Spinal canal stenosis is classified according to location, cause, and severity:

1. By location:
   • Cervical spinal canal stenosis: Narrowing in the cervical spine area.
   • Thoracic spinal canal stenosis: Rare form affecting the thoracic spine.
   • Lumbar spinal canal stenosis: Most common form in the lumbar spine area.
2. By cause:
   • Degenerative: Age-related wear of discs, vertebral joints, or ligaments.
   • Congenital: Congenital narrowing of the spinal canal.
   • Traumatic: Caused by spinal injuries.
   • Inflammatory: Due to arthritis or other inflammatory diseases.
3. By severity:
   • Mild: No or minor symptoms that only occur under stress.
   • Moderate: Significant discomfort during daily activities.
   • Severe: Persistent pain and neurological deficits.

The main causes of spinal canal stenosis can be divided into degenerative, traumatic, and inflammatory factors:

• Degenerative causes:
  • Disc wear with bulging (disc protrusion) or herniation.
  • Thickening of the ligaments (ligamentum flavum) and bony growths (osteophytes).
  • Arthrosis of the vertebral joints.
• Congenital causes:
  • Congenitally narrow spinal canal due to anatomical peculiarities.
• Traumatic causes:
  • Vertebral fractures or dislocations due to accidents.
• Inflammatory causes:
  • Rheumatoid arthritis or ankylosing spondylitis.
• Tumors or space-occupying lesions:
  • Rare causes due to tumor growth or cysts in the spinal canal.

The symptoms vary depending on the location and severity of the narrowing, but often include:

• Pain: Local or radiating pain, e.g., in the legs (lumbar stenosis) or arms (cervical stenosis).
• Numbness and tingling: Often in the extremities, depending on the affected nerve root.
• Muscle weakness: Reduced strength in legs or arms, making everyday activities difficult.
• Spinal claudication: Pain and weakness in the legs when walking for extended periods, relieved by bending the torso forward.
• Movement restrictions: Difficulty walking or standing for long periods.
• Neurological deficits: In severe cases, e.g., bladder or bowel dysfunction.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

- Medical history:

- Collection of medical history, symptoms, and possible triggers.

- Physical examination:

- Checking reflexes, sensitivity, and muscle strength to identify neurological deficits.

- Functional tests, e.g., the walking distance test.

- Imaging:

- MRI: Gold standard for depicting constrictions, disc changes, and soft tissues.

- CT: Assessment of bony changes and narrowings.

- X-ray: Depiction of spinal misalignments or osteoarthritis.

- Electrophysiological tests: To measure nerve conduction velocity in case of suspected nerve damage.

Conservative Therapy

In many cases, symptoms can be alleviated without surgery:

• Medication Therapy:
  • NSAIDs: For pain relief and anti-inflammation.
  • Muscle relaxants to relax tense muscles.
  • X-ray guided corticosteroid injections into the epidural space.
• Physiotherapy:
  • Exercises to stabilize the spine and strengthen the back muscles.
  • Mobilization techniques to improve mobility.
• Pain Therapy:
  • Application of heat or cold therapy.
• Ergonomic Adjustment: Training for back-friendly movements and posture.

Surgical Therapy

Surgery is considered when conservative measures do not bring sufficient improvement:

• Decompression: Widening of the spinal canal by removing bony or soft tissue.
• Laminectomy: Removal of part of the vertebral arch to relieve pressure.
• Stabilization Operations: Fusion of unstable vertebrae with screws or plates.
• Minimally Invasive Procedures: Gentle techniques with shorter recovery time.

The following measures are suitable for prevention and support of treatment:

1. Back training: Regular exercises to strengthen the back muscles.
2. Ergonomic posture: Avoidance of poor posture at work and during leisure time.
3. Weight control: Reducing the load on the spine through a healthy body weight.
4. Regular exercise: Promoting flexibility and stability of the spine.
5. Early detection: Medical advice should be sought at the first signs of pain or numbness.