LUMBAR SPINAL STENOSIS
(SPINAL STENOSIS)

With advancing age, the discs between the vertebrae lose their spongy structure and begin to contain less water. This leads to a decrease in disc height and causes the stiffened disc to bulge towards the spinal canal. The spinal cord carries the nerves that give sensation and strength to the legs. Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through it. Spinal stenosis is most common in the lower back (lumbar) and neck (cervical) regions.

Some people with spinal stenosis may have no symptoms, while others may experience pain, tingling, and muscle weakness. Symptoms can worsen over time.

Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, surgery is recommended to create extra space for the spinal cord or nerves.

TYPES OF STENOSIS

Types of spinal stenosis are classified according to where the condition is in the spine. There can be more than one type. The two main types of spinal stenosis are:

• Cervical stenosis. In this condition, the narrowing occurs in the part of the spine in the neck.
• Lumbar stenosis. In this condition, the narrowing occurs in the lower back part of the spine. This is the most common form of spinal stenosis.

SYMPTOMS

Many people have evidence of spinal stenosis on an MRI but may have no symptoms. When they do occur, they usually start gradually and worsen over time. Symptoms vary depending on the location of the narrowing and which nerves are affected.

Symptoms of stenosis in the neck (cervical spine):

• Numbness or tingling in the hand, arm, foot, or leg;
• Weakness in the hand, arm, foot, or leg;
• Walking and balance problems;
• Neck pain;
• In severe cases, bowel or bladder dysfunction (urinary urgency or incontinence);

Symptoms of stenosis in the lower back (lumbar spine):

• Numbness or tingling in the feet or legs;
• Weakness in the feet or legs;
• Pain or cramping in one or both legs when standing for long periods or walking;
• Back pain;

CAUSES

Some people are born with a small spinal canal. However, most spinal stenosis occurs when something happens to narrow the open space within the spine.

Causes of spinal stenosis can include:

• Bone overgrowth. Wear-and-tear damage from osteoarthritis on the spinal bones can cause the formation of bone spurs, which can grow into the spinal canal. Paget’s disease, a bone disease that usually affects adults, can also cause bone overgrowth in the spine.
• Herniated discs. The soft cushions that act as shock absorbers between the vertebrae tend to dry out with age. Cracks in the outer part of the disc can allow some of the soft inner material to escape and press on the spinal cord or nerves.
• Thick ligaments. The tough cords that hold the bones of your spine together can become stiff and thick over time. These thickened ligaments can bulge into the spinal canal.
• Tumors. Abnormal growths can form inside the spinal cord, within the membranes covering the spinal cord, or in the space between the spinal cord and vertebrae. These are uncommon and can be identified during spinal imaging with an MRI.
• Spinal injuries. Car accidents and other trauma can cause dislocation or fractures of one or more vertebrae. Displaced bone from a vertebral fracture can damage the contents of the spinal canal. Swelling of nearby tissue immediately after back surgery can also put pressure on the spinal cord or nerves.

RISK FACTORS

Most people with spinal stenosis are over the age of 50. Degenerative changes can cause spinal stenosis in younger people, but other causes should be considered. These include trauma, congenital spinal deformities such as scoliosis, and genetic diseases affecting bone and muscle development in the body. Spinal imaging can differentiate these causes.

COMPLICATIONS

In rare cases, untreated severe spinal stenosis may progress and become permanent, causing:

• Numbness
• Weakness
• Balance problems
• Incontinence
• Paralysis

DIAGNOSIS

For effective treatment of stenosis, a comprehensive diagnosis is required, as the symptoms are often caused by other conditions. Magnetic resonance imaging (MRI) is the safest imaging study and forms the basis of stenosis treatment. It uses a magnetic field generated by radio waves to view the skeleton, spine, nerves, brain, joints, muscles, soft tissues, etc. Depending on the purpose of the study, the procedure takes between 15-30 minutes while the patient lies on a sliding table inside the scanner.

SURGICAL TREATMENT

Surgery for lumbar spinal stenosis is generally reserved for patients whose quality of life is low due to pain and weakness. Patients may complain of difficulty walking for long periods. This is usually the reason why patients consider surgery. In our Private Ekol Hospital, the surgical option of Prof. Dr. Erol YALNIZ in the treatment of lumbar spinal stenosis is posterior instrumentation (spinal fusion). This option can lead to excellent pain relief.

What does fusion mean? How is it performed?

Fusion is the process of joining, stabilizing, welding, or freezing two spinal bones together. Instrumentation (rods, screws, and cages) may or may not be used to achieve fusion. The instruments used both help correct the deformity and act as internal supports to hold the vertebrae together while bone fusion occurs.

You will be discharged 4-5 days after surgery.