Further education
Degenerative spinal canal stenosis
Minimally invasive options
Treatment
Mohammad M. Arous
Spinal canal stenosis of the lumbar spine can be the cause
from leg pain and limited walking ability. In
in the advanced stage, persistent sensitive and
motor failures follow. In addition to well-known conservatives and
in the following, a new operative
The method is presented.
tiv conditionally. The physiological Old-
the process of the intervertebral disc leads to
a narrowing of the intervertebral-
space, a narrowing of the foramina
intervertebral and spinal canal
as well as a protrusion of the band-
disc.
Arthrosis of intervertebral gels-
patients with osteophyte formation can
the spinal canal stenosis of the len- ren situations in which the occur and the spinal canal, the
the lumbar spine (lumbar spine) has been lordosed, such as with the lateral recess and the foramen
early on as the cause of
Standing or lying on the floor-
additionally constrict intervertebral.
Claudication of the spinal cord is detected. This
gaps. The night rest can therefore be-
The arthrotic changes of the
Suffering is caused by increasing
be disturbed: The affected can not small vertebral joints can also be too
Tendency to invalidate leg pains-
falling asleep more on his back, he-
Joint effusions and thus too extra-
zen with the consequence of a limited-
waking up at night because of leg pain
and intraspinal synovial cysts for-
ten walking ability.
and need to get up, move
hear. Finally, in old age, the league-
or sit.
mentum flavum is thicker, which is also
Typical symptoms
At the very advanced Spi-
for narrowing the spinal canal at-
Patients with spinal stenosis-
nalkanal stenosis can lead to bladder palsy-
carries.
channel complaints about one-sided or two-sided
and to increase and by-
Degenerative spondylolisthesis
radicular leg pain. Typical-
sensitive and also motorized-
it is often associated with
in this way, the pain occurs when the-
there are also failures, which
the narrow spinal canal. They
and shine, depending on the affected-
after maximum kyphosization of the lumbar spine
occurs as a result of gradual arthroti-
the root of the nerve, into the buttocks and-
do not disappear anymore.
shear destruction of the articular processes.
down to the calf or to the
The cranially located vertebra can
Shin out. When a higher
Origin of leg pain
gliding ventrally, leading to the image of the dege-
lumbar nerve root compressed
The leg pains are radicular-
nerve spondylolisthesis.
the pain can also lead to
and are caused by ischemia of the-
Space-demanding processes such as dis-
In the knee or in the thigh ventrally
or multiple nerve roots infol-
kushernias, vertebral fractures, tumors
broadcast. Patients rarely complain-
a narrowing of the spinal canal
or small epidural hemorrhages can-
only for low back pain.
and/or the intervertebral foramina.
the spinal canal also has a-
When walking, the pain decreases
Since the width of the spinal canal, as well as
If you have the nerve root only
until, after a certain period of time, they
the foramina intervertebralia
intermittently compress, remove-
are strong that the affected increases in inclination, disappear
have the same symptoms as with
bending forward, crouching or sitting in this position, the discomfort. Which
degenerative constrictions.
must. Also about tingling paresthesi-
Therefore, patients kyphosis spontaneously
Spinal canal stenosis is known
or uncertainty of the persons concerned
your LWS and are increasingly going with
even with developmental disorders of the
Extremity is reported. All Symp-
the upper body is tilted forward. From
Spinal canal, e.g. in congenital en-
tome disappear within Se-
for the same reason, they always sit-
in the spinal canal or at the achond-
customers up to minutes when the patients-
piss off or crouch down.
roplasia. With this disease, grow
bend the lumbar spine forward or
the skull, as well as the vertebral bodies
sit.
Causes of the narrow spinal canal
normal, but the pedicles remain like
The pain arises not only The cause of the narrowing of the spinal canal the long tubular bones in the wax-
when walking, you can also take in other-
is degenera in the vast majority of cases-
tum back.
Outpatient Surgery 3-2006
Advanced training Degenerative spinal canal stenosis
Fig: Radiological control postoperatively to verify the correct placement of the implant. The compressible implant
reacts dynamically to different back inclinations.
Clinical examination
Typically, patients have to stop a run or at least brake.
limited mobility of the lumbar spine In the advanced stage are all-
in reclination. Sometimes the re- dings solves the need for surgical interventions.
and / or the sideways movement-
the typical buttocks-
or leg pain. The Move-
the flexibility of the lumbar spine in flexion, on the contrary, is
strikingly free. The fin is often-
ger-ground clearance for these older
Patients zero centimeters! Clinical
palpable radicular, motor or
sensitive failures are typically absent.
As a rule, they occur only after a long
existing spinal claudication.
Diagnosis
Gymnastics and medication the dynamic of the surgical measures is-
stabilization, combined with a
microsurgical decompression. At
the coflexTM implant is
to create a kind of buffer between the
Laminectomy: A possibility of
Spinous processes of the affected vertebra-
surgical intervention is the so-called-
implanted in the column section of the lumbar spine
called laminectomy, in which one or
opens. Thus, a loss of stability is-
several vertebral arches including the
preclude. It also comes to the preservation of the
Spinous processes are removed in order to
Function or mobility, because the
the affected area of the spinal cord
Compression of the implant when the back is tilted-
relieve. This massive Rifferfor-
bar and therefore functionally dynamic
usually requires hospitalization
shall.
from five to ten days, as well as a-
Compared to the conventional
gere rehabilitation period. In addition, suffering
The operation (laminectomy) is the
some patients subsequently-
Implantation is much more gentle.
persistent pain. In a serious
Through a narrow, short one-
a cut on the affected area of the
The diagnosis is based mainly on cases, even a stiffening of the
based on the typical anamnesis and the spinal column in the affected area of the spine, the implant is placed between-
Detection of neural compression.
Structures by means of magnetic resonance-
Tomography (MRI), computer tomo-
graphie (CT) or myelography. At
atypical anamnesis, further
However, in many cases, the-
and be excluded.
Therapeutic options
As a rule, the disease progresses
the spinous processes of the vertebral bodies-
per laid. Often there is a simultaneous
Interlaminar fenestration: An inter-
microsurgical fenestration or De-
laminar fenestration with undercutting compression with protection of the facet-
is more gentle and minimally invasive,
and the spinous processes, where-
according to the patients at 80 to 85%
distance, respectively, prevents the fort-
are painless.
progression of the wear process of the
there are no adjacent segments.
Prof. MD, PhD Mohammad M. Arous
Specialist practice for neurosurgery
just slowly move away. First of all, des- Dynamic stabilization: A scho-
Heegbarg 2
semi-conservative measures such as a new alternative to the existing 22391 Hamburg
36
Outpatient Surgery 3-2006