Spinal Canal Narrowing (Spinal Stenosis)

In this disease, which is the most common cause of low back pain seen in individuals over the age 65 of in the society and spinal surgeries performed in this group, the spinal canal through which the spinal nerve and branches pass narrows by being exposed to the compression of the bones and soft tissues, and this narrowing can cause nerve damage up to waist-hip-thigh-thigh calf pain, burning sensation in the legs, decrease in walking distance, bladder and bowel problems and paralysis.

It is seen 4 times more in the lumbar region compared to the neck spine, and the ratio of men and women is almost the same. Congenital Narrow Canal, which occurs due to the insufficient development of the posterior anatomy of the spine at birth, is quite rare and begins to show symptoms at a very early age. The most common type is Degenerative Narrow Canal (Due to Wear); With age, the suspension we call the disc between the vertebrae, the loss of height due to the decrease in the amount of water and protein in its cushions causes excessive stress accumulation in the back of the disc membrane and causes it to shift towards the canal. At the same time, this load distribution change thins the cartilage of the joints in the back of the vertebrae, which we call the facet joint, and the loosened capsule structure causes the formation of bone protrusions that we call osteophytes, causing narrowing of the spinal canal from the middle-lateral cavity or nerve hole. While standing for a long time, walking and going downhill increase the complaints, sitting, leaning forward and going uphill relieve the patients.

In addition, stenosis at adjacent levels due to previous spinal surgeries, lumbar slippage and stenosis due to trauma appear as other causes of Spinal Stenosis.

In this progressive disease, the diagnosis should be made by a very detailed physical and neurological examination, analysis of the patient’s history, and radiological evaluation with X-ray/MR/Computed Tomography, and differential diagnosis should be made from vascular diseases in the legs and nerve inflammation (neuropathic pain).

The aim of treatment is to relieve patients’ pain and increase their quality of life by increasing their activity levels. It is possible to be successful in some of the patients by using weight control, activity modification, medical treatments, physiotherapy methods to strengthen the hip anterior muscle groups and stretch the waist/thigh muscle groups, by using spinal injection methods in cases of resistant pain. However, in patients with progressive nerve damage, loss of muscle strength, severe pain that cannot be regressed with the above methods, and bladder and bowel control problems due to compression of the spinal cord tail, we aim to surgically eliminate nerve compression and maintain spinal stability without wasting time. Surgical planning is made according to the general health of the patient, the location of the stenosis and the analysis of the balance problems that may occur in the spine, and can range from simple micro-decompression to total laminectomy + instrumentation + fusion surgery.