Cervical spinal stenosis is a health condition with an active process of reducing or narrowing the lumen of the spinal canal due to the development of various pathological structures. In terms of prevalence, cervical spinal stenosis is much less common than lumbar spinal stenosis.

As a rule, the propensity to spinal stenosis is most common in people over 55 years of age. Cervical spinal stenosis is diagnosed in many older people. Without timely treatment, cervical spinal stenosis becomes the cause of disability.

Content

1. What causes cervical spinal stenosis?
2. How is the diagnosis established?
3. Treatment principles in Germany
4. Conservative treatment
5. Surgery
6. What can you expect from surgery for spinal stenosis?
7. Why undergo spinal stenosis treatment in Germany?
8. The cost of treatment in Germany
9. Treatment with Booking Health

What causes cervical spinal stenosis?

Spinal stenosis (abnormal narrowing) mainly develops in the elderly, and is the result of continuous, slowly developing, degeneration affecting the mobile segments of the spinal column. The intervertebral discs become less flexible and the small joints between each vertebra lose their mobility. These two components of the spine responsible for its flexibility continue to perform their functions despite the changes. The ligaments at the front and back of the spine thicken as they are no longer flexible themselves. The thicker these ligaments become, the more they compress the spinal cord at the front and back. This pressure leads to poor blood flow to these areas, and therefore to poor spinal cord function.

The cervical spine is the most mobile, with an initially narrow spinal canal, but a huge neurovascular network. Its vertebrae are distinguished by their small size and specific structure, while the muscular framework, which provides support and performance of the cervical elements of the spine, is anatomically insufficiently strong and enduring. All this explains the widespread occurrence of various kinds of degenerative and traumatic lesions characterized by vivid neurological symptoms in this spinal area.

The possible causes of cervical spinal stenosis are:

• Herniated vertebral discs (very rarely isolated; more often accompanied by kyphosis and hypertrophy).
• Spondylosis (formation of bony outgrowths inside the spinal canal).
• Spondylolisthesis (displacement of one vertebra in relation to another).
• Spondylitis (inflammation of the vertebrae).
• Spinal tumors.

Degenerative disc disease also may be a cause of spinal stenosis. Stenosis usually develops over a long period, as a rule, for several years, but it can also become acute, if large herniated discs occur. However, the pathology can also be congenital.

Of great concern is the fact that cervical pathologies are often accompanied by very serious consequences, including paresis and paralysis of the limbs (especially the arms). In addition, a neglected disease can provoke severe respiratory failure, rapid deterioration of vision and hearing, acute dysfunction of blood circulation in the brain tissue, etc. Therefore, the treatment of cervical spinal stenosis is extremely important to start as soon as possible, just as a person feels the first discomfort in the corresponding area.

How is the diagnosis established?

The diagnosis of cervical spinal stenosis is based on:

• Patient complaints.
• Objective signs of the disease that a doctor detects during the initial examination (muscle weakness, loss of sensitivity, and other symptoms of spinal cord and nerve compression).
• Radiological findings (the data from magnetic resonance imaging (MRI), computed tomography (CT), X-rays, or myelography are most often required).

If cervical spinal stenosis is suspected or if the diagnosis is already confirmed, a consultation with a neurosurgeon is necessary.

Treatment principles in Germany

The experience of German specialists shows that the main manifestation of stenosis is not back pain, but rather walking problems triggered by various sensations in the limbs.

Cervical spinal stenosis puts a pressure on the ligaments that are near the spinal canal, causing their irritation and leading to their thickening and the developing inflammation. The spinal cord and nerves can also become constricted, making it difficult for the patient to walk long distances due to a feeling of heaviness and numbness.

In addition, a very typical feature associated with spinal stenosis is the fact that when the patient's body is tilted forward, the severity of symptoms decreases significantly. This is because the spinal canal becomes wider with this movement. After all, the tension of the ligaments is relieved at the moment.

The treatment of spinal stenosis is selected depending on the intensity of the symptoms and the cause of the narrowing of the spinal canal. In most cases, the specialists attempt to help the patient through conservative therapy, which is aimed at eliminating or alleviating the pain syndrome through the use of medications or injections and strengthening the muscles through therapeutic exercises.

Conservative treatment

The course of such treatment is chosen for each patient, taking into account the peculiarities of each health condition:

• Analgesic drugs (NSAIDs) with anti-inflammatory effects.
• Hormone therapy (may reduce swelling, tissue compression, and pain).
• Diuretics (resolve cerebrospinal fluid and relieve swelling).
• Magnetic therapy.
• Massage.
• Therapeutic exercises (special exercises for spinal stenosis help to strengthen the cardiovascular system, various groups of muscles).
• Manual therapy.
• Spinal traction (type of decompression therapy to relieve spinal compression).

Epidural injections can also be a key component of a personalized treatment plan for cervical spinal stenosis, offering potential pain relief and improved function with varying success rates depending on individual patient factors.

Surgery

Modern spine surgery has made great strides forward in terms of its application for the treatment of spinal stenosis. The unique techniques of spine surgery in use today are distinguished by:

• High efficiency (from 90% and higher).
• A minimum degree of trauma to anatomical structures.
• Maximum preservation of normal function of the area of surgery.
• Low probability of intra- or postoperative complications (up to 5% on average).
• Short hospitalization period (from 3 to 10 days).
• Shorter recovery time after surgery (2 – 3 months).

The methods of surgical treatment of spinal stenosis depend on how severe the disease is and what health problems spinal stenosis causes. For example, with milder forms of spinal stenosis, it is effective to use conservative treatment, which consists of compliance with the regime of rest, proper distribution of loads on the body, and performing therapeutic physical exercises. When spinal stenosis is accompanied by pain syndrome in the lumbar region of the spine and the thoracic spine, painkillers can reduce pain. If these treatments do not contribute to the desired result, blockades are used. A blockade is an injection of a combination of an anti-inflammatory hormone and an analgesic, which relieves swelling from inflamed tissues and pressure from irritated nerves.

Basically, spine surgery for spinal stenosis is used when no other medical and conservative methods show the effectiveness and the disease is progressing, causing serious physiological disorders.

Among the existing surgical techniques used to restore the functionality of the cervical spine, decompression tactics are the most widespread. Such a medical technique is used in cases of compression syndrome, that is, when the pathological defect that occurred within the vertebrae produces pressure on the nerve roots, arteries, spinal cord, and other structures in the corresponding area. The following surgical techniques can be used for decompression:

• Microsurgical discectomy (a surgical procedure used when the intervertebral hernia is the cause of spinal stenosis;  this surgery is performed with partial or total removal of the intervertebral disc, under the guidance of a microscope).
• Laminectomy (partial or total removal of the vertebral arch, facet joints, and ligaments).
• Endoscopic surgery (a surgical procedure performed with the use of an endoscope through miniature access).
• Laser nucleoplasty ("evaporation" of a small fragment of tissue for retraction of the formed disc protrusion with a laser beam).

The stabilizing tactics of surgery can also be used for cervical spinal stenosis, each of which, by the way, can go together with other types of surgery. The most popular of the stabilizing surgical techniques are:

• Arthrodesis or spondylodesis (fixed connection or fusion of two or more vertebrae when they are unstable).
• Vertebroplasty (surgery that involves the placement of high-strength bone cement into the damaged vertebral area to restore its integrity and strength).
• Transplantation (implantation of a fragment of spinal tissue taken from the patient to strengthen the resulting defect after surgery, for example, to fill the space between vertebrae and fix them after the extraction of the intervertebral disc).
• Prosthetics (as a rule, the implantation of special dynamic or fixed metal structures or replacement of the intervertebral disc with a prosthesis).

What can you expect from surgery for spinal stenosis?

The surgical treatment of spinal stenosis can avoid such complications as severe pain, cramps in the upper extremities, loss of sensation in the upper and lower extremities, and muscle atrophy.

However, it is worth considering that, although surgery can eliminate spinal stenosis and related painful symptoms, it is still a disease that is correlated with age and tends to occur as a result of the aging of the body. Therefore, avoiding many other degenerative changes in the spine with the help of surgery is not possible. To do this, you need to observe the regime of rest and sleep, take good care of your spine, and do regular physical exercises.

Be sure to seek help from a medical specialist, if you are experiencing the first symptoms of spinal disorders to avoid the aggravation of the diseases.

Why undergo spinal stenosis treatment in Germany?

According to statistics, Germany ranks first in diagnostic accuracy. This undeniable advantage of German medicine can be explained by the responsibility of high-class professional doctors, state-of-the-art diagnostic technology, unique equipment, huge experience (German doctors diagnose pathologies not only in their fellow citizens, but also in patients from all over the world), and excellent organization of the German healthcare system, ensuring quality control of medical facilities in Germany.

One of the advantages of conservative treatment of spinal pathologies, including spinal stenosis treatment in Germany, is the highly developed pain management therapy, the importance of which in the treatment of spinal diseases cannot be overestimated. The methods of rehabilitation medicine in German hospitals have long been recognized in the world. To make sure, just research the country most frequently chosen by athletes for spinal treatments.

The advantages of spine surgery in Germany primarily include extensive use of minimally invasive endoscopic and microscopic surgeries, which have the following advantages:

• Minimally invasive surgery is not demanding regarding the condition of the patient's body (such surgical procedures can be performed without any risk in old age, as well as in patients with severe spinal diseases).
• Low percentage of postoperative complications.
• Shorter recovery period.

Another important advantage of spine surgery in Germany is the development of surgical techniques aimed at restoring functions of damaged segments of the vertebral column. German hospitals perform the following types of surgery:

• Biological renewal of intervertebral discs.
• Total and partial replacement of intervertebral discs.
• Prosthetics of the cervical and lumbar vertebrae, etc.

Special emphasis should be made on the complex surgery of orthopedic correction, which is used in the treatment of many pathological processes in the spine. Besides, many well-known surgical techniques got the names of their authors – German neurosurgeons.

The cost of treatment in Germany

A huge number of people opt for spinal stenosis treatment in Germany, which indicates that the cost of treatment fully complies with its quality. There are many reasons for this: the trust in foreign methods of disease management, the progressiveness of the treatment methods used, and the high competence of the doctors. The cost of treatment, in turn, depends on the specifics of the health condition, the need for surgery or the choice of conservative treatment sequence, the need for and duration of a rehabilitation course, and the duration of the hospital stay.

The average prices are listed below:

• The price of diagnostics starts from 475 EUR.
• The price of decompressive laminectomy starts from 3,619 EUR.
• The price of combined decompressive laminectomy and stabilizing surgery starts from 8,097 EUR.

You can find out the cost of treatment at German hospitals by contacting Booking Health. Please fill out the request form for a medical advisor to contact you.

Treatment with Booking Health

Booking Health will help you to arrange your treatment in Germany for spinal stenosis, making the whole process much more convenient as opposed to doing it on your own.

Booking Health will initiate the negotiation with the chosen hospital, and tell you which medical documents are required for the start of the treatment. The company will also take care of the organization of your trip, and support you throughout the whole treatment journey.

Do not hesitate to contact Booking Health for any information you need.

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed