SPINAL STENOSIS (STENOSIS - WAIST, NECK HERNIA)

Spinal stenosis (hernia) is a condition that causes compression of the spinal cord and nerve roots passing through it due to the narrowing of the canal between the vertebrae. It is a very common situation. It causes pain, cramping, weakness or numbness by compression of the spinal cord and/or nerve roots. Depending on the location of the narrowing, you may feel these symptoms in the waist, legs, neck, shoulders or arms.

Generally, the narrowing is due to osteoarthritis, that is, “wear and tear.” It is also possible for the discs between the vertebrae to bulge or for a piece to break off and put pressure on the nerve. Spinal stenosis symptoms usually begin slowly and worsen over time. Pain in the legs may be so severe that it is unbearable even when walking short distances. Patients often want to sit or carry a grocery basket leaning forward to relieve the pain or try to reduce weight by using a walker.

WHAT IS SPINAL STENOSIS?

Spinal stenosis is a condition of the spine. or narrowing in more areas. It most commonly occurs in the waist or neck. Due to this narrowing, compression occurs in the spinal cord or its branches. Usually, a person with this disease has pain radiating from the hip to the leg, and this pain becomes severe when standing or walking, shooting towards the waist. Pain may come more quickly when walking uphill or climbing stairs.

They usually say they feel relieved by sitting or leaning on them.

Pain is an important problem. It is a finding. However, there may be patients who have spinal narrowing but do not have pain. For this reason, stenoses that do not cause any symptoms do not require treatment.

HOW DOES SPINAL STRETCH OCCUR?

Some people are born with a small spinal canal. This is called “congenital stenosis”. However, it usually occurs over time due to age, which is called "acquired spinal stenosis."

WHO IS SPINAL STENOSIS MOST OBSERVED?

In those with congenitally narrow spinal canal

Women

Those who are 50 years of age or older

Those who have had a previous spinal injury or surgery

Some medical conditions can cause spinal stenosis. These include:

Osteoarthritis and bone spurs that develop as we age

Inflammation ar spondyloarthritis (for example, ankylosing spondylitis)

Spinal tumors

Paget's Disease

HOW IS SPINAL STENINESS DIAGNOSED?

When you see a rheumatologist He or she will ask you questions about the symptoms of this disease and your medical history. Then you will be examined. These questions are:

Is there numbness, weakness, cramps, pain or difficulty walking in the legs, thighs or feet?

Does the pain radiate down the leg?

Is there any abnormality in bowel and / or bladder function? (Inability to hold urine or defecation)

Is there any loss of sexual function?

Those with partial or complete leg paralysis are severe cases. It is necessary to go to the emergency room or urgently consult a neurosurgeon or orthopedist (who specializes in spine surgery).

You should consult a rheumatologist, heart and blood vessel disorders (such as aneurysm, vascular occlusion), nervous system disorders that may cause similar symptoms. It is the right address to distinguish disorders or other causes such as hip and knee arthritis.

Other tests may also be performed to confirm the diagnosis and determine the severity of the condition. These are:

Direct radiographs (x-rays) of the spine; To show osteoarthritis, bone protrusion and stenosis of the spinal canal

To view the canal inside the spine in more detail; computed tomography (CT) or magnetic resonance imaging (MRI),

ENMG (electroneuromyogram) to check the nerves going to your legs.

To check your blood circulation; Abdominal or leg Doppler ultrasonography can be performed to rule out other diseases that cause similar complaints.

HOW IS SPINAL STRETCH TREATED?

Although there is no treatment for spinal stenosis; Regular exercise, medication, and in some cases surgery can provide relief. There are many mistakes made about herniated disc. First of all, not every back or neck pain is a hernia. Therefore, it is important to distinguish between other diseases that may be involved. With the correct diagnosis; Treatment is planned according to the patient's findings. So not every herniated disc is the same. Medication, rest, pain blockade, physical therapy and rehabilitation are the most common treatments. Surgery only occurs in one in ten patients is being implemented. Even in patients planned for surgery, medication (muscle relaxants, non-steroidal anti-inflammatory drugs-NSAII) and rest are first given for 7-10 days.

Drugs: Acetaminophen (paracetamol) or non-steroidal anti-inflammatory drugs. Steroidal anti-inflammatory drugs (usually NSAIDs - such as ibuprofen or naproxen) can reduce pain. In addition, other painkillers/or muscle spasm-relieving medications may be prescribed.

Cortisone injections: Cortisone injections directly into the area around the spinal cord can provide great temporary, sometimes permanent, relief. These injections are usually given as an outpatient treatment in a hospital or clinic environment.

Surgical: Patients whose complaints do not go away despite the treatments recommended above and whose complaints gradually worsen or who have very serious nerve pressure are treated with surgical intervention called “decompression”. Laminectomy can be performed. In this surgery, the canal space for the nerves and spinal cord is emptied, and the bone spur and bone formation within the spinal canal are eliminated. Next, doctors often perform spinal fusion (joining) of two or more vertebrae to provide better support.

According to the results of many recent studies, the short-term results of surgery are It is better than non-invasive treatments. However, like all surgeries, this surgery carries some risks, although they are rare, and the results may vary. These risks; clot formation in the brain and/or legs, tearing of the tissue around the spinal cord, infection and nerve root injury. Although surgery may bring relief, spinal stenosis or osteoarthritis is not cured and symptoms may recur.

Exercise: Regular exercise will strengthen the muscles in your arms and upper legs (such as hip adductors and abductors, quadriceps). . This balance provides the ability to walk on hills and flat roads, as well as control of pain. A physiotherapist can show you the appropriate exercises.

COMLICATIONS OF SPINAL STENINESS

Spinal stenosis can cause slow but progressive loss of strength in the legs. Even if there is no muscle weakness, pain reduces the quality of life by causing restriction in movements, and can become disabling as it progresses.

LIVING WITH SPINAL STENINESS:

There is no definitive treatment for a herniated disc. But there is a lot the patient can do to feel better. For example:

Be active. Regular exercise is very important, so do stretching exercises for 30 minutes at least three times a week to strengthen your neck, waist and back muscles without over-exerting them. Start with slight forward bends. As you get stronger, add walking or regular swimming.

Change your habits. Avoid activities such as heavy lifting or walking long distances that increase or trigger your pain.

Consult your doctor about alternative treatments such as massage or acupuncture to relieve pain, as well as painkillers.

Get rid of your excess weight.

Points to remember;

Disease history is of great importance in diagnosis.

Everyone over the age of 50 is at risk.

The severity of the disease varies from patient to patient.

Regular exercise is very important to keep the muscles strong and increase their flexibility.

The choice of treatment depends on the severity of the herniated disc and how much it affects the quality of life. Varies depending on the situation.

THE ROLE OF THE RHEUMATOLOGIST IN THE TREATMENT OF SPINAL STENINANCE (HERIAN):

Spinal stenosis seriously affects the person's life. A rheumatologist makes a differential diagnosis of other diseases that may be confused with this disease in a person presenting with back or neck pain. After the correct diagnosis, he creates a treatment plan. This helps to create a treatment strategy such as not only medication but also physical therapy, algology (pain treatment-nerve blocks) or referral to surgery.

Spinal stenosis (hernia) causes the narrowing of the canal between the vertebrae. It is a compression of the spinal cord and nerve roots passing through it. It is a very common situation. It causes pain, cramping, weakness or numbness by compression of the spinal cord and/or nerve roots. Depending on the location of the narrowing, you may feel these symptoms in the waist, legs, neck, shoulders or arms.

Generally, the narrowing is due to osteoarthritis, that is, “wear and tear.” It is also possible for the discs between the vertebrae to bulge or for a piece to break off and put pressure on the nerve. Spinal stenosis symptoms usually begin slowly and worsen over time. Pain in legs from short distances It can be so severe that it is unbearable even while walking. Patients often want to sit or carry a grocery basket leaning forward to relieve the pain or try to reduce weight by using a walker.