Lumbar Spinal Stenosis

Lumbar spinal stenosis ; It is a disease that occurs when the space in the spinal canal, bone and connective tissue grow and narrow ( facet joint hypertrophy and flavum hypertrophy ) and cause pressure on the nerves passing through the spine. It can be seen in any part of the spine. It is often seen in the waist and neck. 

Spinal Stenosis Symptoms

Initially, symptoms may remain silent for a long time. Symptoms are not always associated with narrowing of the spinal canal diameter. What matters is the degree of damage it inflicts on neural tissues. The following symptoms can be observed in the order:

• Back and leg pain (siatalgia) is observed in 95% of patients. Leg pain, neurogenic claudication It is a very typical pain. It usually affects both legs. Pain increases with walking. When the patient sits down, the pain decreases. Walking distance varies depending on the severity of the situation.

• Leg and foot numbness, tingling

• Loss of leg and foot strength

• Awkwardness in walking

• In the most advanced stages of the disease, urinary and defecation incontinence, impairment in sexual functions (impotence), weakness (paralysis) in both legs, saddle-like numbness and numbness occur in the anal areas.

Spinal Stenosis Diagnosis

First of all, the history of the patient is taken. In the second stage, a physical examination is done. A detailed neurological examination such as strength, reflex, and sensation is performed and the findings are noted.

• X-ray; It is one of the most basic diagnostic tools. Two-sided X-rays of the lumbar spine are taken. With this examination; Post-traumatic findings related to spine fractures, lumbar dislocation, calcification, osteophyte, disc degeneration can be seen.

• Tomography ; The body is scanned by sending X-rays from different angles. This scan is analyzed by the computer. Because it is sensitive to bone tissues, it can be preferred in appropriate situations.

• MR (Magnetic Resonance) In imaging, scanning is performed by creating strong magnetic fields. 3-sided sections of the scan result are analyzed and displayed by the computer. MRI is an examination that is more sensitive to soft tissues.

Spinal Stenosis Treatment Options

Complaints due to spinal stenosis often respond to conservative treatment.

Conservative Treatment:

• Nonsteroidal anti-inflammatory drugs

• Epidural steroid injections

• Movement restriction, bed rest

• Physical therapy and rehabilitation, waist exercises

• Waist corsets

Alternative Treatments:

• Chiropraxia

• Acupuncture

Spinal Stenosis Surgery

Patients who do not get results despite conservative treatments can undergo surgery. If the patient has symptoms of paralysis, urinary and defecation incontinence, severe pain, numbness, difficulty in walking, the decision for surgery should be made faster. The purpose of spinal stenosis surgery to be performed on the lumbar spine; It is to save the spinal cord and nerve roots from compression.

Spinal stenosis surgery; It is performed under general anesthesia, that is, by putting the patient to sleep. The patient lies on the table in a prone position. The patient is wiped with betadine and covered in a sterile manner. The planned area is marked. A skin incision is made in the midline. The waist muscles are stripped from the bones. Part of the spinal bone is removed and the diameter of the spinal canal is expanded. The bones that constrict the spinal canal (lamina and facet joints), the yellow ligament we call flavum and the herniated disc are removed with surgical instruments and the nerves are relaxed. According to the surgeon's preference, if instability has occurred in the spine iatrogenically, the spine is stabilized with a titanium screw, rod implant and cage for support purposes.

What are the Risks of Spinal Stenosis Surgery?

As with all surgeries, narrow canal surgery carries unpredictable risks, which we call complications.

The most common complications,

• Rupture of the spinal cord that we call dura

• Infection

• Bleeding

• Vascular occlusion after clot formation

Such risks can be controlled with early intervention. But it may delay the healing time.

Long Term Results of Spinal Stenosis Surgery

After a good surgery, there is a significant reduction in the patient's pain. Walking distances become longer as the pain decreases compared to before the operation. The reduction in pain level can vary from patient to patient. In patients with developed nerve damage, some pain and numbness complaints may continue.

Dr. Tamer Tekin