Diseases

Lumbar Narrow Canal (Spinal Stenosis)

lumbar-narrow-canal with advancing age, the discs between the vertebrae lose their spongy structure and begin to contain less water. This event causes the disc height to decrease and the hardened disc to bulge towards the spinal canal.

The spinal cord carries the nerves that give sensation and strength to the legs. Due to arthritis (destruction of cartilage tissue), the bones and ligaments of the facet joints in the spine thicken and put pressure on the spinal canal. These changes cause narrowing of the lumbar spinal canal, which is called lumbar narrow canal (spinal stenosis).

The lumbar narrow channel can be likened to the accumulation of lime in a garden hose over time. Just as lime narrows the diameter of the proboscis over time, the narrow canal similarly narrows the diameter of the spinal canal.

The lumbar spine consists of a series of interconnected bones called vertebrae. Bones surround the spinal canal, which runs between the vertebrae through which the spinal cord passes. Other structures that form the boundaries of the spinal canal are the intervertebral discs, facet joints and connective tissues between the vertebrae.

Symptoms

What are the Symptoms of Lumbar Narrow Canal?

Lumbar narrow canal may not always cause complaints in the person. But pain or loss of sensation in the back; leg pain, cramps, numbness, weakness; There may also be complaints such as urinary incontinence.

Complaints may increase due to sitting or standing for a long time. Existing complaints may come and go and persist with varying severity over time.

Leaning forward or sitting can increase the diameter of the spinal canal, thus reducing or completely disappearing the pain.

The most typical complaints of the patients are weakness, changes in sensation, numbness and tingling in their legs after walking a certain distance, and that the legs can no longer take a step.

In this case, patients always look for a place to sit. By sitting down and leaning forward a little, the legs regain strength and they start walking again. However, after a certain distance, the complaints recur and the need to sit still arises.

Diagnostic Methods

How Is Lumbar Narrow Canal Diagnosed?

First of all, you should give detailed information about your complaints to your doctor's questions. Narrowed disc spaces or thickened facet joints can be viewed by taking X-ray films.

Thanks to magnetic resonance imaging (MRI), detailed information can be obtained about the stenosis in the spinal canal and the compression of the spinal cord. Computed tomography (CT) or lumbar myelogram can likewise be used to obtain detailed images.

Each of these studies can provide information about the presence, location and severity of spinal canal stenosis and nerve root compression.

Treatment Methods

What are the Treatment Methods for Lumbar Narrow Canal?

After your doctor diagnoses the lumbar stenosis as the cause of the pain, he or she will first try non-surgical treatments.

What are the Non-Surgical Treatment Methods in Lumbar Narrow Canal?

Non-surgical treatments for lumbar stenosis include anti-inflammatory drugs or pain relievers that reduce inflammation. Physical therapy may also be considered to facilitate your daily activities by maintaining and increasing your flexibility, strength and fitness. Spinal injections (epidural cortisone injections) may also be recommended.

Drug Treatment Method in Lumbar Narrow Canal

One or more medications may be prescribed by your doctor to reduce symptoms of discomfort and increase your mobility. Medicines used in pain control are called analgesics. In most cases, the pain responds to commonly used (over-the-counter) pain relievers such as aspirin or acetaminophen.

Some analgesics called non-steroidal anti-inflammatory drugs (NSAIDs) can be added to control irritation and inflammation that may occur. These include ibuprofen, naproxen and various prescription drugs.

If your doctor prescribes painkillers or anti-inflammatory drugs, you should be wary of side effects such as stomach upset or bleeding. You should be followed up by your doctor for problems that may arise from the long-term use of prescription or over-the-counter pain relievers and NSAIDs.

If you have severe and persistent pain that does not benefit from other analgesics or NSAIDs, your doctor may also prescribe narcotic analgesics (such as codeine) for a short time. You should only use the recommended amount of medication. Taking a higher dose will not speed up your recovery.

High-dose drug use can cause nausea, constipation, drowsiness and imbalance, and its use can cause addiction. All medications should be taken only as directed. Tell your doctor about any medication you use (including those you take without a prescription) and if they have prescribed pain medication for you, and if you have used these medications before, tell them whether they worked for you and their side effects.

Other drugs with anti-inflammatory effectsbody. Corticosteroid drugs (in the form of tablets or injections) are sometimes prescribed for very severe back and leg pain because of their strong anti-inflammatory effects. Like NSAIDs, corticosteroids can have side effects. You should discuss the benefits and risks of these medications with your doctor.

Selective spinal injections or "blocks" may be used to relieve very severe pain. These are injections of corticosteroids into the epidural space (the space around the spinal nerves) or facet joints by a doctor trained in this technique.

Depending on the response to treatment, the first injection may be supplemented with one or two injections at a later date. These are usually done within the rehabilitation and treatment program.

Lumbar Narrow Canal Surgery

People with lumbar stenosis usually avoid activities. This can also lead to decreased mobility, flexibility, strength and cardiovascular fitness. This condition can be improved with a physical therapy or exercise program.

Physical therapy and exercise program usually starts with stretching exercises to make tense muscles flexible again. You may be asked to repeat stretching exercises frequently to maintain your flexibility.

Cardiovascular exercises such as exercise bikes, treadmills and swimming can be added to the program to increase the condition and improve blood circulation in the nerves. Increased blood flow in the nerves can reduce some narrow canal complaints. In addition, exercises to strengthen the back, abdominal and leg muscles can be given.

Your daily activities will become easier if your flexibility, strength and conditioning are maintained and increased. Your physiotherapist or doctor may tell you that you can add a continuous exercise program to your life by using simple tools at home or by going to a sports center.

For some people with lumbar narrow canal, home changes and home security are important. Household appliances such as washing machines may need to be taken to more useful places. A nightstand next to the bed can come in handy.

If necessary, safety devices to prevent falling in the bathroom are also recommended. Plans for preparing meals, scheduling activities, and saving work should be reviewed. It is important that the necessary tools such as canes or walkers fit the patient exactly.

The presence of the stenosis does not create a dangerous situation in adults unless significant or increasing weakness in the legs, bowel and bladder control problems occur. Therefore, the aim of the treatment is to reduce the pain and increase the functionality of the patient.

Non-surgical treatments do not correct the narrowing of the spinal canal, but provide long-term pain control and increased functionality without the need for surgery. A participatory rehabilitation program requires three months or more of supervised treatment.

When is Surgical Treatment Necessary for Lumbar Narrow Canal?

Surgery in patients with lumbar stenosis is recommended for patients whose pain and complaints cannot be relieved by non-surgical treatment methods and whose functions such as walking and movement are seriously impaired.

Surgical treatment in patients with lumbar stenosis is also applied to people with progressive leg weakness or bladder and bowel control problems. At the same time, surgical treatment can be considered as a good option for patients whose walking distance is getting shorter and whose quality of life is deteriorating.

Rehabilitation support should also be taken in order to make the transition to daily life more comfortable after the surgery.

Spinal Fusion Treatment in Lumbar Narrow Canal

lumbar-narrow-canal In cases of narrow canal, the vertebrae can sometimes slip over each other (spondylolisthesis). In some cases, scoliosis (side curvature) may have developed in the waist. In this case, abnormal movements (instability) can be seen between the vertebrae.

In such cases, in addition to decompression surgery, spinal fusion surgery can be performed to detect the relevant vertebrae. It can be done by placing bone fragments, bone-like substances or metal instruments (instrumentation) between the relevant vertebrae to be fixed by fusion.

Fusion can be performed with an anterior or posterior approach, or both approaches. The choice of approach (anterior/posterior) in fusion surgery is determined by many technical factors such as the need to remove the bony prominences, the location of the protrusions, anatomical differences between patients, and the degree of instability.

In most patients with lumbar stenosis, pain decreases after surgery, and significant improvement and increase in all activities are observed 6 to 9 months after surgery. In order to return to daily activities and a normal life, a rehabilitation program is usually started after surgery.