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Spinal stenosis: which surgery is the right one? Always weigh operations carefully
Surgery must always be carefully weighed up, especially when it comes to the clinical picture of spinal stenosis. Because many patients suffering from numbness, pain in the legs and lumbar region or in the buttocks help conservative measures well. Surgery can only be considered once these no longer have any effect. The most common treatment options after the relief operation are vertebral spreaders, flexible spine stabilization and stiffening. The statutory health insurance companies usually cover the costs for all three operational procedures.
The culprit of the disease is a narrowing in the spinal canal. This is often caused by general wear and tear 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 vertebrae on top of each other causes instability in the spine, which in turn leads to narrowing of the nerves. No matter what the cause of the disease is, the doctor and patient must always decide together which treatment method is best. "The aim of surgery should be to relieve pain and improve the quality of life," explains Dr. Mathias Pippan, spine surgeon and orthopedic specialist from the Spine Institute at the Orthopedic Center Mainz (OZM). "In order to achieve these goals, the doctor and patient consult and take into account the 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 relieve the spinal canal, surgeons always remove disruptive tissue structures that lead to narrowing. Doctors speak of decompression here. It creates space for the narrowed nerve fibers and permanently relieves symptoms such as leg pain. Depending on the extent of the operative pressure relief, surgeons combine this with a stabilization operation.
Vertebral spreader: less invasive procedure for mild cases This treatment option is more suitable for patients with a more mild form of spinal canal stenosis who do not additionally suffer from vertebral sliding. "Since the surgical procedure is less invasive, it may also be more suitable for older people or patients who, in addition to spinal stenosis, also suffer from diseases such as cardiac insufficiency," explains Dr. Pippan. "Today, however, the process is only of minor importance."
Stiffening surgery: no alternative in the case of severe vertebral gliding Whenever the patient can no longer be stabilized by a movement-maintaining implant, or cannot be stabilized sufficiently, the stiffening surgery is suitable. It is also indicated in the case of strong vertebral sliding as well as medium and severe form of scoliosis, in which the natural curvature of the spine changes. During the stiffening operation, in which several vertebrae are connected to each other, the mobility of the spine suffers.
Flexible spine stabilization: protects neighboring joints When stiffening, the neighboring joints must then take over the movement of the stiffened spine section and this additional load often also causes complaints at a later point in time. With flexible spine stabilization as a motion-preserving surgical procedure, on the other hand, excessive load transfer to other areas of the spine is prevented. The younger the patient, the more likely the latter method is recommended. In addition, the stiffening option remains open to patients in a later step, whereas stiffening cannot be revised. With this option, patients can continue to bend, stretch, tilt and turn sideways. "This procedure is therefore particularly recommended for active and athletic patients," concludes Dr. (pm)