Therapy of spinal stenosis
Conservative therapy
Therapy for spinal stenosis is mostly conservative.
In the case of serious nerve damage, uncontrollable, disabling pain and circumscribed disease findings, surgical therapeutic measures for spinal stenosis can help.
Since there is no causal (causal) Therapy for an advanced degenerative spinal disease is the focus of the treatment on pain therapy and physiotherapy.
These include:
- Drug pain therapy (NSAIDs, opiates, etc.)
- Pain patches
- Implanted pain pumps
- Physical pain therapy (electricity therapy, ultrasound, heat, etc.)
- Infiltration therapy (nerve blocks, periradicular therapy, trigger point infiltration)
- psychotherapy
- Mobilizing, stabilizing physiotherapy
- Back school
- Delordosing bodice
A precise diagnosis, the sounding out of the optimal therapy for spinal stenosis and adequate pain therapy are only possible in advanced cases during an inpatient stay.
Infiltrations (syringes) that are injected directly into the spinal canal (epidural / peridural) have the greatest non-invasive pain therapeutic effect.
Sacral blockage
For one Spinal stenosiswhich are predominantly in the lower area of the Lumbar spine sacral blockages or sacral infiltrations are suitable. In this therapy the Spinal stenosis is a mixture of local anesthetics and Cortisone injected into the spinal canal via the sacral canal. The access is in the course of the gluteal fold above the arched transition to the coccyx.
An imaging of the Spinal stenosis is not necessary for sacral infiltration. You orientate yourself on the anatomical landmarks.
Then under sterile conditions 20-30 ml A local anesthetic and cortisone are injected into the spinal canal. The patient is then asked for a period of time (1-2 hours) not to walk around, because the local anesthetic can sometimes lead to sensory disturbances and weakness in the legs, which creates a risk of falling. After the anesthetic has subsided, this effect disappears.
The pain therapeutic effect is good and due to the applied cortisone also persistent. Sometimes the increase in volume and pressure in the spinal canal can cause a temporary increase in pain. As a harmless side effect of the cortisone, facial reddening can occur, which disappears after a few days.
Please also read our article on this Spinal stenosis of the lumbar spine
Appointment with a back specialist?
I would be happy to advise you!
Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)
The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.
The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
You can find me in:
- Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main
Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert
Epidural Infiltration
For spinal canal stenosis, which affects the upper parts of the lumbar spine, the therapy is suitable Epidural Infiltration. With sacral infiltration, usually only a height of up to about the 4th lumbar vertebra is reached for pain therapy.
With epidural infiltration you are very flexible with regard to the level of infiltration. The access corresponds to that of the anesthetists in spinal cord anesthesia.
A long needle is used according to the principle of "Loss of resistence“The spinal canal space is visited and, as with sacral infiltration, a mixture of local anesthetics and cortisone is injected. The pain therapeutic effect corresponds to that of sacral infiltration. If the drug administration is to be repeated several times, a Catheter system (Hose system) so that access to the spinal canal is retained.
physical therapy
Physiotherapy can help reduce pain in patients with spinal stenosis. In the best case, back-friendly movement is promoted and the core muscles (back and abdominal muscles) are efficiently strengthened.
The affected patients often suffer from severe limitations and pain. Therefore, additional pain therapy is often necessary for successful physiotherapy.
Additional passive treatments such as mud therapy, thermotherapy or other physical approaches can be useful as a supplement. However, passive treatment alone, in which the patient does not have to be active himself, is not promising.
Basically, physiotherapy cannot achieve a cure. Nevertheless, exercises and training can lead to pain relief, more movement and a higher quality of life.
The advantage is also the conservative approach (no surgery). It is important to continue the exercises you have learned at home in order to achieve permanent muscle building.
Osteopathy
Osteopathy can be used in addition to patients with spinal stenosis.
In osteopathy, the entire body is considered. It is believed that the disruption of the muscles, ligaments and joints also leads to limitation of the internal organs.
The focus is not only on the spinal canal stenosis, but the entire problem complex is considered.
An osteopathic therapy alone usually does not lead to a satisfactory result, but osteopathic treatment can alleviate symptoms and promote self-healing.
If you are interested in therapy, this should best be coordinated with the treating doctor or orthopedic surgeon so that any physiotherapy, pain therapy, conventional medicine and osteopathy can contribute to improving the condition in parallel and in a coordinated manner.
acupuncture
Acupuncture is classified in the group of alternative medicine. There have been some positive studies on the effectiveness of acupuncture for certain conditions or symptoms.
In Germany, the costs of acupuncture for chronic pain in the lumbar spine and chronic knee pain (and if certain conditions are met) have been covered by the statutory health insurance companies for several years.
Doctors can complete the additional training in acupuncture and then use it professionally. There are some general practitioners who have this additional designation and who can answer questions.
During acupuncture, special needles are placed at certain points that run on so-called meridians. This should make the flow of energy run more smoothly again.
Different puncture sites are used for different symptoms, causes and locations of pain.
Exercises
If pain occurs during the exercises, if an uncomfortable or insecure feeling develops, the exercises should be interrupted and other exercise advice should be obtained from the attending physician or physiotherapist.
- Starting position: four-footed stance (propping up on the floor with your palms, knees and shins)
In this exercise, it is important that your back and neck stay straight in line with your head. The left leg is now fully extended backwards and the position is held. Then the exercise should be done with the other leg.
- Starting position: Lie on your back, put the soles of your feet on the floor and bend your knees
With an even movement, the pelvis should now be rolled / tilted upwards and then downwards, thereby “opening” and “closing” the pelvis alternately.
-
Starting position: Standing, lunge forward (approx. One meter) with the left leg, left knee slightly bent, right knee relatively extended backwards, toes pointing forward
The pelvis should now be pushed forward. This creates a stretch of the right leg. The upper body must form a straight line during the exercise. The stretching position can be held for a few seconds depending on the pain and feeling. Then the legs should be switched.
Depending on where the spinal canal narrowing is located, different exercises can help.
For more exercises, also read: Exercises for spinal canal tenosis of the cervical spine
Therapy after an operation
If an operation is unavoidable despite the exhaustion of other forms of therapy (physiotherapy, acupuncture, etc.), physiotherapy therapy is carried out relatively soon.
This can take place outside the hospital as part of follow-up treatment. Depending on the situation and the patient, this treatment can be inpatient, partial inpatient or outpatient.
Information on this can be obtained from the attending physician or from the hospital's care adviser before the operation. For follow-up treatment, an application is made to the health insurance company after the operation.
In general, it is important to keep in mind that an operation does not cause all problems to evaporate at once. The subsequent physiotherapy helps with rehabilitation and is particularly important.
Read more about this: Operation of the spinal stenosis
