Close in the spinal canal no room for nerves

Physiotherapy and flexible spine stabilization achieve good results

07/11/2014

If it hurts in the back, buttocks and spasmodic legs, tense muscles or a disc problem may be responsible. But it can also be that a too narrow spinal canal causes the agony. Above the age of 50, this wear-related disease called spinal canal stenosis is on the rise. In addition, when walking and standing pain is hard to bear and sufferers need breaks in which they sit down or bend forward. The treatment spectrum ranges from conservative to minimally invasive therapies to surgery.

„The drug of first choice is a conservative treatment with targeted exercise therapy in the form of physiotherapy and back training to strengthen the back and abdominal muscles“, explains Dr. Bernd Illerhaus, spine surgeon and specialist in neurosurgery from the Orthopedic-Neurosurgical Center in Datteln and Recklinghausen. Special exercises to strengthen the muscles restore the mobility and stability in the back. In some cases, the disease can get a good handle. Patients with already advanced spinal stenosis can also achieve good results with exercise therapies. Those who consistently carry out these many years can even bypass an operation. Heat treatment, electrotherapy and other physical applications, as well as acupuncture and neurostimulation, may be complementary to doctors.

Pain therapy often provides the next stage. Patients often take anti-inflammatory and cortisone-containing medications which, however, can lead to side effects if taken for long periods. Also, root-injected, analgesic and decongestant medications sometimes relieve discomfort. In special cases, local anesthetics are injected into the facet joints. „These minimally invasive procedures are designed to break the cycle of inflammation, pain and restraint. In spinal stenoses, however, they only help to a limited extent and in many cases can not avoid surgery“, so Dr. Illerhaus assessment.

For him, an operation is out of the question if unbearable pain sets in with a walking distance of less than five meters. „Then surgery should be carried out because the quality of life of those affected is considerably limited in these cases.“ In all other cases, the doctor and patient would have to balance the decision for or against surgery individually. In this, an operative extension of the spinal canal provides relief. Sometimes this is followed by a stabilization operation. Here, the method of choice is a stiffening operation under which, however, when multiple vertebral segments are stiffened together, the mobility may suffer and the disease later relocates to adjacent areas. For several years now, medical specialists have increasingly turned their attention to movement-preserving surgical procedures such as flexible spine stabilization. A dynamic implant, the TOPS system, ensures that the patient remains mobile and permanently painless in all directions after surgery. „This prevents load transfer to other areas of the spine and permanently stops the disease“, explains Dr. Illerhaus. (Pm)