Balancing spinal canal stenosis operations well

Spinal stenosis: Which OP is the right one? Always weigh operations well

09/30/2014

Especially in the clinical picture spinal stenosis it is important to always consider an operation carefully. Because many patients who suffer from numbness, pain in the legs and lumbar region or in the buttocks, conservative measures help well. Only when these show no effect, can be thought about an operation. The most common postoperative care options are spinal spreaders, flexible spinal stabilization and stiffening. The statutory health insurance usually covers the costs for all three surgical procedures.

Culprit of the disease is a narrowing in the spinal canal. This is often caused by general signs of wear such as osteoarthritis. Thickening of the joints in the form of bone growths then protrude into the surrounding tissue and press on nerves. Sometimes the disease is caused by so-called sliding vertebrae. Moving two superimposed vertebrae causes instability of the spine, which in turn leads to constriction of nerves. No matter what the cause of the disease is based, doctor and patient must always decide together which therapy is best suited. „Objectives of surgery should be pain relief and quality of life improvement“, clarifies Mathias Pippan, Spine Surgeon and Specialist in Orthopedics at the Spine Institute in Mainz Orthopedic Center (OZM). „In order to achieve these goals, doctors and patients consult each other and include individual medical requirements as well as the personal life situation, such as work and leisure time, when choosing the surgical procedure.“

Surgical pressure relief relieves pain
In order to achieve a relief of the spinal canal, surgeons remove first always disturbing tissue structures, which lead to a constriction. Doctors are talking about decompression here. It creates space for the constricted nerve fibers and permanently relieves symptoms such as leg pain. Depending on the extent of the surgical pressure relief operators combine this with a stabilization operation.

Vertebral spreader: less invasive procedure for mild cases
This care option is more suitable for patients with a mild form of spinal stenosis who do not additionally suffer from spondylolisthesis. „Since the surgical procedure is less invasive, it may also be more suitable for the elderly or patients suffering from vertebral canal stenosis as well as other diseases such as heart failure“, explains Dr. Pippan. „However, the procedure only takes on a low priority today.“

Stiffening operation: no alternative for strong eddy gliding
Whenever the patient can no longer be stabilized by a motion-preserving implant, or can not be sufficiently stabilized, the stiffening operation is suitable. It is also indicated for severe spondylolisthesis as well as for medium and severe scoliosis, in which the natural curvature of the spine changes. In the stiffening operation, in which several vertebrae are connected to each other, but suffers the mobility of the spine.

Flexible spine stabilization: protects neighboring joints
When stiffening the adjacent joints then have to take over the movement of the stiffened spinal column section and this additional burden often causes complaints at a later time. In flexible spine stabilization as a motion-preserving surgical procedure, however, excessive load transfer to other areas of the spine is prevented. The younger the patients are, the more likely they are to get to the latter method. In addition, in a later step, patients still have the stiffening option open, whereas stiffening can not be revised. Patients may continue to bend, stretch, tilt sideways, and rotate with this care option. „Especially for active and athletic patients, this procedure is therefore rather recommended“, concludes Dr. Pippan. (Pm)