Diagnosis of spinal stenosis when to surgery?

Often, aggravation can be conserved

24/09/2013

Take 100 steps, then you're done: no step is possible, your legs tingle and a dull ache pulls from the back to the feet. Malefactor is a narrowing in the spinal canal, the so-called spinal stenosis, which presses on nerves. Patients typically report not only running problems, but also immediate improvements in symptoms when bending over. Since 2005, the diagnosed cases have almost doubled - and rising. For those affected the next shock comes but already after the diagnosis: Spinal canal stenoses are not curable. But there is also good news. „It is not always necessary to undergo surgery, because often an aggravation and thus an operation can be postponed“, makes Dr. Thomas Bierstedt, spine surgeon and specialist in neurosurgery from the Orthopedic Neurosurgical Center in Datteln and Recklinghausen, patients courage. „Still, if surgery is indicated, today there are methods such as flexible spinal stabilization that restore spinal mobility.“

In the foreground of the conservative treatment are pain therapies, massages, back training and physiotherapy. The reason is obvious: strong muscles stabilize the spine, painkillers prevent a cramping of the muscles. If a stenosis is present, doctors recommend surgery only when uncontrollable pain is present, when important muscles are paralyzed or when bladder-rectal disorders occur. „At the end of the operation, the goal is to restore space to the trapped nerve“, emphasizes Bierstedt. „For this we remove disturbing tissue structures with fine instruments.“ Depending on the extent, however, it often comes after an instability of the spine. Therefore, sometimes joins another stabilizing intervention. In many cases, this is done by a stiffening operation. For many patients, this is the best practice. But if the stiffening extends over a larger area, sometimes the flexibility of the spine suffers. In addition, it can come later in the problems again: Because a piece of the spine is stiff, vertebrae and intervertebral discs above and below have to do more than before. For some, flexible spine stabilization is an alternative: instead of structurally connecting vertebrae, surgeons use a dynamic implant - known as the TOPS system. Dr. Bierstedt explains for whom the method is suitable: „For people with active lifestyles, this is a good thing and maintaining freedom of movement is a significant quality of life for them.“ However, the procedure requires a healthy disc and there must be no scoliosis. For the cost of the operation come the health insurance. The clinic usually bears the cost of the implant. (Pm)