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 lit erature 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 sympt om of the lumbar spinal stenosis is the claudicatio spinalis and of the cer vical spinal stenosis the cervical myelopathy occasionally combined with ra diculopathy. The first therapeutic step should be the conservative therapy in nearly all cases, the only exception is a severe cervical myelopathy whe re an operation is indicated. In case of persistent or progressive symptoms under a sufficient conservative therapy, operative therapy is indicated. T he different possible therapy decisions will be based on flow-charts. Concl usion: Whereas in lumbar spinal stenosis the indication for operative thera py should be considered with reservation, in cervical spinal stenosis with myelopathy operative therapy should be considered at an early stage.