measure the size of the spinal canal. Of course, CT and MRI are more accurate methods. In some cases, to confirm the diagnosis may need electroneuromyography, myelography, scintigraphy.

Treatment

Treatment of stenosis of the spinal canal of the lumbar spine can be conservative and operative.

Conservative treatment is used in cases of minor (relative) stenosis, in the absence of pronounced neurological violations (when the primary complaints are pain in the lower back and legs), with timely treatment for medical help.

Conservative treatment consists of the use of medications, physiotherapy procedures, massage, and physical therapy. Only the integrated use of these methods can give a positive result.

Drug treatment consists of the following:

• nonsteroidal anti-inflammatory drugs: they allow you to eliminate pain syndrome, to remove the inflammatory process(to which the nerve root undergoes compression), to reduce edema in the region of the nerve root. These groups of drugs are more often used Xephocam, Ibuprofen, Revmoxicam, Diclofenac (Diclobert, Naklofen, Voltaren, Rapten Rapid and others). And there are various forms of these medicines (ointments, gels, tablets, capsules, injections, patches), which allow using them both locally and inward;
• muscle relaxants: Tizanidine (Sirdalud), Midokalm. They are used to relieve pronounced muscular tension;
• vitamins of group B (Kombilipen, Milgamma, Neurorubin, Neurovitan and others) in connection with their positive effect on the structures of the peripheral nervous system, as well as with an analgesic effect;
• cardiovascular agents that improve blood flow (and, hence, nutrition of nerve roots), provide optimal venous outflow and Liquor circulation: Kurantil (Dipiridamol), Pentoxifylline, nicotinic acid preparations, Nicergoline, Cavinton, Escuzan, Detralex, Venoplant and others;
• decongestants: L-Lysine escinate, Cyclo-3-fort, Diakarb;
• medicamentous blockades (epidural, sacral) using anesthetics (lidocaine) and hormones. They can be very effective for relieving pain and swelling.

Along with medication, physiotherapy is used. Their spectrum is quite diverse: it's electrophoresis with various drugs, and the effect of sinusoidal modulated currents (amplipulse), and mud therapy, and magnetotherapy. Selection of the method should be carried out individually, taking into account contraindications to a specific procedure.

Patients with stenosis of the vertebral canal of the lumbar spine are shown massage sessions. Complexes of physiotherapy exercises in a number of cases allow to reduce the severity of the pain syndrome and improve the state of health.

Operative treatment is performed with inefficiency of conservative, neurological symptoms, the appearance of paresis, impaired functions of the pelvic organs, in neglected cases with late treatment.

The purpose of surgical intervention is to release the roots of the spinal nerves from compression. To date, both open and extensive operations, as well as endoscopic, with minimal tissue cuts are carried out. Among all the methods of surgical treatment, the most commonly used are:

• decompression laminectomy: the operation consists in removing part of the arch of the vertebra, spinous process, part of the yellow ligaments, intervertebral joints, which contributes to the expansion of the spinal canal and the elimination of compression of the dorsal root the brain. This is the earliest method of surgical treatment, quite traumatic;
• stabilizing operations: usually performed in addition to the previous one to strengthen the support function of the spine. Use special metal plates (staples), with which the vertebral column is strengthened after decompression laminectomy;
• microsurgical decompression and installation of interstitial dynamic fixation systems: this type of surgical intervention provides for strengthening spinal column after the removal of stenosis with the preservation of the possibility of flexion and extension of the spine, which is more physiological than the usual stabilizing operation;
• in the event that the stenosis of the spinal canal is caused by a herniated disc, then surgery to remove the hernia (in particular microdiscectomy, endoscopic microdiscectomy, laser vaporization of the nucleus of the affected disk). In some cases, they must be combined with a laminectomy.

The type and extent of the operative intervention is determined individually, depending on the causes and clinical features of stenosis of the spinal canal of the lumbar spine in this patient. In most cases, surgical treatment ensures recovery. An important role is played by the patient's correct behavior in the postoperative period, a sparing regimen (concerning the loads for the back) and a clear implementation of rehabilitation measures.

Stenosis of the lumbar spine is a disease that manifests itself in back pain and legs, restriction of movement due to pain, and sometimes a violation of urination and weakness in the muscles (paresis). The disease requires immediate medical treatment, because in some cases the patient needs not only conservative, but also in surgical treatment. From stenosis of the spinal canal of the lumbar region can be completely eliminated, it is only necessary to be attentive to your health and not ignore the symptoms.

A. In, Печиборщ, the neurosurgeon, tells about what is the stenosis of the spinal canal: