What is Spinal Stenosis (Narrow Canal)
The vertebrae are the bones that make up our neck, back and lower back. The spinal canal runs between the vertebrae and contains the nerves that provide strength and sensation in the legs and arms and control urination and bowel movements. Between the vertebrae are the discs and facet joints of the spine.
As we age, the water content of the discs decreases. This results in a decrease in the height of the disc and a hardened disc protruding into the spinal canal. Reactionally, it can cause the bones and ligaments of the facet joints of the spine to become calcified (thickened and enlarged), pushing them into the spinal canal. These changes can lead to narrowing of the spinal canal. It is more common in the elderly and in the lumbar vertebrae. A narrow spinal canal, which is less common at a younger age, is more likely to be congenital and may be caused by slipped vertebrae (listhesis) or curvature of the spine (scoliosis).
This narrowing can be likened to the reduction in the number of lanes on the Fatih Sultan Mehmet road due to renovations. Closing one lane will not disrupt traffic too much. But closing more than two lanes will disrupt all traffic and become unmanageable (Figure 1). It is when a slow onset of spinal stenosis becomes more pronounced over time (as in the case of more than two lane closures) that symptoms begin to appear. In case of canal stenosis in the neck, there are complaints such as weakness and numbness in the arms and legs, as well as urinary and fecal incontinence, while in case of canal stenosis in the dorsal spine, inability to eat and urinary and fecal incontinence may be observed. As a result of narrowing in the lumbar spine, after walking a certain distance, there is weakness in the legs, changes in sensation such as numbness and tingling; therefore, there is a desire to stop and rest. The patient typically leans forward and rests and does not eat upright. They have difficulty walking up slopes and stairs. They may complain of frequent cramps in their legs and a feeling of ejaculation in their feet. In lumbar disc herniation, the patient's complaints are unilateral on the right or left side, while in narrow canal, both arms or legs are involved. Since the narrow canal is a slowly developing disease, low back pain may not always be noticeable.
How to make a diagnosis
After the examination of the patient by a neurosurgeon or physical therapist, X-ray, tomography and magnetic resonance imaging (MRI) examinations may be requested. MRI and tomography examinations are especially important for narrow canal. The degree of canal stenosis and whether or not there is a hernia can be determined, and electrophysiological studies (such as EMG-SEP) should be performed for differential diagnosis.
Treatment?
With canal stenosis, it is important whether conservative treatment (medical treatment, physical therapy), pain management (algology) or surgical treatment is chosen.
In the starting stage of the narrow canal, the patient is given painkillers and muscle relaxants, bed rest and avoidance of movements that strain the lower back. If the patient does not respond to treatment, he/she may be referred to physical therapy and pain management (algology). If the narrow canal progresses (especially if the walking distance has fallen below 500 meters), painkillers, physical therapy and algological interventions do not help;If it does not, the patient may need surgery if there is loss of vision and sensation, thinning of the leg, urinary and fecal incontinence, or if the distance to travel has gradually decreased.
Operation
If surgery is not performed and the compression of the nerve continues, the patient may develop problems such as incontinence, paralysis of the feet and arms. There is a fear among the public from the past. There are beliefs that if I have surgery, I will be disabled, I will not be able to get out of bed for a long time, or I will have surgery again. Nowadays, technology and surgical methods have improved. As a treatment, the canal needs to be decompressed (opened and relieved, in other words, increasing the number of lanes on the road). With the microsurgical method, the patient can stand up and be discharged in a short time. In particular, we are able to relieve the canal in patients with lumbar and back narrow canal (except for the narrow canal in the neck) by opening both sides (bilateral decompression surgery with unilateral approach) with a unilateral approach including the distance. This method reduces the need for fusion surgeries with screws, also known as platinum in the public. In some different cases, spinal fusion surgeries with screws are required (the inserted screws are compatible with MRI). Correct treatment planning is made according to the patient. In our hospital, we do not use instrumentation (surgery is performed without screws) for many patients we operate for narrow canal complaints. If there is a hernia along with the narrowing of the canal, we also remove the hernia with the "microdiscectomy method"
Post-operative Recovery Process?
Pain decreases after surgery in patients with narrow canals. Patients who can stand up and walk around the same day after surgery can be discharged the next day (within 1-2 days). If the patient's paralysis is long-term, it may not improve. In case of short-term paralysis, the patient may recover. Improvement in all activities can be seen 6 months to 1 year after surgery. A physical therapy and rehabilitation program is usually required after surgery.
These patients are usually overweight elderly patients, and we encourage weight control (diet) and eating. Female patients who have entered menopause should be routinely checked for osteoporosis and should use osteoporosis medications. For spine health, the use of appropriate full orthopedic beds, chairs, and the correct movements for the cervical and lumbar vertebrae should be explained to the patient in a good way.
