Spinal canal stenosis is the spinal canal located just behind the vertebrae, narrowing all around, compressing the spinal cord passing through it from top to bottom at various levels, along with pressure on the nerve roots. In these patients, weakness, tingling, numbness in the arms and/or hands, weakness in the legs, loss of function and gait disturbance may be seen in more severe cases.
If spinal cord compression is advanced, symptoms such as difficulty in doing fine work or not being able to do it (such as not being able to button your shirt or tie your shoes) may occur. In advanced cases where the disease also affects the legs, patients may not be able to walk unaided or may have spastic gait, incontinence of urine and stool.
On examination, patients may have increased reflexes in the arms and legs, and loss of strength and sensation in the hands and legs. In addition, a group of abnormal findings, which we call pathological reflexes, may be detected in the hands and feet. Some or all of the mentioned findings may be found in a patient.
Worsening in attacks is more common in the cervical narrow canal. The patient has comfortable or very few symptoms in the interim periods of these attacks. Very slow progression is seen in 25% of patients, and sudden worsening in 2% of patients.
Diagnostic Methods
The alignment and radiological anatomical structure of the neck region vertebrae, the diameter of the channels where the nerve roots exit, degenerative changes, whether there is a shift in the vertebrae, neck vertebrae and skull junction anatomy can be evaluated on direct X-ray. Computed tomography or 3-dimensional reconstruction computed tomography of the neck vertebrae 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 tomography of the neck spine is also necessary to measure to determine the size of the spine stabilizing systems such as screws and plates that are sometimes required to be used in surgery. However, in recent years, the gold standard diagnostic method 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 and the condition of the nerve roots emerging from the spinal cord. The appearance of spinal cord damage (myelopathy) seen in this examination can be considered as a sign that the disease is quite advanced.
The tests we call electrophysiological examinations are electromyography abbreviated (EMG) and somatosensory evoked potential (SSEP). Peripheral nerves are evaluated with EMG and spinal canal compression is evaluated with SSEP. Electrophysiological examinations are very helpful diagnostic methods in the differential diagnosis of spinal canal narrowing, especially in the neck region, with other similar diseases.
Treatment Options
Damage caused by compression in the spinal cord, which we call myelopathy, due to canal stenosis, is one of the most important factors in making the decision for surgery. If there is no myelopathy, if weakness and loss of sensation in the arms, hands and legs are not advanced, non-surgical methods (such as physical therapy, drug therapy) may help partially solve the patient’s problem.
The basis of the surgery is the disc that creates pressure on the spinal cord, osteophyte formation, calcification of the strong connective structure passing behind the vertebrae, the yellow ligament at the back of the spinal cord grows and becomes evident, the facet joints where the vertebrae articulate with each other, inward degenerative It is the elimination of factors that cause narrowing of the spinal canal by sliding the vertebrae over each other. This is briefly called decompression surgery, that is, the removal of the press.
Removal of this press is possible with anterior or posterior surgeries. However, the decision of which one will be more appropriate is made by the brain and nerve specialist after the examinations to be made. If only the disc causes the pressure in anterior operations, only disc-oriented surgery can be performed without any intervention on the two vertebrae adjacent to that disc. Sometimes the structure that creates the front pressure can be the calcification of a very strong ligament that extends behind the vertebrae. In this case, the spine body(s) and disc tissue are removed along the affected level. In its place, a bone graft or a cage-like prosthetic material that will replace the spine is placed. Afterwards, fixation (fusion) is performed with plates and screws from the front.
In operations performed from the back, it may be necessary to completely remove the yellow ligament that creates the pressure and the lamina that forms the back of the spine. In this case, it would be appropriate to perform fixation (fusion) surgery by placing screws and rods holding them on the spine in order to strengthen the spine. It is possible to enlarge the spinal canal with laminoplasty surgery, which is applied with the help of the prosthetic material placed after a part of the lamina is removed and cut and separated.
Postoperative Period
·It is usually sufficient to stay in the hospital for 2 days. You will be up and about on the same day immediately after the surgery.
·You can go home by sitting in the car.
·You can do your daily simple activities at home.
·Use clothes that can be opened and closed from the front for a while after the surgery.
·Difficulty in swallowing and a feeling of being stuck in the throat may occur in the first week (sometimes more). The problem is edema in the esophagus. Therefore, for the first 3-4 days, choose soft foods (such as pasta, rice, soup, rice pudding, pudding).
· If hoarseness occurs, it is mostly temporary, but sometimes it can last for 3 months. Persistent hoarseness is very rare.
· In the first days, there may be some complaints such as pain, burning sensation and stinging at the incision site in your neck. Therefore, do not worry. Necessary medications will be given to you at discharge for any pain that may occur in the neck and arm. In the following period, the pain goes away first. Problems such as numbness and tingling may take longer to pass.
·If I have suggested you a neck brace, I will also explain how to use it.
· You do not need to take medication when you are discharged from the hospital, unless you have been told otherwise.
·Make sure that your bed and pillow are suitable for neck health. Make sure to use your bed for sleep.
·Come for the check-up on the appointment day given to you after the surgery. The necessary information to take a bath will be given to you during this control.
·The first dressing of the wound site after discharge will be done by me and it will be closed. After being closed for 2 days, open the dressing yourself and then leave it open.
·No suture removal is required. The incision was sutured internally. Sometimes there are situations where external stitches are required, then your stitches will be removed on the 7th day.
·Call me if there is redness, swelling, discharge at the wound site.
· If it is recommended to use the neck collar, stop using it completely after the first 15 days. However, when traveling with the vehicle for the first 3 months, wear it only during travel and make sure that the seat cushion behind your head in the vehicle is at the same height as your head.
·You can go out after the operation after discharge.
· Those who work at a desk can return to work after 15 days if they wish. However, those who do heavy work should rest for 6 weeks.
·Do not carry more than 1 kg in your hand for the first 6 weeks. After 1 year, take care not to carry a total weight of more than 7 kg in both hands.
·Do not drive for 6 weeks after the operation.
·You can make short plane trips. However, do not make long (such as extreme ocean) plane trips in the first 3 months.
·Do not do sports activities that require contact for the first 4 months. Just take a walk. Afterwards, you can start non-contact sports activities. The most recommended sport activity is swimming.
·The period we call the full recovery period is 4 months and later. After this period, you can do many activities as in your previous healthy period
