Narrow Canal (Spinal Stenosis)
In the canal formed by the spinal bones, there is the main nerve called the spinal cord, from which the nerves going to the arm, torso, and leg originate. This nerve can be compressed and crushed after bony protrusions originating from the spinal bones, herniated disc, or excessive growth of the ligaments around the spine. The nerve that progresses in the canal becomes compressed and turns into an hourglass-like appearance. In addition to the narrow canal, other additional problems such as lumbar shift or scoliosis may increase the patient's existing problems.Narrow canal can also occur in the back or neck region, apart from the lower back. This situation often occurs in advanced ages when calcification begins in the spine. Narrow canal may not cause symptoms in every patient. In other words, although narrow canal findings are detected in the MRI, the person may continue his/her normal life. In the early period, it can only reveal itself with low back and mild leg pain.
Patients apply to the doctor with complaints of leg pain and weakness in the legs, especially when walking a certain distance. There is a decrease in walking distance. Patients are no longer able to walk the distance they used to walk, or they have to rest while walking. It is often accompanied by low back pain. In advanced cases, even short-distance walking difficulties, weakness in the legs, loss of sensation, and problems with bowel and bladder control may also be encountered. When the patients lean forward, the complaints are alleviated as the spinal canal widens. For this reason, some patients tend to walk by leaning forward.
Sometimes, complaints of narrow channels and congestion in the arteries leading to the legs can be confused. Patients with vascular complaints may also have leg pain that increases with walking, and these two diseases can be confused with each other.
The diagnosis of the disease can be made with direct x-ray films, tomography, and MRI films. Doppler ultrasound examinations will be useful in patients with suspected vascular occlusion.
It is very important that patients continue to exercise in the early period. Physical therapy and exercise program usually starts with stretching exercises to make tense muscles flexible again. Exercise can increase the blood supply around the nerve and provide regression in complaints. Pain relievers and muscle relaxants may be helpful for pain. If the patient does not have a loss of strength, urine and stool problems, and if the complaints are mild and the complaints continue despite drug therapy and physical therapy, epidural steroid (cortisone) injection can be applied.
The spinal cord should be relieved by widening the narrowed canal by surgical methods in patients with limited daily activities, severe walking difficulties, and with urinary and stool problems. This procedure can be performed with the open method under the classical microscope, as well as the fully closed endoscopic narrow canal surgery is performed with the help of a camera through two 0.5 cm long holes without making large incisions. Muscle tissues are not damaged during the fully closed narrow canal surgery method. There is very little bleeding during the surgery. Since water is used during the procedure, the possibility of post-operative infection is reduced. Another advantage is that the postoperative pain is less compared to the open method. Fully closed stenosis surgery can also be performed under spinal anesthesia, especially in elderly patients. The patient is discharged the next day and can take a shower. It is possible to return to office work that does not require mild excessive physical activity in an average of 2-4 weeks.
If the physician deems it necessary, in the presence of accompanying problems such as lumbar shift or scoliosis, the spine should be fixed with the help of screws and rods in addition to the expansion of the narrowing canal. Patients are carried out in the early postoperative period and physical therapy is continued.