Spinal Stenosis

Our spine is a structure that includes the skeletal system that supports our body and allows us to stand upright. Our spine is made up of vertebral bones arranged in a row. Between these bones, discs, and ligaments, it forms a skeleton from our head to our pelvis. This skeleton is essential to our respiratory system. Our skeletal system is also responsible for our body movements.

Between the vertebrae that make up our spine are joints that connect the vertebrae and allow for movement. Another feature of our spine is that it contains the spinal canal. There is flexibility between the joints and the discs that connect our spine. In general, the discs can lose their flexibility as we age. As a result, the joints become wider and the spinal canal narrows due to calcification or thickening of the soft tissues.

What is Spinal Stenosis?

In its simplest form, this can be compared to the limescale that builds up in the pipes of a washing machine over time, making it difficult or impossible to send water to the machine. Spinal stenosis occurs in a similar way. It is a serious condition caused by a narrowing of the nerve canals that pass through the spinal cord. As a result of this narrowing, the nerves and spinal cord cannot perform their normal function.

Spinal canal narrowing is a condition that directly affects the legs. It causes numbness in both legs because all the nerves to the legs are compressed. In general, this condition is likely to progress if left untreated. It is more common in older age due to calcification and osteoporosis, but in rare cases there is a congenital predisposition.

If left untreated, it can lead to serious consequences that can make the patient’s quality of life unlivable. Although the typical symptoms of spinal canal narrowing are weakness and numbness in the legs, the location and character of the pain can change over time. Patients experience a sudden feeling of emptiness and weakness in the legs, especially when walking. Curvature of the spine may occur due to pinched nerves.

Symptoms of Spinal Stenosis

Patients feel this discomfort with numbness in the legs. Especially when walking, even if the distance is short, it causes the patient to need rest. It should not be confused with a slipped disc. A herniated disc compresses a single nerve that goes to the leg. Spinal canal stenosis, on the other hand, is caused by compression of a group of nerves that go to the leg. So there are some similarities between herniated discs and spinal stenosis.

Some patients go to the doctor complaining of a herniated disc. However, the specialist diagnoses spinal canal stenosis. While a herniated disc causes sudden pain in the legs, spinal stenosis causes numbness and gradual pain in the legs. However, the symptoms of spinal stenosis are not as obvious as those of a herniated disc. Instead, it shows some symptoms. These symptoms include;

• Pain in the lower back and neck
• Loss of strength in the leg after walking a certain distance, pain
• Numbness and loss of feeling in the legs
• Pain in the legs
• Cramps in the legs
• Difficulty standing upright
• Bowel problems
• Urinary incontinence (in later stages)
• Decreased sexual ability (in later stages)

Patients generally express their discomfort with complaints such as, “I used to rest on the way to the market, but now I rest 4 to 5 times”. Resting for a while reduces the pain and the patient can start walking again. Some patients start walking by leaning forward to reduce pressure on the nerves. As a result, patients usually start walking less and begin to gain weight above their ideal weight. Unfortunately, gaining weight above ideal weight prolongs the treatment process.

Spinal stenosis is more common in people over the age of 50. As we age, the body loses flexibility and calcification occurs. As a result, the tissues in the spine begin to thicken and compress the nerves. Patients with this congenital condition begin to experience symptoms after the age of 30. Congenital spinal defects, curvature of the spine or scoliosis, herniated discs, narrowing of the spinal cord, and bone tumors are factors that cause narrowing of the spinal canal. However, early diagnosis can prevent such problems from developing into serious ones. There are also some conditions that trigger the disease. These include;

• Working in a heavy job
• Being over the ideal weight
• Calcification of the spinal cord due to aging
• Smoking cigarettes
• Lumbar hernia
• Genetic factors

If left untreated, spinal stenosis can seriously affect a patient’s life.

Spinal Canal Stenosis Treatment

Diagnosis of spinal stenosis

If you have any of the symptoms listed above, you should see a doctor. The diagnosis of spinal canal stenosis is made by a comprehensive neurological examination followed by tests such as magnetic resonance imaging (MRI), computed tomography (CT), and x-rays.

Treatment of spinal stenosis

Once the diagnosis of spinal canal stenosis has been established, the specialist will first use non-surgical treatment of the narrowed canal. If the discomfort is severe enough to affect the patient’s quality of life, surgical treatment is used. However, the healing process is primarily initiated with non-surgical treatment methods.

In fact, exercises are recommended as a first step as well as medications. In addition, the patient is asked to lose weight if he/she is over his/her ideal weight. If the pain persists as a result of all these, physiotherapy is applied. In the following stage, if there is no result from the treatment, injections around the spinal cord are used. If the disease does not respond to all methods of solution, surgical treatment is applied.

Non-Surgical Treatments

Medication treatment

In fact, most pain can be controlled with simple pain relievers recommended by the doctor. However, prolonged use of painkillers has various side effects. For example, prolonged use of painkillers can lead to stomach problems. High doses can also cause addiction, constipation, and nausea. Unfortunately, some pain is not relieved by pain relievers, so narcotic pain relievers are recommended by the doctor. However, it is important to reiterate that medication must be started and continued under medical supervision.

Treatments other than medication

Patients usually have difficulty moving with decreased strength. Physical therapy and various exercises may be recommended to strengthen the muscles and regain strength. In particular, patients are advised to swim and walk. These activities can slightly reduce the symptoms of spinal stenosis. Patients often want to remain sedentary because of the effects of spinal stenosis. However, inactivity causes the muscles in particular to become weak and wasted. This increases pain. Exercises to strengthen the abdominal, lumbar, and leg muscles can also help.

In addition to medication and exercises, the patient must be especially careful when bending, standing, and walking. The patient should adjust his or her lifestyle to accommodate the narrowing of the spinal canal. They may prefer to use a cane or walker to help them walk. Safety in the home is an issue that needs special attention. Moving household appliances to more convenient locations will make life easier for the patient. Necessary measures and precautions should be taken to prevent slips and falls in the bathroom. It is also very important for the patient to avoid heavy work.

If medication and exercises do not produce results, interventional procedures should be used. Depending on the situation, drug injections into the spinal canal and/or facet joints may provide temporary relief.

Surgical treatment

Surgery is used when non-surgical treatments have failed and the patient has difficulty walking and moving. Surgical treatment gives good results in cases where the patient’s quality of life is diminished. It is also a preferred method in cases where the patient has bowel and bladder problems and extreme weakness in the leg.

Spinal Stenosis Surgery

It is the most effective treatment. It is a surgical treatment that is performed by specialized doctors on patients who are considered suitable for surgery. The surgery enlarges the diameter of the spinal canal, relieving pressure on the patient’s spine and alleviating pain in this area.

Spinal canal surgery

The goal is to relieve pressure on the spinal cord and nerves. The location of the narrowed canal and the degree of compression also determine the type of surgery. During surgery, structures such as discs, bones, and ligaments that cause compression of the spinal cord may be removed. During surgery, the nerves are seen one at a time. The disc or bone compressing the spine is removed and the canal is unblocked.

If the patient has not had surgery before and does not have any problems such as fractures or slipped discs, in other words, if it is a single-level stenosis, the use of screws and rods may not be necessary. However, if more than one stenosis needs to be opened, screws and rods may be used during surgery to support the vertebrae together. Because these metals act like bone after surgery, the patient will not feel the metals. Within a few months, the bones will fuse together and the vertebrae will begin to support the load.

After spinal stenosis surgery

The patient is usually discharged from the hospital within a few days. The patient is ambulatory the same day or the next day after surgery. Patients are advised to spend the first week after surgery at home to avoid prolonging the healing process. In the second week, patients can return to their daily routine and go out of the house. The patient’s pain is gone within three to four months. However, full recovery takes up to a year. Starting a rehabilitation program will shorten the recovery period.

• Things to be aware of after spinal stenosis surgery;
• After the surgery, special care should be taken while walking, bending and getting up, climbing stairs.
• The operated area should be protected from shocks. Expanding the areas where the patient can get support while walking at home or at work will make the patient’s life easier.
• The use of a toilet bowl should be preferred.
• The patient should not carry heavy objects.
• Diet should be consciously chosen to strengthen muscles and bones. Good nutrition will help speed up the healing process.
• The bed on which the patient will sleep; if it is a bed that does not protect the lower back, it should be replaced with a bed that can protect the lower back.
• Exercises recommended by the doctor should be done without neglect.

Is spinal stenosis surgery risky?

It must be performed by experienced and specialized doctors. It is a very safe and successful surgery when performed by an experienced physician. For patients with advanced spinal stenosis, the risk to their health increases many times over if they are not treated.

Of course, any surgery has risks. However, the risk of the patient being bedridden and unable to walk is much more dangerous than the risk of the surgery. Most patients who have this surgery usually report that their walking distance is increased and the pain in their legs is relieved. The risk of paralysis during the surgery is extremely low.

Because the surgery takes one to three hours, anesthesia is required. Although it is very unlikely, if the screws placed in the vertebrae during surgery are not placed properly, it may cause fractures in the vertebrae and some damage to the nerve tissue. For this reason, a carefully performed surgery by an experienced team can minimize the risks of spinal stenosis surgery.

Spinal stenosis is a serious condition that should not be ignored. If you notice any of the symptoms, you should see a doctor immediately. The fact that it is already a disabling disease that reduces the patient’s quality of life, will lead the person to seek treatment. If medication does not work, surgery with a reliable team can give satisfactory results. As long as the patient shows the necessary care to this disease and seeks medical attention.