Lumbar Narrow Canal
What Is The Narrow Canal
Narrow canal It narrows the anterior-posterior or right-left diameter of the spinal canal located in the middle of the vertebral bones that make up the spine. Then it strangles the spinal cord at some level.
What are the Symptoms of Narrow Canal Disease?
- Pain that increases with and decreases with rest.
- The pain is partially reduced by leaning forward and increases by bending backwards.
- The patient is more uncomfortable while descending a slope or stairs, and is more comfortable when ascending.
- In the legs; numbness, tingling, chills, feeling hot or cold, weakness, tiredness.
- Clumsiness, frequent falls, tripping of the toes while walking.
How Is The Diagnosis For Narrow Canal Disease?
- Direct dynamic lumbosacral radiographs
- Lumbosacral lateral radiographs in standing flexion and extension.
- Normal standing lumbosacral radiograph.
With these dynamic graphs; It is understood how stable the spine is and we decide whether it is necessary to apply a pedicle screw to the surgery to be performed.
2: Lumbar Computed Tomography (CT); it shows better the events such as tumoral and degenerative (calcification) especially in bone structure. Except this; It also shows congenital or subsequent bone fractures and other lesions in spinal slips.
3: Lomber Manyetik Rezonans (MRI); It shows the diseases of the spinal nerves and surrounding soft tissues (muscle, ligament, tendon, fascia, etc.) and stenosis in the spinal canal by 3D.
What Are The Differences Between Narrow Canal Disease And Herniated Disc?
Narrow canal and herniated disc are actually very similar diseases.
While herniated disc is a more acute and young age disease; On the other hand, narrow canal is an advanced age disease caused by chronicity of herniated disc and facet hypertrophy.
In other words, the most important cause of the narrow canal is the chronic herniated disc.
What Is Neurogenic Cladication?
Narrow canal patients walk with a slight forward bend. When the patient has been standing for a long time or when he has been walking; pain, numbness or only weakness or a combination of these occur in one or both of his legs. The patient has to sit or rest for a while. This condition is called neurogenic claudication.
In this case over time; There are patients whose walking distance is reduced to a few steps or who are completely bedridden.
If surgery will be apply, it is beneficial to do it before the canal stenosis progresses and the walking distance is shortened.
Causes Of Narrow Canal Disease
Congenital narrow canal: The congenital narrow canals of the patients cause the disease by compressing the lumbar part of the spinal cord at advanced ages.
Degeneration: It is the most common cause. With aging, the discs between the vertebrae shrink. Bone protrusions, which are popularly called calcification, occur in the vertebrae and cause the canal to narrow.
Spinal Displacement: It can develop congenitally or later. Canal narrowing can occur with the slipping of the vertebrae over each other and the deterioration of the balance of the spine.
Large Lumbar Hernias: Large hernias that move into the spinal canal can also cause narrowing of the canal.
Narrow Canal Disease Treatment Methods
Non-surgical treatment methods:
People with narrow canal complaints often avoid activities. This situation; reduced mobility, flexibility, strength and cardiovascular condition. A physical therapy or exercise program usually begins with stretching exercises to make tense muscles flexible again. You may be asked to repeat stretching exercises frequently to maintain your flexibility. Cardiovascular exercises such as cross trainer, treadmills and swimming can be added to increase the condition and improve blood circulation in the nerves. Increased blood flow in the nerves can reduce some narrow canal complaints. In addition, exercises to strengthen the back, abdominal and leg muscles can be given.
For some people with narrow canal; Home changes and home security are important. Household appliances such as washing machines may need to be taken to more useful places. A nightstand next to the bed can come in handy. Bathroom safety appliances are also recommended, if needed. Plans for preparing meals, scheduling activities, and saving work should be reviewed. It is important that the necessary tools such as canes or walkers fit the patient exactly. The narrov canal does not create a dangerous situation for adults unless there is significant or increasing weakness in the legs or bowel and bladder control problems. Therefore, the aim of the treatment is to reduce the pain and increase the functionality of the patient.
Non-surgical treatments; they do not correct the narrowing of the spinal canal. However, they provide long-term pain control and increased functionality without the need for surgery. A participatory rehabilitation program requires three months or more of supervised treatment.
Surgical treatment methods:
Surgery is only recommended for the rare patient whose pain cannot be relieved by non-operative methods. Surgery is also recommended for people with progressive leg weakness or bladder and bowel control problems. Surgery may also a proper option for patients whose walking distance is shortened and their quality of life is reduced.
The purpose of the surgery; It is to open the narrowed bone canal with surgery and to provide sufficient space for the nerves. This procedure is called lumbar decompression surgery or laminectomy.
When surgical decompression is applied; It can improve leg pain and lower back pain. But this surgery is less effective for low back pain. It takes a few weeks for patients to be able to do their normal activities. Rehabilitation may be recommended after surgery. That's why we start to apply physical therapy to our patients, from the first day of surgery.
In cases of narrow canal, sometimes the vertebrae may slip over each other (spondylolisthesis). In this case, there may be abnormal movements (instability) between the vertebrae. In such cases, in addition to decompression surgery, spinal fusion surgery (instrumentation) should be performed to detect the relevant vertebrae.
You will stay in the hospital for at least a few days after the surgery. Most of the patients can return to all their previous activities 6 to 9 months after the operation. Rehabilitation program is usually started after surgery for return to daily activities and a daily normal life.