[Diagnosis and therapy of the narrow lumbar spinal canal]

In 30%-40% of the patients who are operated on for herniation of lumbar discs, osseous stenosis plays a certain role. However, only in one-third of them are special operative measures such as laminectomy necessary with or without additional lumbar fusion. When spondylodesis is carried out after laminectomy it is often combined with metal implant, which can drastically reduce the time a patient requires perioperative treatment. In younger patients showing typical signs of nerve root compression due to osseous stenosis of lateral recess, only segmental decompression in the form of foraminotomy is done. On the other hand, in cases of narrow spinal canal, which is found in elderly patients, neurogenic intermittent claudication is the predominant clinical picture. Kyphosis, scoliosis, and vertebral displacement can lead to local spinal stenosis. On addition, local pressure and tension on unstabile segments in combination with secondary fibrosis can lead to compression of the neural structures. The diagnosis is based on the clinical history and myelography. Computed tomography helps reveal the presence of herniation of a lumbar disc, which should be simultaneously operated upon. For the operative treatment there is no age limit. All in all, the operative results are so good that one is inclined to decide in favour of operation.