Spinal stenosis is a narrowing in the spinal canal and/or in the lateral spaces where the spinal nerve roots exit, enough to cause clinical symptoms by squeezing the spinal cord or nerve roots exiting the spinal cord. It may be due to developmental or subsequent degenerations. Developmental ones are present from birth. The most common type is due to degeneration. It may also develop after trauma or surgical procedures.
The exact cause of degenerative spinal stenosis is unknown. However, it is thought that changes in the movable joints cause narrowing in the canal. Degeneration may begin in the intervertebral cartilaginous cushions we call discs, or in both facet joints, or in all three at the same time. Ultimately, all three are affected.
As degeneration develops, the disc protrudes into the canal and narrows it. The canal narrows due to calcification or ossification of the disc material, vertebrae or ligaments in this region. As the fluid in the disc decreases and its height decreases, the facet joints overlap and loosening occurs in the facet joint. As a result of this event, mobility in the segment increases. Facet joints thicken and compress the nerve.
Signs of Canal Narrowing
Pain increases with standing upright and walking. The pain decreases when you sit, lean forward, or squat.
They feel the need to sit and rest at a certain distance while walking. This distance gradually becomes shorter. Pain and numbness from the waist to the legs develop. The pain is more of a burning type. Pain decreases when squatting (Neurogenic Claudication).
Since patients walk while leaning forward, they can climb uphill more easily than downhill. Since lumbar lordosis will increase, patients cannot lie on their back with their legs extended. They usually lie more comfortably in a fetal position, bent forward, with their legs pulled to their stomach.
They feel like their legs are cold or don’t belong to them.
Lateral Canal Stenosis
It develops from the stenosis in the canal where the nerve root exits in the spine. For this reason, there is more unilateral leg pain. The pain is accompanied by widespread numbness and tingling in the foot. The pain continues day and night, does not change with coughing or sneezing, and may increase with sitting.
Canal Narrowing Treatment
After the diagnosis is made, the treatment is examined according to the patient’s complaints, clinical findings, findings of the diagnostic methods, evaluated according to the patient’s age, general medical condition (presence of systemic diseases such as heart, hypertension, DM, etc.), comorbidity (risks that may occur due to surgery and anesthesia) and the most appropriate treatment is determined by the physician. method is determined. If the patient does not have many complaints or symptoms and the walking distance has not decreased too much, medical treatments will be sufficient.
Medication
Analgesics (painkillers), anti-inflammatory drugs and muscle relaxants, analgesics usually greatly reduce pain. Muscle relaxants are useful by relieving muscle spasm in the early stages. Anti-inflammatories, on the other hand, are effective by resolving edema and inflammation at the root level.
Exercise
Flexion and extension exercises strain the tense long ligament and the posterior fibers in the disc, pushing the bulge forward and transferring the disc material forward, removing the pressure on the nerve roots. It strengthens the abdominal muscles and opens the narrowed intervertebral foramen.
Injections into the spine
Steroid injections may be administered into the epidural space or around the nerve root in the foraminal region.
Physiotheraphy
Appropriate physical therapy methods aim to relieve the spasm by strengthening the waist and abdominal muscles and reduce the pressure on the spine by ensuring proper posture.
Surgical treatment
The aim of surgical treatment is to open the narrowed canal, release the nerve structures and eliminate the pressure. Various methods can be used for this purpose.
The most appropriate method is microsurgical unilateral approach, called bilateral laminotomy, to open the posterior bone structures and relieve (decompression) the nerve structures.
In case of lateral canal stenosis, foraminotomy and medial facetectomy (widening of the nerve exit site) methods can be applied.
In case of multi-distance canal stenosis, if necessary, spinal stabilizing applications can be performed to prevent the spine from slipping, which is popularly known as “platinum insertion”.