Spinal canal stenosis is the most common indication for spinal surgery in older age. Causes are degenerative bulging of intervertebral discs and, over the course of months and years, reactive thickening of adjacent ligaments and bone, which narrow the spinal canal and press on the nerves and spinal cord. Symptoms usually begin gradually with pain in the neck or lower back, which over time radiates into the arms or legs. In cases of severe or long-standing nerve compression, gait instability, sensory disturbances, or paralysis can also occur. It is characteristic that the radiating pain typically increases with exertion, forcing patients to stop the activity or, most commonly, to stand still or sit down. The lumbar spine is most often affected, and particularly in older patients, stenosis of the spinal canal at multiple levels is not uncommon.
If there is not yet any weakness, spinal canal stenosis is usually treated conservatively with pain medication, targeted injections, and physiotherapy. If symptoms persist or even progress, surgery to relieve the nerves and spinal cord should be discussed. Depending on the type of stenosis, the operation is usually performed from the front in the case of the cervical spine, or from the back in the case of the more commonly affected lumbar spine. In the lumbar spine, microsurgical, meaning minimally invasive surgery performed under the surgical microscope, bilateral widening of the narrowed spinal canal can usually be carried out through a one-sided surgical access route using a skin incision only a few centimeters long. For patients, this means, in the vast majority of cases, a clear improvement in pain and, above all, in standing and walking duration, with an acceptable surgical risk. Discharge from the hospital is usually possible after just a few days, and this also applies to older patients over 65 years of age who are in an operable general condition.