What Is the Treatment for Spinal Stenosis?
Spinal stenosis is a disease that occurs as a result of the anatomical narrowing of the spinal canal. Spinal stenosis generally begins with degeneration caused by fluid loss in the discs over time and progresses with facet joint and ligamentum flavum hypertrophy.
The main cause of the narrowing is generally the pressure placed on the spinal cord and nerves as a result of degeneration of spinal components such as the discs and ligamentum flavum, which is seen in elderly patients. Along with the increase in life expectancy, there has also been an increase in diseases caused by such degenerative changes. For this reason, the number of patients experiencing spinal stenosis is increasing day by day. Spinal stenosis is generally seen in people aged 50 and over. The rate of occurrence in men is higher than in women.
The most common symptom seen in patients with spinal stenosis is pain and numbness in the legs and hips while walking. Spinal stenosis is a progressive disease; therefore, the distance a person can walk painlessly and without interruption gradually decreases day by day. While the complaints increase further during prolonged standing, they decrease when bending forward and sitting. This is the most typical symptom of spinal stenosis. Because in positions such as sitting and bending, the canal widens, the person feels temporary relief and does not notice the complaints.
The walking distance of patients with spinal stenosis gradually decreases, and along with these symptoms, neurogenic claudication, that is, muscle weakness, is also observed in the patient.
When Is Spinal Stenosis Surgery Needed?
Spinal stenosis is primarily treated with painkillers, injections applied to the lower back, and physical therapy. If no response is obtained from treatment with these methods, the only option is spinal stenosis surgery. In this way, the spinal canal is widened through surgical intervention. The aim of the surgical procedure is to relieve the pressure on the spinal cord and nerves, reduce the patient's pain, and increase mobility again.
Generally, two surgical methods are used in the treatment of spinal stenosis.
Decompression, that is, widening of the canal, is the most commonly used method. In addition, its success rate is also quite high. This surgery is generally performed under a microscope. To remove the pressure on the spinal nerves, the yellow ligament or bone protruding into the canal is removed. In this way, the spinal canal is widened. This procedure can be performed on a single vertebra or on several vertebrae. After this surgery, a significant degree of relief is felt in the spinal cord and nerves.
Spinal fusion, that is, vertebral stabilization surgery, is preferred in cases where the patient experiences lower back pain at the same level as the complaints in the legs. These types of patients require spinal fusion. The aim of this surgery is to relieve pain by preventing the instability of the vertebrae and their slipping over one another. During the surgery, screws are placed into the vertebrae and fixed together with metal rods. It is reinforced by placing local bone on top. If necessary, bone and a cage can be placed in place of the disc. The metal structures remain in that area for life. This surgery is generally performed in addition to decompression.
One of the frequently asked questions about spinal stenosis treatment is whether spinal stenosis surgery is a risky surgery. Since most patients are of advanced age, they fear surgery. However, what should really be feared is not the surgery, but being late for the surgery. If the surgery is postponed, the nerves remain under pressure a little more each day and become damaged. If this damage reaches a level that cannot be treated even during surgery, the surgery may not be enough to relieve the patient. In order to prevent irreversible damage to the nerves, if no benefit is obtained from non-surgical treatments, spinal stenosis surgery should be performed without delay. In addition; thanks to the technology of microsurgery, which allows the surgeon to work in great detail even in very narrow and small areas, the risk of spinal stenosis surgery is quite low. In surgeries performed with microsurgery, tissue damage and bleeding are less than in other surgeries, and the recovery process progresses faster.
The patient should come to the hospital one day before the spinal stenosis surgery and have the necessary tests done. After the surgery, once the patient recovers, they are taken to their room and are helped to stand up the next morning. The physiotherapist will provide the necessary information on this matter.
What Should Be Considered After Spinal Stenosis Surgery?
In surgeries performed with microsurgery, stitches are not used, and the patient can recover much faster and more comfortably / painlessly. After spinal stenosis surgery, the patient feels significant relief in pain and begins to perform daily life activities again. They can walk longer distances more comfortably again. In the postoperative period, the patient does not experience any other problems apart from a few points they need to be careful about.
The points to be considered after spinal stenosis surgery are as follows;
- The patient should avoid lifting heavy objects after the surgery.
- Before returning to work, about 4-6 weeks should be waited. The time to return to work varies depending on the physical demands of the job. While those working at desk jobs can return to their daily lives earlier, patients working in physically demanding jobs should wait longer before returning to work.
- It is recommended that the patient start physical therapy after the surgery.
- Sports such as swimming and walking help the patient feel better. During this period, the patient is advised to walk and, if possible, swim.
