Treatment of spinal stenosis

Treatment tactics for spinal stenosis can be conservative (without surgery), interventional or surgical. Stenosis
is a chronic degenerative process in which the intervertebral foramen, central spinal canal, or lateral recess gradually narrows.
Ultimately, this leads to compression (squeezing) of the spinal cord roots and nerve endings. The patient experiences severe pain in the back or neck, numbness and weakness of the limbs, and other neurological symptoms listed below. The disease progresses due to the fact that fragments of growing cartilage or bone tissue (osteophytes) and hypertrophied soft tissue (ligaments and muscles) wedge into the space occupied by the nerve roots.

Degenerative spinal stenosis is caused by injuries, genetics, metabolic disorders, osteochondrosis, arthrosis or other diseases of the musculoskeletal system. In the initial stages of the degenerative cascade, symptoms of spinal stenosis may not bother you at all. However, if the situation worsens over time, then it is no longer possible to cure the disease without surgery. Removal of stenosis is possible only surgically. In this case, non-traumatic spinal surgeries are performed to decompress (and sometimes stabilize) the deformed segment.

Relative stenosis

The central spinal canal narrows to 12-10 mm.

Treatment of relative stenosis without surgery often gives good results.
The patient is prescribed complex therapy, which includes medications (NSAIDs, NSAIDs), physiotherapy, and exercise therapy. In our clinic, specialists from the Pain Treatment Center will help you choose an effective treatment strategy for central relative stenosis. Don't put off seeing a doctor. Degenerative stenosis does not go away on its own. Over time, the disease worsens and at the next stage causes back or neck pain, and sometimes also neurogenic intermittent claudication syndrome (for example, with lumbar stenosis L3, L4, L5
), paralysis of the limbs.

Causes

The development of spinal stenosis can be based on a variety of reasons:

Congenital pathology of the spinal canal - achondroplasia (congenital chondrodystrophy), diastematomyelia .
Injuries of the spinal column with displacement of vertebrae/fragments, intracanal hematomas.
Facet arthropathy (changes in intervertebral joints of degenerative-dystrophic origin in the form of bone growths inside the spinal canal).
Discopathies with prolapse/ossification/sequestration of intervertebral hernia
Spondylolisthesis (anterior displacement of the vertebra) due to an anatomical defect of the vertebral arch.
Thickening of the capsule of the intervertebral joints as a result of their inflammation ( Bechterew's disease ).
Calcification/thickening of the yellow ligaments of the spine as a result of an inflammatory process or their degeneration.
Forestier's disease (hardening of the longitudinal anterior ligament).
Cysts/tumors and scar changes inside the spinal canal.
Stagnation of venous blood inside the spinal canal.

Absolute stenosis

The central spinal canal narrows to 10 mm or less. Treatment of absolute stenosis with conservative methods sometimes no longer gives the desired effect. At this stage, pain in the limbs becomes a serious obstacle to an active life. Especially if the patient has neurological symptoms: pain radiates to the legs and hips, there is a feeling of muscle weakness, and the sensitivity of the limbs decreases. Unlike relative stenosis, absolute stenosis is characterized by pronounced clinical symptoms and may be an indication for spinal surgery. Expansion of the central spinal canal by surgery may be most appropriate, since there is a serious risk of complications without surgery. For example, irreversible paralysis of the limbs, which occurs due to vascular ischemia and circulatory disorders in the spinal root.

Complications of spinal canal stenosis

The main danger of primary stenosis is dysfunction of the respiratory system, which is observed against the background of compression of the spinal roots. Shallow breathing may be replaced by attacks of suffocation, which sometimes goes away on its own. But such situations are extremely dangerous for human life, so it is better not to take risks and immediately seek medical help.

Also, as a result of the narrowing of the canal, a change in the quality of nutrition of the spinal cord and brain is observed, since formations protruding into its lumen can compress the vertebral arteries, as well as other blood vessels. In such situations, surges in blood pressure may occur, which can lead to ischemic areas in the brain and stroke.

Other complications of such conditions include:

brain hypoxia;
massive swelling;
poor circulation throughout the body;
development of deviations in the functioning of internal organs;
changes in the tissues surrounding the spinal canal.

Such complications do not pose such a threat to life as respiratory failure or ischemia of brain tissue, but they can significantly reduce a person’s quality of life and ultimately lead to extremely severe and sometimes fatal consequences. Therefore, it is important not to neglect the existing symptoms of the disease, but to immediately consult a doctor in order to diagnose the causes of their occurrence and prescribe treatment appropriate to the situation.

Lumbar stenosis

An extremely common type of degenerative stenosis, which is diagnosed in 85-90% of cases. Symptoms significantly reduce the patient’s quality of life, since lumbar stenosis is characterized not only by pain in the back and lower back, but also in the limbs. Very often manifests itself as a syndrome of neurogenic intermittent claudication. The patient feels weakness, numbness and pain in the legs. It is important to understand that paresis of the limbs is completely reversible only with timely treatment. The most common clinical cases include L3 - L4 or L5 - L4 stenosis (low back pain radiating to the leg). Another common variant is L5-S1 spinal canal stenosis. At this level, the lumbar region passes into the sacral region, that is, it is a fairly mobile and susceptible to load segment. With lumbar stenosis L5 - S1, the patient also suffers from pain that “radiates” to the legs.

If there are indications for surgery for lumbar stenosis, neurosurgeons at the Pirogov Clinic perform them using the latest endoscopic technology or microsurgical instruments. This eliminates the need for additional installation of implants and metal structures. Thus, patients recover in a short time - without heavy rehabilitation.

Prevention

There are no specific measures for spinal stenosis. Among the general activities we can recommend:

A lifestyle with systematic sufficient and adequate physical activity, including morning exercises, walking, swimming, and sports games.
Avoid dynamic/static overloads of the spinal column.
Maintaining hygiene/proper organization of work and sleeping space.
Timely diagnosis of the condition of the spinal column and, if necessary, correction/treatment of changes (weight loss, wearing a corset, exercise therapy, wearing a corset).

Cervical stenosis

Less common than lumbar stenosis. However, due to the high mobility of the segment and its comparative fragility, spinal surgery (endoscopic or microsurgical) may require additional installation of an intervertebral disc implant or interbody cage. This is necessary to stabilize the spinal segment and prevent the development of degenerative complications in the future. With cervical stenosis, local pain occurs, radiating to the arms and atrophy of the muscles of the upper extremities. Neurosurgeons at the Pirogov Clinic prefer minimally invasive endoscopic operations and interventional pain treatment, which avoid traumatic operations with the installation of metal structures.

If you have been diagnosed with cervical stenosis and have been experiencing pain that is resistant to conservative therapy for more than 12 weeks, send the images to your neurosurgeon through a special form on our website to clarify which treatment would be most appropriate in your case.

5-minute exercise therapy for the lumbar region

Lying on your stomach, legs straight, bend your arms at the elbows and press them to your body. Lean on your straight arms and lift your upper body off the floor. Turn your head first in one direction, then in the other. Return to the starting position and relax. Do 2-3 repetitions.
Lying on your stomach, stretch your arms forward. Legs remain straight. Raise your torso while simultaneously performing a crawl motion with your arms. Repeat 4-6 times.
Similar to the previous exercise, move your arms using the breaststroke technique. Do 4-6 reps on each arm.
I. p. - lying on your stomach, hands pressed to your chin. Crawl on your bellies. The movement involves pulling the knee towards the elbow. Repeat 4-6 times.
The situation is similar to that described above. Lift one of your straight legs up, point your toes down. Repeat the exercise with the other leg. Do 4-6 times.
Raise your arms and legs at the same time. Hold this position and after a few seconds return to the starting position. Relax. Do 3-4 repetitions.

Symptoms of spinal stenosis

Pathological compression of the nerve roots, which leads to their ischemia, causes specific symptoms of spinal stenosis:
Back pain that occurs when walking and radiates to the legs (legs, front or back of the thigh);
Numbness and discomfort in the legs occur with a certain position of the spine (bending the torso, walking down the stairs, prolonged static standing position);
Back pain becomes less intense or disappears altogether with a certain position of the spine (for example, if the patient is sitting, bending or squatting);
Muscle weakness, numbness and decreased sensitivity of the limbs are especially noticeable after physical activity;
Problems with urination and bowel movements;
Problems with potency and erectile dysfunction.
If, along with severe pain and paresis of the limbs, the patient experiences the last 2 symptoms, emergency spinal surgery may be necessary.

MRI images BEFORE

and
AFTER
surgery for foraminal spinal stenosis using the endoscopic method.
The roots are marked in red (dots and lines). Blue color shows the bone-ligamentous structures that compress the root. The green arrow, as well as the white color in the pictures, shows the free space for the spine. The goal of the operation has been achieved! Endoscopic decompression was performed by a neurosurgeon, a doctor of the highest category, candidate of medical sciences. Sciences Meredzhi Amir Muratovich
.

Classification

The classification of spinal stenosis is based on a number of signs, according to which the following are distinguished:

Primary and secondary stenosis of the spinal canal. Primary stenosis is caused by congenital pathology (underdevelopment) of the vertebral foramen, manifested by shortening of the vertebral arch, fibrous/cartilaginous diastematomyelia and achondroplasia (decreased vertebral body height/increased arch thickness/shortened pedicle), while secondary spinal stenosis (acquired) develops as a result of various diseases spinal column ( deforming spondyloarthrosis , occurring with the formation of marginal osteophytes/hypertrophy of intervertebral joints, ossification / hypertrophy of the ligamentum flavum , degenerative spondylolisthesis , ankylosing , ossified herniated intervertebral discs, Forestier disease , postoperative scars/subarachnoid adhesions, etc.).
According to anatomical criteria, central stenosis , manifested by a decrease in the anteroposterior size of the spinal canal, which occurs due to the development of pathological processes in the anatomical processes that directly form the spinal canal (intervertebral joints/discs, posterior longitudinal and yellow ligaments) and lateral stenosis - narrowing of the intervertebral foramen, developing as a result of hypertrophy of the superior articular process, peculiarities of the formation of the facet joint, the development of osteophytes localized at the site of attachment of the yellow ligament (foraminal stenosis). In turn, lateral stenosis is divided into “middle zone stenosis”, “entry zone stenosis” and “exit zone stenosis” of the nerve root from the intervertebral foramen.
Relative and absolute spinal stenosis.

Diagnosis of stenosis

You should not guess about the disease based on the symptoms. Diagnosis of spinal canal stenosis is only possible using MRI results. The quality of the images must be at least 1.5 Tesla so that the doctor can accurately determine the specifics of the degenerative change, its location, and then prescribe effective treatment. The patient is also prescribed a survey spondylography with functional tests, which allows one to determine the mobility of the cervical, thoracic or lumbar segment. If there is a possibility of facet syndrome, CT and selective blockade of intervertebral joints may be additionally prescribed. If there are indications for spinal surgery or interventional pain treatment, diagnosis and treatment tactics are prescribed individually, depending on the clinical picture.

Pathogenesis

The narrowing of the spinal canal is based on changes of various types: thickening of the spinal ligaments, arthrosis of the facet joints , thickening of the bone, slipping of the vertebrae, etc. The pathophysiological mechanisms of neurological symptoms are caused by a combination of three groups of factors: increased pressure in the epidural space, ischemia and aseptic inflammation , each of which develops under the influence of chronic compression of the vascular/nervous structures of the spinal canal.

In the presence of prolonged compression, the blood supply to the nerve structures suffers, since the amount of blood flow does not correspond to current needs. Developing against the background of a decrease in the amount of incoming blood, ischemia of the nerve root contributes to the development of demyelination , the formation of adhesions between the paranoid and soft membranes of the spinal cord, as well as the development of interstitial fibrosis / cicatricial adhesive epiduritis .

The specificity of the pathogenesis of lumbar spinal stenosis is the pronounced dependence of the volume of the spinal canal on the position of the body: thus, at the time of squatting, the lumbar lordosis becomes kyphotic/straightened, and the articular processes diverge and the lumen of the intervertebral foramen increases, thereby freeing the blood vessels that are under compression, which contributes to normalization blood flow and nutrition of ischemic neural roots. When the spine is flexed, the height of the intervertebral foramen increases by 12%, while during extension it decreases by 15%, which explains the regression of pain when sitting down/bending the body.

Surgery for spinal stenosis

Doctors at the Pirogov Clinic treat degenerative stenoses both conservatively and surgically. All spine surgeries are performed using the latest endoscopic or microsurgical technology, as well as X-ray or radiofrequency equipment.

In most cases, preference is given to endoscopic operations for spinal stenosis

. They allow you to avoid the installation of implants - with the exception of cervical stenosis and cases where spondylolisthesis and instability of the spinal segment are also observed. In addition, such operations are characterized by maximum controllability, minimal risks, and for patients, rapid recovery after endoscopic surgery for spinal stenosis is tolerated most comfortably. The pain in the legs goes away immediately after the operation, and hospitalization in the clinic is only 1 day.

Find out more about endoscopic spine surgeries.

Stenosis surgery performed using microsurgical method

, also refers to minimally traumatic interventions. It is advisable (and may even be the only solution) if, along with expansion of the spinal canal and decompression of the spinal roots, stabilization of the spinal segment is necessary. Such operations show good clinical results and, unlike traditional open spinal surgeries, allow the patient to recover quickly and avoid the risk of disability.

Unfortunately, sometimes it is impossible to do without the installation of metal structures and endoscopic surgery is impossible. A difficult case from the practice of neurosurgeon Mereja Amir Muratovich

. The patient developed stenosis complicated by spondylolisthesis due to displacement of the vertebrae, which caused acute compression of the roots of the spinal canal. To avoid destabilization of the L4-L5 spinal segment and avoid severe consequences in the future, it was decided to fix the segment with screws and install an interbody cage. The operation was performed with pinpoint precision—the pain and weakness in the patient’s legs disappeared immediately after the intervention. The case was difficult and exceptional, but thanks to the experience and skill of our specialists, the patient was able to recover within 1 day.

Find out more about microsurgical operations on the spine.

Gentle physical therapy exercises for osteochondrosis of the lumbar spine

1. Lying on your back.

Hands at your sides, legs together. As you inhale, pull your arms up, and as you exhale, lower them. Number of repetitions – 4-5.
Bend and straighten your feet while clenching and unclenching your fists. Do it 10 times.
Rotate your feet in a circle. In each direction 4-6 times.
Pull your knees to your chest one at a time. Do 6-8 reps.
Move your right arm and leg to the side, for example. Repeat in the same way for the left limbs. Do 4-6 repetitions.
Clasp your fingers in a “lock” at the back of your head. Raise your head while pulling your toes towards you. Number of repetitions – 8.
Hands at your sides. As you inhale, stretch your arms up, while simultaneously pulling your toes in the opposite direction from you.
Place your legs bent at the knee joint, shoulder-width apart. Use your knee to touch the opposite foot, and vice versa. Do 4-6 times.
Exercise “bicycle”, simulating pedaling. Repeat five circles back and forth.
Place your hand on your stomach. Take a deep breath into your belly and then exhale slowly. Number of repetitions – 3-4.
Stretch your left hand along your body, and stretch your right hand up. Repeat the exercise, changing the position of your hands. Do 10–12 times.
Spread your arms to the sides, feet shoulder-width apart. With your left hand, reach your right hand. Repeat the exercise for opposite limbs. Number of repetitions – 6–10.
Pull your knees towards your chest with your hands. First the left knee, then return to the starting position and repeat the exercise with the right. Do 6-8 times.

2. Exercise therapy lying on your side.

Swing your arm and leg upward. Repeat about five times.
Pull your knees to your chest: 6-8 reps.
Swing your leg forward and backward. Repeat 6-8 times.

Perform the exercises in the same way, lying on the other side.

3. Exercises while standing on all fours.

First move one hand to the side, then the other. Do 10–12 reps.
Swing your leg back, straightening it. Repeat with the other leg. The quantity for each is 8–10.
Pull your left knee towards your right hand. Repeat, switching sides of limbs. Do 6-8 times.
Pull one knee toward your chest. After this, take your leg back, the toe should slide along the floor. At the same time as this movement, you need to sit on the opposite heel. Perform the exercise in the same way with the other leg.
Swing your straight leg up and back. At the same time, pull your opposite hand up. Repeat similarly for the other leg and arm. Do 6-8 times.
The legs are fixed in one position, and move your hands to the right and left sides. Repeat five times in each direction.
Without lifting your hands from the floor, try to sit on your heels. The exercise is performed slowly. Do 6-8 times.
Without lifting your hands from the floor, sit first on your left buttock and then on your right. Repeat 6-8 times.
Place your hands on the floor and raise your head. Arms straight. Lower your head to your chest and arch your back, then arch it back. Make movements at a slow pace. Number of repetitions – 8–10.

Recovery after surgery for stenosis

After surgical decompression of the nerve endings and spinal roots, the pain in the limbs goes away immediately. Associated neurological symptoms (numbness and weakness) may take a little longer to resolve, depending on how long the patient has endured the symptoms and how much the disease has progressed. For several hours after surgery, the patient can stand and walk around the room. For 1-2 days (depending on the chosen method of surgery for stenosis), the patient is under the supervision of a doctor and medical staff. The doctor can then send him home with recommendations for the recovery period. After a month, it is advisable to come for a follow-up examination with a neurosurgeon - the doctor is always in touch and guides his patients until the recovery is successfully completed. The patient may be indicated for correction of motor habits. As a rule, no further additional restoration measures are required.

Effective exercise therapy for the lumbar region depending on the stage of the disease

1. Acute period.

Exercise therapy for exacerbation of osteochondrosis of the lumbar spine should be carried out only under the supervision of a trainer. Make slow movements. If pain occurs, training should be stopped. The exercises are performed from a lying position.

It is necessary to develop the feet by performing movements of flexion and extension. First together, then after each other. Increase the pace whenever possible. Clench your fingers into a fist and then unclench them.
I. p. – bend your legs at the knee joint. Extend one leg, your heel should slide across the bed. Repeat for the other leg. Do eight reps.
Raise your hand up. Once you lower it, repeat for the other hand.
Bend your left leg and move your right leg to the side. Repeat, switching the position of your legs with each other. The exercise loads the lumbar region. Avoid sudden movements. They can put increased pressure on nerve cells and aggravate osteochondrosis.
I. p. – put your hands on your shoulders. Move in a circle. First clockwise and then counterclockwise.
Rest your thighs on the bolster. Straighten your legs at the knee joint one at a time.
As you exhale, bend your arms, trying to touch your shoulders. As you inhale, straighten, touching your thighs with your fingertips.
I. p. – bend your legs at the knee joint. Move one knee to the side and return to the starting position. Repeat the same with the other one.
Stretch your arms up. At the same time, pull your socks towards you. After lowering your arms, relax.
I. p. – bend your legs at the knee joint. Spread and bring your knees together. You can diversify the movements by moving your knees first to one side, then to the other.
Try to pull your bent knees one after the other towards your stomach. Help with your hands when doing this.

We recommend

Therapeutic massage for the back: features, indications and contraindications More details
2. Subacute period.

If there is an improvement in the course of the disease, the pain has subsided, you can diversify exercise therapy for the lumbar spine with more dynamic movements.

I. p. – bend your legs at the knee joint. Straighten your right one up. Repeat for the left, four times on each. Do not straighten your leg completely if you experience pain.
Lean on the bed with your arms bent. Try to arch your chest as much as possible. After completing the exercise, relax.
In a lying position, you need to bend your legs and raise your back area in the sacrum area. Try to lean on your lower spine.
Tighten and relax your buttocks.
Bend your legs one after the other. While straightening them, press down on the bed with your foot and try to arch your lower back a little.
Lie down and bend your legs. Raise your head while contracting your abdominals and buttocks. If the exercise is easy, try raising your pelvis a little.

3. Remission.

Exercise therapy for osteochondrosis of the lumbar spine in remission can be supplemented with complex movements. At the same time, the load increases, which means you need to carefully monitor your condition even without pain. Physical overexertion is dangerous and can lead to a sudden exacerbation of the pathology.

I. p. - lying on the side. Pull one thigh toward your stomach first, then the other. Try to do the exercise all the way, thereby stretching the lower back muscles as much as possible. Perform five to seven repetitions on each leg.
I. p. - on all fours. Imagine an obstacle and carefully crawl under it.
I. p. - sitting on a hard surface, hands on knees. The back is straight. Slowly lean back, tensing your abdominal muscles. Stay a while. Return to the starting position at the same pace.
I. p. - on all fours. Arch your back while lowering your head. Make reverse movements: arch your back, raising your head up.
Stand up straight. Bend forward, trying to reach your toes with your hands. The chest should be pressed against the hips as much as possible. The exercise is also effective from a sitting position.
I. p. - on all fours. Raise your legs bent at the knee joint and bend your lower back slightly. Movements help relieve symptoms of osteochondrosis.
The legs are bent at the knee joint. Sit on them, and your heels should be level with your buttocks. Reach up and interlock your fingers. Sit on the floor, changing direction: first left, then right.
I. p. - on all fours. Raise your arm and opposite leg. Stay in this position for a while. After returning to the starting position, repeat with the other limbs. Do five times for each side.

Why is it worth having surgery for stenosis at the Pirogov Clinic?

The Pirogov Clinic has accumulated 20 years of experience in minimally invasive spine surgeries. The clinic is equipped with modern endoscopic technology, as well as radiofrequency equipment, which in the world practice of spinal neurosurgery is the “gold standard” for the treatment of degenerative diseases of the musculoskeletal system. The operations are performed by a candidate of medical sciences. Sciences, leading neurosurgeon in St. Petersburg and leader of positive reviews from patients on independent platforms (for example, Napopravku.ru). In addition, we can offer our patients:

Free remote consultation with a neurosurgeon (second opinion) on your disease;
Availability of all highly specialized medical specialists in one place, as well as our own diagnostic laboratory;
Service under VHI policies;
Affordable prices, as well as assistance in obtaining a loan for treatment.

If you have any questions, leave a request for a call back through our website or call (812) 320-70-00 - we are always happy to help you!

Make an appointment

Exercise therapy for the lumbar region with a fitball

"Locust". Lie on the fitball with your stomach and take turns lifting your arms and legs.
Hyperextension. The stomach and thighs lie on the ball. Hands behind your head, legs extended back. As you inhale, bend forward, and as you exhale, return to your starting position. The exercise affects the back, do it smoothly.
Half bridge. I. p. – lying on the floor on your back, put your feet on the fitball at an angle of 90 degrees. As you exhale, you need to straighten your legs and raise your pelvis. While inhaling, take the starting position.
I. p. similar to the previous paragraph. Grab the ball with your feet, clasp your hands behind your head. Pick up the exercise ball.
Twist/"flugel". Back on the floor, feet on a fitball. Hands are spread to the sides. Roll the ball with your legs in different directions. Your goal is to touch your knees to the floor.

Effective exercise therapy for the lumbar region involves repeating these exercises about 20 times.

Treatment

Conservative treatment of absolute stenosis is not used. It is ineffective due to the rapidly deteriorating condition of the patient. Self-administration of painkillers and ointments by patients is contraindicated, as this further aggravates the situation. The person does not feel pain, but pathological processes continue to progress .

Surgical treatment of the disease involves the use of the following types of operations:

Decompressive laminectomy.
Installation of vertebral stabilization systems.
Application of interspinous fixation.

Decompression laminectomy

This method has been used since the days of Henk Wibster. It consists of removing those structures that cause compression . That is, resection of the spinous processes, vertebral arches, and affected joints is performed.

Laminectomy is used if severe compression of the spinal cord occurs

However, this type of intervention has a number of significant disadvantages. Namely, the removed structures constitute the third supporting column of the spine, and their resection leads to the development of instability. According to statistics, instability occurs in 45% of those operated on. In addition, the operation is performed using a posterior approach, in which the complication rate reaches 12.

If the cause of the stenosis is a hernia, then it is possible to perform a disectomy , that is, complete removal of the disc followed by its replacement with an implant.

Installation of stabilizing systems

Stabilizing operations are used as independent treatment or as a complement to laminectomy .

Recently, minimally invasive operations with access through small incisions have been used. Spinal stabilization as a method has a number of advantages, but is not without its disadvantages. When installing mechanisms, neighboring vertebrae are damaged, as a result, their mobility increases and related pathologies develop: spondylolisthesis, scoliosis.

Interspinous fixation

With stenosis, the load is redistributed from the anterior spinal support to the posterior one. Installation of clamps reduces the load on the posterior support and expands the lumen of the spinal canal .

The operation is performed through small incisions under microscope control. First, posterior decompression is performed, then an implant is inserted into the interspinous space. This preserves the possibility of flexion and extension of the spine.

Interspinous fixation allows you to distribute the load on the vertebrae

A positive outcome of the operation can be achieved in 85% of cases. At the same time, related diseases do not develop. The load on the joints is also reduced, the spine relaxes, and pain disappears.

Such operations are contraindicated in cases of vertebral instability , since the effect of the intervention is insufficient. In this case, it is advisable to use stabilizing operations. If stenosis has developed as a result of a vertebral hernia, then the optimal therapy is microdisectomy, which involves resection of the bone structure that caused the narrowing of the canal.

Rehabilitation

The most important stage of treatment is postoperative rehabilitation. Be sure to wear a support corset . Physiotherapy procedures are also required: ultrasound, electrical stimulation.

At the late rehabilitation stage, physical therapy and massage are included. Patients who have undergone surgery are recommended to undergo annual spa treatment. These activities are aimed at strengthening muscles, normalizing metabolism and preventing relapse.

Exercise therapy of the lumbar region according to the method of Bubnovsky and Evdokimenko

Sergey Bubnovsky is a rehabilitation specialist by profession, the author of a large number of exercise therapy complexes for joints, recognized by official medicine.

Pavel Evdokimenko is a rheumatologist, a member of the highest level of the Academy of Medical Sciences of the Russian Federation. Among his works are a huge number of books that describe recommendations for the treatment of arthritis and arthrosis.

Doctors Bubnovsky and Evdokimenko developed an effective set of exercises. You can familiarize yourself with the technique of their implementation, which will make physical therapy of the lumbar spine more effective, in the video.

Lying on your stomach, reach your buttocks with your heel, bending your legs one at a time. The head is turned in the opposite direction. Hold the position for 10 seconds. After this, relax for a few seconds and repeat the movement again.
I. p. - on all fours. Arch your back and hold this for five seconds. After that, relax. Performing the exercise from the side resembles the behavior of a cat on its hind legs, which is why it has a similar name.
I. p. - lying on your back. First pull one leg towards your stomach, then the other. Help with your hands. Tighten your muscles for seven seconds and then relax.
I. p. - lying on your back. Wrap your arms around your legs and pull them towards your stomach. Tighten the muscle tissue for 10 seconds, then relax.
I. p. - sitting on a chair. Bend over slowly. Your task is to thoroughly stretch your back. As you inhale, tighten your lower back muscles for six to seven seconds, and as you exhale, relax.

Video instructions for exercise therapy of the lumbar spine:

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Intervertebral hernia

Intervertebral hernia is a local displacement of disc material (nucleus, cartilaginous nodule, fragments of the fibrous ring) into the spinal canal and intervertebral foramen. Intervertebral hernias can also cause compression of nerve fibers and spinal cord roots.

Depending on the stage of development of the disease, the following types of hernias are distinguished:

Protrusion is a displacement of disc material (nucleus pulposus, annulus fibrosus) towards the spinal canal. Visualized as a small protrusion. The fibrous ring is stretched.
Extrusion is a more pronounced displacement of disc material into the spinal canal. Often leads to damage to the fibrous ring.
Sequestration is the prolapse of the nucleus pulposus and fragments of disc material into the spinal canal with rupture of the fibrous ring. Provokes severe pain.

Schmorl's hernias are cartilaginous nodules that invade the bodies of adjacent vertebrae and deform them. The depression forms at the border of the vertebra and the disc. Large Schmorl's hernias can provoke immune reactions in the body, accompanied by pain. However, the vast majority of such hernias do not affect the quality of life and do not require surgical treatment.