Treatment of Lumbar Spinal Stenosis in Germany

Lumbar spinal stenosis is a narrowing of the spinal canal. Narrowing of the bony spinal canal can be caused by bone overgrowths, and herniated spinal discs. These usually result in load-dependent pain, irradiating on one or both sides. Subsequently, load-dependent symptoms in the legs as well. The problems usually occur when people walk, while they are almost non-existent during cycling (i.e., when the spine is bent forward).

This condition is fraught with disability and serious complications, and therefore requires adequate, and most importantly, timely treatment.

Content

1. Overview of lumbar spinal stenosis
2. Causes and symptoms of lumbar spinal stenosis
3. Diagnosis of lumbar spinal stenosis
4. Tactics of treatment of lumbar spinal stenosis in Germany
5. Conservative treatment of lumbar spinal stenosis in Germany
6. Surgery of lumbar spinal stenosis in Germany
7. Rehabilitation after surgery
8. Prognosis of lumbar spinal stenosis
9. The cost of treatment of lumbar spinal stenosis in Germany
10. Treatment of lumbar spinal stenosis in Germany with Booking Health

Overview of lumbar spinal stenosis

One of the most important functions in the human body is performed by the spinal canal. It protects the spinal cord inside the vertebrae. The spinal cord and brain form the central nervous system that regulates the functions of the human body. Therefore, for the spinal cord to function properly, the spinal canal needs to be intact.

Spinal stenosis is a chronic pathological process characterized by a stenosis (narrowing) in the diameter of the spinal canal and intervertebral foramen due to bone and cartilage overgrowth. The normal size of the spinal canal at the lumbar level is 15 – 25 mm and transverse is 26 – 30 mm. Spinal stenosis is a decrease in its size relatively up to 12 mm. At the same time, clinical manifestations may not be present at all. A decrease to 10 mm or less is called absolute spinal stenosis. This stenosis already has clinical signs.

Causes and symptoms of lumbar spinal stenosis

Lumbar spinal stenosis can be either congenital or acquired.

Congenital lumbar spinal stenosis is a rather rare condition. This condition is usually associated with narrowing of the spinal canal caused by abnormalities in the postnatal stage of development

The majority of clinical cases of stenosis still occur because of the underlying process of inflammation in the intervertebral discs initiated by the infection or injury.

Even though anatomical spinal canal narrowing is a pretty obvious and definitive component of lumbar spinal stenosis, it is not always obvious when undergoing the diagnostics. It can be diagnosed, if the degree of narrowing causes compression of neurovascular structures and impairs their function.

Patients also frequently experience impaired coordination, sensory dysfunction, and muscle weakness in the lower limbs. However, any problems in the lower extremities are not usually caused by stenosis, even when MRI shows severe anatomical damages caused by the disease.

There is a dynamic component to lumbar spinal stenosis as well. So, for instance, when walking or standing symptoms intensify, and on the contrary, when sitting or lying down patients feel relief.

Diagnosis of lumbar spinal stenosis

Medical diagnosis, like with any other pathology in medicine, starts with first examining the complaints and medical history in detail. A neurologist will ask about the nature of pain, where it is localized, how it relates to movement, etc. The specialist will also ask about other symptoms of diseases of the nervous system: decreased skin sensitivity, muscle weakness, and dysfunction of the pelvic organs.

Next, a physical examination is performed. It allows the doctor to make a preliminary diagnosis and determine the patient's further examination plan. A medical specialist examines and palpates the body parts where the patient feels pain, numbness, or weakness. To assess the function of the spinal cord, tendon reflexes are examined, as well as skin sensitivity and muscle strength are measured.

Additional instrumental diagnostic tests are usually needed to confirm the diagnosis. For spinal stenosis, specialists will prescribe a spinal X-ray and MRI. In some cases, a multislice computed tomography scan may be needed in addition to an MRI scan.

Tactics of treatment of lumbar spinal stenosis in Germany

Lumbar spinal stenosis treatment tactics depend on the severity of neurological disorders caused by stenosis, pain intensity, and the features of narrowing.

There are surgical and conservative (non-surgical) approaches to treatment. When treating patients with lower back pain, rational psychotherapy and various types of physical therapy are of great importance. Currently, the efficacy of physiotherapeutic methods for the treatment of back pain is being studied.

It is always advisable to start with conservative treatment, which includes therapeutic exercises, physiotherapy, manual therapy and massage, vitamins, and anti-inflammatory drugs. In most cases, a positive result can be achieved without surgery. The surgical treatment of spinal stenosis should be resorted to only in the absence of the effect from conservative therapy. This is due to the fact that any surgical treatment can be associated with the development of the most common complication of spine surgery – scarring and fibrosis. Therefore, it is extremely important to consider all the pros and cons for choosing the best option, to conduct a thorough analysis of the results of clinical examination and diagnostic imaging methods. Lumbar spinal stenosis cannot be treated without a comprehensive preliminary diagnosis.

Conservative treatment of lumbar spinal stenosis in Germany

The conservative treatment of stenosis is similar to conservative treatment of other degenerative diseases of the spine. The conservative treatment of lumbar spinal stenosis consists of a comprehensive and individualized approach, including recommendations for changes in lifestyle and motor activity, prescription of drugs from NSAID groups, anticonvulsants, vasoactive drugs, prostaglandin E1, calcitonin, epidural administration of glucocorticosteroids and local analgesics, and B vitamins.

The conservative treatment that includes drug therapy, physical therapy, massage, and epidural injection of steroids is effective for moderately pronounced symptoms of lumbar spinal stenosis. The latter method consists of injecting solutions of glucocorticoid hormones into the peridural space in the area of lumbar spinal stenosis. The effect of glucocorticoids is based on pain syndrome reduction due to the reduction of inflammation in the area of nerve compression. Glucocorticoid hormones are often used in combination with local analgesics, which quickly relieve pain, but have a rather short-term effect. In contrast, the effect of glucocorticoid hormones develops quite slowly and lasts for 2 – 4 weeks. Epidural injection of steroids is effective in 50% of patients with lumbar spinal stenosis. At the same time, this method of treatment can cause complications, so it is used only when other methods of conservative therapy are ineffective.

The surgical treatment is indicated if conservative therapy is ineffective.

Surgery of lumbar spinal stenosis in Germany

The main indication for surgery is the irresponsiveness of patients with lumbar spinal stenosis to conservative therapy. Considering the fact that the disease may be accompanied by periods of remission and exacerbation, doctors mostly resort to surgery when severe symptoms persist.

The following options can be used for lumbar spinal stenosis surgery:

• Stabilizing surgery (stabilizing and expanding of the spinal space with subsequent enhancement of support function by implanting braces).
• Decompression laminectomy (a surgical procedure to expand the spinal canal by removing some parts of the bone tissue, the arch of the spine, and ligaments; this surgery is considered one of the most traumatic).
• Microsurgical decompression (a surgical procedure involves the use of a fixation system after the stenosis has been eliminated; most importantly, the function and flexibility of the spine is preserved after surgery).
• Microdiscectomy or laser vaporization (types of interventions performed sometimes together with a laminectomy, in cases where the stenosis is caused by a herniated disc).

Surgery is aimed at alleviating compression on the nerves that are the common subject to it. The approach to spine surgery varies, but the goal stays the same. And the most widespread technique for it is conventional laminectomy.

Minimally invasive spine surgery for decompression consists of percutaneous removal of the hypertrophic ligament. A randomized study, which evaluated the outcomes of treatment over 6 weeks in 38 patients, showed no significant differences in the symptom relief between the patients who had minimally invasive spine surgery compared to the group receiving epidural steroid injections. Although, pain relief was higher in the group of patients who received minimally invasive spine surgery for decompression.

The use of one or another method of surgical intervention depends on the clinical situation. In most cases, the patient fully recovers after surgery. An important role in rehabilitation is played by the patient's behavior, compliance with all restrictions and rules established by the doctor.

Rehabilitation after surgery

Rehabilitation after the surgery for lumbar spinal stenosis can take place both on an inpatient and outpatient basis. For the first few days, patients remain under the supervision of a neurosurgeon, who performs daily bandaging and assesses the quality of healing of the postoperative wound. After discharge from the hospital, the patient gradually returns to his/her normal way of life.

The stitches are removed on the 7th or 10th day after surgery. A complete recovery takes 1-6 months, depending on the aggressiveness of the disease prior to treatment and the extent of conducted surgery. During this time, it is recommended to limit physical activity and stress factors. It is necessary to follow a diet, rest and adhere to the recommendations of the neurosurgeon.

Prognosis of lumbar spinal stenosis

Medicine cannot yet provide us with any concrete patterns for a good prognosis, since most people require individualized treatment.

The patients without severe progression usually have very good chances for recovery from stenosis. There are some cases when symptoms worsen after treatment, but in general, people remain symptom-free.

A recent study, based on MRI monitoring and general observation of 34 patients with spinal stenosis, showed that 60% of patients had regression of symptoms, despite condition worsening on MRI. Other studies have shown that manifestations of stenosis can have both negative and positive dynamics, regardless of stable condition according to MRI.

The cost of treatment of lumbar spinal stenosis in Germany

The financial aspect of treatment is one of the main considerations in choosing a destination. How much does treatment in Germany cost?

Many hospitals in Germany have a quite similar cost of treatment due to the unified pricing system, which is based on the diagnosis of the patient in a standardized case and the calculation of the cost of treatment in the German hospitals based on the average prices for different treatments. The cost of treatment in German hospitals is individualized for each case and also depends on the number of narrowed areas, the severity of the disease, the duration of a hospital stay, and other factors:

You can contact Booking Health to estimate a preliminary cost of treatment in Germany. This will allow you to assess your financial capabilities in advance.

Treatment of lumbar spinal stenosis in Germany with Booking Health

Booking Health will assist you in every matter regarding the organization of treatment in Germany. We will help you to get a medical visa, book the airline tickets and accommodation for you and the accompanying person (if needed), and even provide you with a personal interpreter for the period of your stay in Germany.

To get more information on how to proceed, please leave your request on the Booking Health website, and our medical advisor will contact you.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

National Spine Health Foundation

SPINE-health

UpToDate