Stenosis of the spinal canal is a process that has a chronic character, which is manifested by a narrowing of the central spinal canal due to cartilaginous or soft tissue structures, which are introduced into the region of nerve roots and spinal cord. Narrowing can also occur in the area of the intervertebral foramen or lateral pocket.
For the first time about this disease they started talking in 1803, and it was the doctor Antoine Portap. He described the situations in which the spinal column curved because of the narrowing of the spinal canal, which, in his opinion, was due to rickets or venereal diseases. This author emphasized that the patients had other serious symptoms - muscle atrophy, lower limb paralysis and weakness in the legs. Thus, from the illness according to his studies, his legs suffered greatly.
Classification of spinal stenosis
Spinal diseases, as a rule, have a branching classification, since the areas of damage and the nature of this lesion are important here.
So, according to anatomical parameters, the disease is divided into two groups:
- Central - stenosis of the vertebral canal, in which the distance from the posterior surface of the vertebral body to the opposite point on the arch decreases (with absolute stenosis of the spinal canal up to 10 mm, with relative stenosis of the spinal canal - up to 12 mm).
- Lateral - this same distance narrows no more than 4 mm.
On the etiology:
- Primary stenosis of the spinal canal - occurs at birth, without interference from external circumstances.
- Secondary stenosis of the spinal canal is the acquired stenosis of the spinal canal, which can occur due to disc displacement, Bechterew's disease, spondyloarthrosis and other diseases.
- Combined stenosis of the spinal canal is a combination of primary and secondary stenosis.
Causes of degenerative spinal stenosis
Congenital sagittal stenosis of the spinal canal can be caused by the following reasons:
- fibrotic and cartilaginous diastematomyelia;
- achondroplasia;
- shortening of the arcs of the vertebrae.
Acquired (secondary) stenosis occurs for the following reasons:
- deforming spondylarthrosis (with the presence of joint hypertrophy);
- hypertrophy of the yellow ligament;
- hernia of intervertebral discs ;
- Bechterew's disease;
- postoperative scars;
- spondylolisthesis.
Symptoms of spinal stenosis
The main symptom of stenosis is pain in one side of the waist or both. The nerve channel is irritated by degenerative formations, and therefore pain can be felt even in the leg. Walking and any movement, as well as vertical position, contribute to increased pain. The patient experiences relief by taking a horizontal position or sitting down.
In most cases (75%) patients are limping. This is especially true in older people (45 years and older), as well as those who have varicose veins, hemorrhoids, postthrombophlebitic syndrome.
Lameness arises from the fact that the venous outflow is disturbed because of the venous plexus of the spine. Already after a thirty minute walk the patient feels pain and this causes him to sit down.
Treatment of spinal stenosis
Stenosis can be cured by a conservative or surgical method.
As conservative agents, anti-inflammatory and antialgic medicines are used. In acute cases, a strict pastel regimen is shown. When acute symptoms are removed, the patient is prescribed exercise therapy, massage and physiotherapy.
Already during treatment it is very important to organize the patient correctly placed workplace, to explain the mechanics of correct posture and movements.
Surgery for stenosis of the spinal canal is necessary when conservative treatment does not work. During the operation, the nerve endings are released from the degenerative formations, which lead to pain and squeezing of the tissue.