Diagnostics and therapy of spinal stenosis in the elderly.

Problem: Spinal stenosis is a common and increasing problem in the elderly population and a diagnostic and therapeutic challenge. Methods: An overview of etiology, epidemiology, diagnostics and therapy is given based on a literature review of the gears 1978-1998 and experiences since 1985. Results: Dealing with spinal stenosis we have to distinguish concerning diagnostics-and therapy between cervical and lumbar spinal stenosis. The cardinal symptom of the lumbar spinal stenosis is the claudicatio spinalis and of the cervical spinal stenosis the cervical myelopathy occasionally combined with radiculopathy. The first therapeutic step should be the conservative therapy in nearly all cases, the only exception is a severe cervical myelopathy where an operation is indicated. In case of persistent or progressive symptoms under a sufficient conservative therapy, operative therapy is indicated. The different possible therapy decisions will be based on flow-charts. Conclusion: Whereas in lumbar spinal stenosis the indication for operative therapy should be considered with reservation, in cervical spinal stenosis with myelopathy operative therapy should be considered at an early stage.