The spinal cord is a structure located in the canal behind the vertebral bodies. It starts from the bottom of the head and goes along to below. There are 4 separate groups of vertebrae in the spine: neck, thoracic, lumbar and sacral region. Spinal canal narrowing is more common in the lower back and neck region. There are 5 vertebrae in the lumbar region. This region is the spine region where body weight is most concentrated. Other anatomical formations included here; The disc between the vertebrae (lumbar hernia consists of this structure), the facet joints where the vertebrae articulate with each other, the strong connective tissue passing behind the body of the vertebrae and the yellow ligament behind the spinal cord.
Spinal canal narrowing is called the spinal canal located just behind the vertebrae, by narrowing all around, compressing the spinal cord passing through it from top to bottom at various levels, and the pressure exerted on the nerve roots. Lumbar spinal canal narrowing is a degenerative process. Degenerative changes of all the structures listed above contribute to this process, and the patient may face the problem of narrow canal after a while. The main factors in lumbar spinal canal narrowing are the decrease in water content of the intervertebral discs as we age, the enlargement of the facet joints in overweight patients, the calcification of the ligament at the back of the vertebrae and the thickening of the yellow ligament located at the back of the spinal cord.
Symptoms
Spinal canal narrowing in the lower back is a slowly developing process. Therefore, it may not cause complaints and findings at first. However, when the disease progresses, patients’ quality of life deteriorates and their daily activities are significantly restricted. When this clinical picture occurs in patients, the diameter of the spinal canal is mostly narrowed above a certain degree, the spinal cord and the nerve roots coming out of it are compressed.
Patients may experience back, low back pain, loss of strength and numbness in the feet. The most obvious finding in patients is cramps and contractions in the legs after walking a certain distance. Over time, the distance at which these symptoms appear decreases, and in very advanced periods, patients face cramps and spasms in the legs, even during walking at home. If walking patients rest when cramps and contractions occur, their complaints decrease. Then when they start walking again, they face the same problem again. Patients may have pain that starts from the waist and hips and spreads to the legs and feet.
Patients with lumbar spinal canal stenosis may have difficulty lying on their back. In advanced periods, these patients tend to lean forward and walk. Because the patient wants to voluntarily bring the spinal canal to a slightly wider position by leaning forward.
Diagnostic Methods
The alignment and radiological anatomical structure of the vertebrae of the lumbar region, the diameter of the channels where the nerve roots exit, degenerative changes, whether there is a shift in the vertebrae, and the anatomical relationship between the lumbar vertebrae and the sacrum region are evaluated in direct X-ray. Computed tomography or 3-dimensional reconstruction computed tomography of the lumbar spine gives the above-mentioned information in more detail. In addition, 3D images help to visually define the spinal canal in more detail. In addition, computed lumbar spine tomography is also necessary to measure to determine the size of spine stabilizing systems such as screws and rods that are sometimes required to be used in surgery. However, the gold standard diagnostic method in recent years is the examination of this region with magnetic resonance imaging. Magnetic resonance imaging is an indispensable diagnostic tool to evaluate the disc structures in the distance between the vertebrae, the facet joints where the vertebrae articulate with each other, and the ligament structures that hold the vertebrae together, the spinal cord sac and the anatomical condition of the nerve roots coming out of it. The fact that the spinal canal diameter seen in this examination has fallen below a certain level can be considered as a sign that the disease has progressed considerably.
When we say electrophysiological examination, the first thing that comes to mind is electromyography (EMG). With EMG, which nerve root coming out of the spinal cord is under pressure and peripheral nerves are evaluated. EMG is sometimes used as an auxiliary diagnostic tool in the differential diagnosis of other diseases.
Treatment Options
In advanced cases, non-surgical methods such as bed rest, drug therapy, physical therapy, spinal injections can be applied to patients. Many drugs can be used in drug treatment, from simple pain relievers to very severe pain relievers in the narcotic group. However, the necessity of these and which dose to use is a situation for the physician to decide. Epidural injection is one of the non-surgical treatment methods. In this application, corticosteroid (cortisone) is applied to the epidural space outside the membrane layer surrounding the nerves. If successful, it may be necessary to repeat it later. In the physical therapy applications to be made after the decision of the physical therapist, the main aim is to reduce the pain or reduce it to tolerable levels, strengthen the muscles and provide freedom of movement.
However, surgical treatment should be applied in cases of neurogenic claudication, when the patient’s walking distance decreases over time, accompanied by cramps and contractions in the legs, in case of loss of strength in the legs, urinary bladder and bowel problems, and the patient’s quality of life decreases. Surgical treatment has become more comfortable and successful today, with advanced technological possibilities and especially with the increase in the use of the operating microscope in neurosurgery practice. Our aim in surgery is to remove the pressure on the spinal cord and the nerves in it. The name of this surgery in the medical literature is lumbar decompression surgery. The bones and yellow connective tissue on both sides forming the posterior roof of the spine are removed and the spinal cord is relieved. In appropriate cases, an approach is made from one side in order not to disrupt the dynamics of the spine further, that is, bone tissue is removed from one side behind the spine, but widening surgery is performed on both sides under the microscope. Since lumbar spinal canal narrowing is an advanced degenerative process, some patients may have vertebrae slipping over each other. In this case, in addition to spinal cord release surgery, screw application may be required to fix the slipped vertebrae of the patient.
Patients should pay attention to their low back health in the postoperative period and avoid activities that may cause low back pain. Two other important factors affecting future waist health are to continue the recommended exercise programs and to take care not to gain weight.
Postoperative
·If your surgery was in the morning, at 15:00, if it was after 17:00, I will get you up at 22:00 at night. Afterwards, you will stay in the hospital for 1 or 2 days, depending on your condition.
· It is okay to go home by sitting in your car after being discharged. If possible, traveling in the front seat and with the seat back up to 110 degrees will minimize the possibility of pain.
· If you have to climb stairs in the first 2 weeks, go up the steps one by one, bringing the other foot next to one of your feet on each step.
·You can have your meal sitting down. When you sit down to eat, take care to have back support and, if possible, to eat while sitting in a chair.
· Take care to behave as you were taught while sitting and standing.
· In the first days, you may sometimes have complaints such as pain, burning sensation and stinging in your lower back. Therefore, do not worry. In this case, choose the way to rest by lying on your bed.
·Make sure that your bed is suitable for back health. In your next life, do not sleep in places such as armchairs, sofas.
· When getting out of bed, first turn to your side, then get into a sitting position with your hands on the sides and get up like that.
·Come for the check-up on the appointment day given to you after the surgery. I will give you the necessary information to take a bath at this check.
· When you are discharged from the hospital, you do not need to take the same drugs again, unless you are told otherwise.
· For the toilet, a European style toilet must be used.
·Take care to wear your shoes while sitting. Do not wear shoes with very high heels or without heels. Medium height shoes will be more appropriate.
· When buying something from a height, try to get it by going up to a suitable height.
·Do not let yourself fall to sit on a chair or armchair. Get into a sitting position slowly and with control. Get support from your knees or armrests on the side of the seat when getting up.
10. Start walking outside from day one (first short distances (10-15 min), after the 30th day, longer distances (20-30 min)).
·If you are doing a desk job, you can start your job after 1 month. Those who work in heavier work conditions can return to work after 45 days.
· Take care not to carry weights for the first 45 days, and then not to carry more than 5 kg in total in both hands. When lifting weights, squat down and lift the weight as close to your body as possible.
