Vertebrae are the bones that make up our lower back. The spinal canal runs between the vertebrae and contains nerves that supply the strength and sensation of the legs. Between the vertebrae are the discs and the facet joints of the spine.
As we age, discs become less spongy and less fluid-filled. This results in a decrease in the height of the disc and the hardened disc protrudes into the spinal canal. Arthritis can cause the bones and ligaments of the facet joints of the spine to thicken and expand and push them into the spinal canal. These changes lead to narrowing of the lumbar spinal canal.
WHAT ARE THE SYMPTOMS?
If symptoms are present, these may include numbness or cramping of the legs with or without pain or low back pain. Weakness in the legs may occur. Rarely, bowel and/or bladder problems may occur.
Symptoms may worsen with prolonged standing or walking. Symptoms may appear and disappear and vary in severity when present. Leaning forward or sitting increases the width of the spinal canal and can lead to a reduction or complete disappearance of pain.
HOW IS IT DIAGNOSED?
Your doctor will take a medical history and perform a physical examination.
X-rays that can show narrowed disc and/or thickened facet joints may be ordered. Magnetic resonance imaging may be performed for a more detailed evaluation of the spinal structures, or similarly, a computed axial tomography (BAT) scan and/or a lumbar myelogram may be recommended to see the details.
Each of these studies can provide information on presence, location, spinal canal narrowing and nerve root compression.
WHAT TREATMENTS ARE APPLIED?
If your doctor determines that the condition causing the pain is lumbar canal stenosis, they will usually try nonsurgical treatments first.
These treatments may include using anti-inflammatory drugs (by mouth or injection) to reduce swelling or pain relievers to control pain.
Physical therapy may be given to increase your strength, endurance and flexibility in order to maintain or maintain a more normal lifestyle.
Spinal injections such as epidural cortisone injection may be given.
MEDICATIONS AND PAIN MANAGEMENT
Your doctor may use one medication or several medications as part of your treatment plan. Medicines used to control pain are called analgesics. Most pain can be treated with over-the-counter medications such as aspirin, ibuprofen, naproxen, or acetaminophen. Some analgesics, known as nonsteroidal anti-inflammatory drugs or NSAIDs, are also used to reduce swelling and inflammation that may occur. These drugs include aspirin, ibuprofen, naproxen, and a wide variety of prescription drugs. If your doctor gives you anti-inflammatory drugs, you should carefully monitor for side effects such as stomach upset or stomach bleeding. Long-term use of prescription or nonprescription NSAIDs should be monitored by your doctor as any potential problems develop.
If you have persistent and severe pain that cannot be relieved by other painkillers or NSAIDs, your doctor may prescribe some narcotic pain relievers, such as codeine, for short-term use. Take only the amount of medicine prescribed for you. More doses will not make you recover faster. It has side effects such as nausea, constipation, drowsiness and drowsiness, and their use can result in addiction. All medications should be taken only as directed. Be sure to tell the doctor about any type of medication you are taking, including over-the-counter medications, and if your doctor prescribes medication for you, let him know how it worked for you.
There are other drugs with anti-inflammatory effects. Corticosteroid drugs – by mouth or by injection – are sometimes prescribed for more severe back and leg pain because of their very strong anti-inflammatory effects. Like NSAIDs, corticosteroids can have side effects. You should discuss the risks and benefits of these medications with your doctor.
Your doctor may prescribe medications such as gabapentin (which was originally developed for people with seizures) for symptoms in the legs—especially numbness, tingling, burning, and cramping pain. The use of gabapentin for several months has been shown to improve walking tolerance and reduce pain in some patients. This medication can be started at a low dose and increased as the patient can tolerate, as directed by the physician.
Certain spinal injections or “blocks” may be used to relieve pain symptoms. These are corticosteroid injections into the epidural space (the area around the spinal nerves) or facet joints and should be administered by a doctor who has had special training in this technique. Depending on the response to the first injection, several follow-up procedures may be performed in the following days. Injections should often be given as part of a comprehensive rehabilitation and treatment program.
NON-SURGICAL THERAPY
Symptoms of spinal canal stenosis often result in abstinence from activity. As a result, flexibility, strength and cardiovascular endurance decrease. A physical therapy or exercise program usually begins with stretching exercises for tight muscles to restore their flexibility. Frequent stretching may be recommended so that you can maintain flexibility. Cardiovascular (aerobic) exercise, such as stationary cycling or walking on a treadmill, can be added to improve endurance and increase blood circulation to the nerves. The improvement of the blood circulation of the nerves will alleviate the symptoms of canal stenosis.
You can also be given special strengthening exercises for your back muscles, abdomen and legs. Daily activities can be less challenging if flexibility, strength and endurance are optimized. Your therapist and doctor can advise you on how best to incorporate a continuous exercise program into your life, either at home or in a gym using simple tools.
For some people with canal strictures, home arrangements and safety considerations will be considered. Maybe the washing machine and dryer need to be moved to a more suitable location. A nightstand can be recommended next to the bed. If necessary, tools can be written for bathroom safety. Meal preparation strategies, walking activities and energy conservation can be reviewed. Assistive walking aids such as canes and walkers may be recommended.
Duct stenosis itself is not dangerous in an adult unless marked or progressive leg weakness develops or bowel or bladder problems develop. As a result, the aim of the treatment is to reduce the pain and increase the functionality of the patient.
Non-surgical treatments do not correct the canal stenosis itself; however, it can improve life function without requiring long-term pain control and more intensive treatment. A comprehensive program may require three months or more of ongoing treatment under supervision.
IF SURGERY IS NEEDED?
Surgery is considered for the small proportion of patients whose pain is not relieved by non-surgical treatment modalities. Surgery will also be recommended for people who experience progressive leg weakness, bowel or bladder problems.
Since canal narrowing is a narrowing of the bony canal, the purpose of surgery is to widen the bony canal to increase the area where the nerves are located. This is called lumbar decompression surgery or laminectomy.
Surgery, when necessary, will relieve leg pain and less reliably lower back pain. Patients are allowed to return to most activities within a few weeks. Post-operative rehabilitation may be recommended to assist in returning to normal activities.
Sometimes, in canal stenosis, the vertebrae shift or displace in relation to each other (spondylolisthesis). Abnormal movement (instability) may occur between the vertebrae. In such cases, spinal fusion surgery may be necessary in addition to reducing pressure (decompression) to stabilize the involved vertebra.
Fusion is performed by placing bone tissue, a bone substitute material and/or tool between the vertebrae to be fused. Fusion can be performed anteriorly (anterior approach) or posteriorly (posterior approach) or may require both anterior and posterior approaches. The choice of surgical approach is influenced by many technical factors; These include the necessity of removing the protrusion (spur, thorn?), anatomical variations among patients, and the degree of instability. The success rate of fusion surgery is more than 65%.
After surgery, you will stay in the hospital for at least a few days. Most patients can return to all activities within six to nine months. A post-operative rehabilitation program is usually given to guide you in returning to normal life activities.
