Lumbar spinal stenosis, known as lumbar stenosis, is frequently seen in patients over the age of 50. With advancing age, the fluid content of the intervertebral discs decreases, the disc height disappears, and these hardened tissues curve towards the spinal canal. In addition, due to the deterioration of the cartilage tissue in the joints at the back of the spine, thickening occurs in the bone structures and ligaments, increasing the narrowing of the canal. If this degeneration continues, slipping between the vertebrae and even bending such as scoliosis may develop. Lumbar stenosis may not always cause complaints. The typical complaint is pain in the legs that increases with walking. This may be accompanied by symptoms such as numbness, tingling, and weakness in the legs. These complaints improve by sitting and leaning forward. However, as the disease progresses, walking distance becomes shorter. In addition, urinary incontinence and varying degrees of loss of neurological strength in the legs (motor weakness) may be seen as advanced symptoms.
Surgery in lumbar stenosis is only applied to patients whose pain cannot be relieved by non-surgical methods. Surgery should also be performed on people with progressive leg weakness or bladder and bowel control problems. Surgery may be the best option for patients whose walking distance has become significantly shorter and their quality of life has decreased. Since the stenosis is the result of the narrowness of the bone canal, the aim of surgery is to open the bone canal and provide sufficient space for the nerves. This procedure is called lumbar decompression surgery or laminectomy. When performed, surgery will relieve leg pain and, although less effectively, lower back pain. Patients are allowed to return to most normal activities within weeks. Postoperative rehabilitation may be recommended to assist with return to normal activities. Different surgical techniques can be applied for lumbar canal narrowing. In appropriate cases, shaving only the thickened bones and ligaments narrowing the canal will be sufficient. In these cases, it may not be necessary to wear instruments popularly called sinkers. However, in patients with advanced stenosis at more than one distance, the stability of the waist may deteriorate after this shaving procedure. In later periods, it may cause deterioration in the alignment of the lumbar vertebrae, that is, slippage (spondylolisthesis). Case like this In addition to successive decompression surgery, spinal fusion surgery should also be performed to stabilize the relevant vertebrae. Fusion is usually done through a posterior approach. In addition to screwing, if there is a height loss in the distance, it may be necessary to place a cage (TLIF, etc.) in the intervertebral space.
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