Vertebrae are bone structures that protect the structures called spinal cord and nerve fibers. Spinal cord and nerve fibers start from the lower part of the head and descend downwards along the canal in the middle of the vertebrae. There are structures called discs between the vertebrae, which connect the vertebrae to each other. These discs lose their fluid amount as we age. This may cause the disc's load-carrying ability to decrease and it may harden and move from its location towards the spinal canal, narrowing the diameter of the canal. Another cause of canal stenosis is the thickening of the connection structures called facet joints behind the vertebrae.
What are the symptoms?
Spinal stenosis may not always cause symptoms. Studies have shown that there are many people who have no symptoms but have severe spinal stenosis. Symptoms, if any; pain, numbness and cramps in the back or legs. Weakness may occur in the legs. Rarely, it may cause bladder and/or bowel problems. Complaints may increase with prolonged standing and walking. Symptoms may be continuous or come and go in the form of seizures. After walking for a limited time, you may need to stop and squat due to weakness and numbness in your legs. Walking distance may gradually decrease. The pain may ease or disappear completely by bending or sitting.
How is it diagnosed?
Examination and history are very important. Plain radiographs (x-rays) can reveal the presence of narrowed or weakened discs. The amount of stenosis in the spine can be determined in detail with magnetic resonance imaging (MRI). Computed Tomography (CT) can also be used for measurement and research. All these studies enable the stenosis of the spinal canal, nerve root compression, and the location of the stenosis to be determined.
What are the Treatment Options?
If a stenosis that causes pain is detected, firstly, non-surgical methods should be tried. These treatment options are anti-inflammatory treatment (oral medication or injection) and painkillers to control pain. When deciding on concrete treatment, it is important to consider whether your endurance and complaints reduce your quality of life. It is different. Spinal injections (such as epidural injection) can be performed.
Medication treatment and pain control:
A single drug or multiple drug treatment can be chosen when planning your treatment. Medicines used to control pain are called analgesics. Most pain can be controlled with simple painkillers. Some analgesics (painkillers) are called NSAIDs. These types of medications are used to relieve pain as well as eliminate any inflammation that may occur. If your doctor has recommended such painkillers and you use them, you may experience side effects such as stomach problems. You should be under the supervision of a doctor in case of problems that may occur with long-term use of such painkillers. If you have a persistent pain that does not go away with painkillers of the type mentioned above; Your doctor may recommend medications called narcotic painkillers. Do not use these types of painkillers unless your doctor recommends them. In these types of drugs, higher doses do not mean greater and faster effects. These drugs have side effects such as vomiting, constipation, dizziness, drowsiness, and these drugs can be addictive. All medications should only be taken if your doctor recommends them. Make sure you understand correctly how and how much to take the medications your doctor prescribes, and consult your doctor if you think your medication is not working. There are other drugs that have anti-inflammatory effects. Corticosteroids can be used orally or by injection due to their strong anti-inflammatory effects. Corticosteroids, like NSAIDs, also have side effects. Discuss the risks and benefits for you with your doctor. Spinal injections or blocks can be used to eliminate pain.
Such procedures are performed by administering corticosteroids to the epidural space (the space between the membranes surrounding the nerves and the bone structure) or to the joint space.
This procedure is performed by a specialist. The doctor does it. The procedure can be repeated in the future, considering the success of the first procedure. This method; It is a frequently used method in the treatment program.
Treatment options other than drug therapy (non-surgical):
Symptoms of spinal stenosis often cause patients to avoid movement. This situation causes a decrease in bending and durability. . Physical therapy or an exercise program is important to strengthen muscles and restore bending ability. Swimming and walking are recommended. Because such actions increase the amount of blood coming to the nerves and thus reduce the symptoms of narrowing. You may also be recommended exercises that strengthen your back, abdominal and leg muscles. For many people, paying attention to in-home security is very important. For example, the washing machine and dishwasher can be placed at a higher place. A more suitable bed could be used. If necessary, changes can also be made in the bathroom. It is appropriate to make walking easier and obtain a walker or cane if necessary. Spinal stenosis is not a dangerous condition in adults unless significant and progressive leg weakness develops and there are bladder or bowel problems. In such cases, the aim of treatment is to preserve the patient's quality of life and, if there is pain, to control the pain. Non-surgical methods alone do not correct the stenosis in the spinal canal and cannot eliminate the pain for a long time.
Surgical treatment:
Surgical methods are applied to patients whose pain cannot be controlled with non-surgical methods. Surgical intervention also; It is a preferred treatment method for those with progressive leg weakness, bladder and bowel problems. The purpose of the surgical intervention is to relieve the pressure and expand the diameter of the canal. The name of this procedure is lumbar decompression. Laminectomy is one of the surgical methods that can be chosen.
In this method, the bones in the back are removed and the narrowed bone canal is widened. In the hemilaminectomy bilateral flavectomy technique, the bones in the back are removed from one side and the canal is widened. Leg pain and loss of function of the leg improve with surgical intervention with the correct indication. Nowadays, patients can return to their normal lives a few weeks after the operation.
In spinal stenosis, sometimes there is a slippage between the weaker vertebrae and this is called spondylolisthesis. And in such a situation, the stability between the vertebrae is lost. In such cases, spinal fusion surgery can be performed together with decompression to fix the vertebrae. The joining process is done with bone tissue or some technical tools between the two vertebrae to be joined. merge front It can be done from the back or from both sides.
The hospital stay after surgery is only a few days. Most patients can return to all activities in 6-9 weeks.
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