LUMBAR SPINAL STENOSIS

Lumbar stenosis, also called 'Lumbal Spinal Stenosis' in medical language, is a slowly developing condition. It is mostly caused by calcification or wear and tear changes that occur spontaneously in the spine with aging. For this reason, although some changes are seen in the x-ray films or imaging tests performed for another reason, it does not cause any symptoms for a long time. However, over time, symptoms of numbness, pain, tingling and weakness may be experienced in the back, neck, arms, legs, hands and feet, depending on the spinal stenosis and its severity.

WHAT IS LUMBAR SPINAL STENOSIS?

“What is spinal stenosis?” The question can be answered as narrowing of the channels through which the nerves pass at one or more points of the spine. With advancing age, the discs between the vertebrae of the person lose their spongy structure and contain less water. This causes the disc to decrease in height and bulge towards the hardening spinal canal. The spinal cord carries nerves that give strength and sensation to a person's legs. Due to the destruction of the cartilage tissue, a condition called arthritis, the bones and ligaments of the facet joints in the spine thicken and put pressure on the spinal canal. All these changes cause narrowing of the lumbar spinal canal, which is called lumbar spinal stenosis.

A lumbar spinal stenosis can be compared to a garden hose's accumulation of limestone over time. Just as lime narrows the diameter of the tube over time, this also causes the diameter of the spinal canal to narrow. The lumbar spine, consists of a series of connected bones called vertebrae. These bones surround the spinal canal, which runs between the vertebrae through which the spinal cord passes.

SIGNS AND SYMPTOMS OF LUMBAR SPINAL STENOSIS

The lumbar spinal stenosis, which does not always cause symptoms in the person, has some symptoms that vary from person to person. The potential symptoms of this narrowing are as follows:

• With the lumbar spinal stenosis, symptoms such as; loss of sensation or pain in the back, as well as numbness, pain, cramps in the legs and in addition urinary incontinence may be experienced.
• Lumbar stenosis complaints may increase in people who sit or stand for a long time. These complaints continue with varying intensities over time.
• Most typical complaints are weakness, numbness and tingling in the legs after walking a certain distance.

CAUSES OF LUMBAR SPINAL STENOSIS

One of the biggest causes of lumbar spinal stenosis, is aging. With aging, a degenerative process begins in the body. As part of this process, the tissues in the spine begin to thicken and the bones grow and the nerves are compressed. In addition, conditions such as inflammatory rheumatism (rheumatoid arthritis) and osteoarthritis (osteoarthritis) can contribute to the lumbar spinal stenosis. Other conditions that can cause a lumbar spinal stenosis are as follows:

• Congenital spinal abnormalities
• Congenitally narrow spinal canal
• Herniated discs
• Scoliosis
• Pagets bone disease
• Bone tumours
• Achondroplasia which is a disease of dwarfism

DIAGNOSIS OF LUMBAR SPINAL STENOSIS

The patient's complaints are listened to, and then the necessary x-ray films are taken. With these films, narrowed disc spaces or thickened facet joints are assessed. The films used in diagnosing the condition are as follows:

• Magnetic resonance imaging
• Computed tomography
• Lumbar myelography

TREATMENT OF LUMBAR SPINAL STENOSIS

After diagnosing the lumbar spinal stenosis condition that causes pain in the person, the doctor applies different treatment methods according to the situation. The lumbar spinal stenosis treatment methods applied according to the situation are as follows:

• Pharmacological
• Surgical

In the drug treatment method, anti-inflammatory drugs or painkillers that reduce inflammation are used. In addition, physical therapy can be applied to protect and increase the strength, flexibility and condition of the person. Epidural cortisone injections, also called spinal injections, may be recommended at this stage.

In the applied physical therapy, it is aimed to improve the inactivity, strength and flexibility of the patient. The physical therapy and exercise program given to the person begins with stretching exercises to make the tense muscles more flexible. At this stage, it is important for the person to repeat these stretching movements frequently in order to maintain their flexibility. Exercises such as swimming, jogging or treadmill walking are added to the physical therapy program to increase the condition of the person. With this treatment plan, the person's flexibility, strength and condition increase is supported.

LUMBAR SPINAL STENOSIS SURGERY

Surgical planning is performed in cases that do not respond to pharmacological treatment and physical therapy. In lumbar spinal stenosis surgery, it is aimed to remove the pressure on the spinal cord and nerves of the person. The surgery performed at this stage is determined by the location of the stenosis in the canal and the level of compression in the canal. Ligaments and bone structures that cause compression of the spinal cord are removed during surgery. Relief is provided by removing the bone or disc that puts pressure on the spine.

If the patient has not undergone surgery before and does not have problems such as lumbar slip and fracture, there is no need for screw-rod use in the surgery. However, if more than one stenosis is required, the spines can be supported with each other by using rods and screws during the surgery. Since these metals used will be like bones after surgery, they do not cause discomfort in the person. Within a few months following the surgery, these bones fuse and they begin to carry the vertebral load.

AFTER THE SURGERY OF LUMBAR SPINAL STENOSIS

The patient is usually discharged within a few days after surgery. After this process, it is recommended that the patient spend the first 1 week at home. At the end of the second week, the patient can return to his routine life. Post-operative pain also subsides within 3-4 months and full recovery takes 1 year. However, it should be known that this process will differ from person to person.

Below are the things that the patient should pay attention to in the post-operative period:

• The person should be careful when climbing stairs, walking, bending and getting up after the surgery.
• It is necessary to protect the operated area from possible impacts.
• The patient should benefit from areas where he or she can get support while walking at home or at work.
• A toilet bowl should be preferred after the surgery.
• Patient should avoid carrying heavy objects.
• After the surgery, the nutrition routine should be regular and the person should pay attention to a balanced diet.
• The patient should lie in a bed that can protect his or her back.
• The exercises given by the doctor should not be neglected.