What is Canal Narrowing (Spinal Stenosis)? What are its Symptoms and Causes? How is it Treated?
The spine is the bony structure that protects the spinal cord, extending from the skull to the tailbone at the back of the body. Some people may be born with a small spinal canal, or a condition may arise during their lifetime that causes this canal to narrow. This condition is referred to as canal narrowing or spinal stenosis. As a result of the narrowed canal pressing on the spine and nerves, pain, numbness, and tingling may be felt in certain areas. Due to the delicate nature of the spine, surgical methods are often considered a last resort in the treatment of spinal stenosis. Most people can respond well to treatment options such as physical therapy and medication. You can read on for answers to questions like what is canal narrowing or what are the symptoms of canal narrowing.
What is Canal Narrowing (Spinal Stenosis)?
Canal narrowing, also known as spinal stenosis, occurs when the space within the spine is very small. This narrow space reduces the area available for the spinal cord or the nerves passing through it. As a result of the narrowing, conditions such as compression or irritation of the spinal cord or nerves can be observed. Canal narrowing is commonly seen in the lower back and neck. Symptoms such as pain, tingling, and numbness may be observed in individuals with spinal stenosis. In some cases, canal narrowing may be asymptomatic (showing no symptoms). In patients with symptoms, worsening may be observed over time.
Spinal stenosis is a condition that can occur in anyone. It can be congenital in some individuals, or it may occur in young patients who have suffered spinal injuries due to accidents. One of the most common causes of canal narrowing is changes in the spine due to wear and tear caused by arthritis (joint disease). Another cause may develop with age. With advancing age, damage or wear in the joints can naturally occur. Osteoarthritis, commonly known as calcification, constitutes another common cause of spinal stenosis. Depending on the location and severity of spinal stenosis, you may experience pain, weakness, and tingling in the arms, legs, hands, and feet, especially in the neck and back.
Canal narrowing is a slowly developing disease that progresses over time. Therefore, even if changes are noticed in X-rays or other imaging tests during the control of another disease, you may not experience any symptoms for a long time. There are various treatment options for spinal stenosis. These include both surgical and non-surgical options. For severe cases, surgical methods are often preferred. The narrowed space causing compression can be widened during surgery, thereby relieving pressure on the nerves. With reduced pressure, symptoms may also decrease. However, any surgery or other treatment does not completely cure arthritis. Therefore, you may continue to feel some degree of spinal pain.
What are the Symptoms of Spinal Stenosis?
Spinal stenosis often does not cause symptoms. Symptoms are observed, especially when narrowing occurs affecting the lower back and neck. Increased pressure as a result of narrowing can lead to some symptoms. Symptoms generally develop gradually in most individuals and worsen over time. In some people, no symptoms may be observed at all. The symptoms of spinal stenosis can vary depending on which part of the spine is affected.
In cases of spinal stenosis occurring in the lower back:
- Pain in the lower back,
- Burning or normal pain that spreads from the hips to the legs, improving with standing, walking, bending forward, or moving,
- Numbness or tingling in the legs and feet (which may worsen with walking or standing),
- Cramps,
- Weakness in the legs and feet may occur.
In cases of spinal stenosis occurring in the neck:
- Pain in the neck,
- Tingling or numbness spreading from the arms to the hands,
- Weakness in the hands, arms, and fingers,
- Problems with balance and walking may occur.
Symptoms generally worsen with walking or standing. Stretching the lower back and neck may help alleviate symptoms.
In individuals with more severe stenosis:
- Problems with bowel function,
- Problems with bladder function,
- Issues with sexual function may be observed.
What are the Causes of Canal Narrowing?
Spinal stenosis is a condition that can occur in anyone. It can be congenital or may develop later in life. The causes of canal narrowing include:
- Bone spurs (bony projections that develop in the spine due to wear and tear from arthritis)
- Paget’s disease (a bone disease that causes excessive bone breakdown)
- Herniation of the inner material of discs, which are soft substances between the vertebrae, causing pressure on the spinal cord or nerves
- Thickening and hardening of ligaments that help hold the vertebrae together due to calcium salt accumulation over time
- Tumors that develop within the spinal canal
- Rheumatoid arthritis (joint inflammation)
- Spondylolisthesis (one vertebra slipping over another)
- Spinal injuries resulting from various traumatic events such as car accidents
- Swelling of nearby tissue following back surgery
- Epidural lipomatosis (fat accumulation on or around the spine)
Congenital conditions that can lead to spinal stenosis include:
- Congenital stenosis, known as having a small and narrow spinal canal,
- Scoliosis, known as spinal curvature,
- Achondroplasia, which causes problems in bone formation in the body, including the spine.
How is Canal Narrowing Diagnosed?
Your doctor will first conduct a physical examination to diagnose canal narrowing. During this examination, they will ask you questions about your complaints and medical history while also pressing on different areas of your spine to determine if there is any pain. Additionally, your doctor may have you perform some movements to check your balance, arm, and leg strength. After the physical examination, you will be referred to imaging devices to better visualize the issue. These imaging devices may include:
- X-Rays: Changes in the bones causing narrowing in the spinal canal can be observed with a back X-ray. This method contains a small amount of radiation.
- Magnetic Resonance Imaging (MRI): Provides precise cross-sectional images of the spine.
- Computed Tomography (CT): Preferred in cases where MRI cannot be performed. It is obtained by combining X-rays taken from different angles.
What are the Treatment Methods?
There are multiple treatment options for spinal stenosis, which can be categorized into surgical and non-surgical methods. The treatment of spinal stenosis may vary depending on the location of the stenosis, the source of the symptoms, the severity of the symptoms, and your health history. Generally, in individuals with mild symptoms, medication is the first treatment applied. In progressively worsening cases, physical therapy and, as a last resort, surgery may be recommended.
Surgical Methods
Due to the delicate nature of the spine, surgical methods are the last option preferred in the treatment of spinal stenosis. Most spinal stenosis patients can be treated without the need for surgery. However, if you are having difficulty walking and maintaining your balance, experiencing problems with bowel, bladder, and sexual function, or if your symptoms are severe enough to reduce your quality of life, it may be best to inform your doctor as soon as possible to discuss surgical options.
Open Surgical Method:
Open spine surgeries typically involve incisions of 5 to 15 centimeters in the skin and muscles, and the technique called laminectomy is used to remove ligament and bone tissue from the back of the spine. Some risks may arise during and after these surgeries:
Risk of bleeding during surgery,
Risk of destabilizing the spine, displacements in the spine, and back pain,
Need for systems such as screws and plates to restore the balance of the spine.
However, this method may still be preferred in some cases. For example, open surgeries can be effective in treating certain complex spinal issues and allow the surgical team better visibility and access.
Types of Open Surgery and Operations
Spinal stenosis surgery is performed using various techniques aimed at widening the narrowed canal of the spine and removing tissues that apply pressure on the nerves. These techniques include:
Laminectomy: This surgery removes the back part of the spinal bone (lamina), creating more space by reducing pressure on the nerves.
Laminotomy: In this procedure, a portion of the lamina is removed, targeting the area causing the most pressure on the nerve.
Laminoplasty: This procedure, which can only be applied to the cervical spinal cord, involves removing a portion of the lamina to create a wider space.
The duration of spinal stenosis surgery may vary depending on the complexity of the procedure. Like any surgery, these procedures may carry certain risks. Nerve injury, improper healing of the bone, infection, and tearing of tissues are some of these risks. After the successful completion of the surgery, your recovery process begins. This process may vary depending on the complexity of the surgery and your overall health condition, but it generally lasts at least 3 months.
Closed Method Canal Narrowing Treatment
Spinal canal narrowing surgery is performed using a method called endoscopic spine surgery, which utilizes special camera systems. This method has many advantages.
In particular;
- Does not damage healthy tissues,
- Reduces the amount of bleeding,
- Reduces the risk of infection,
- Shortens the recovery time,
- Reduces the need for painkillers after surgery,
- Shortens the hospital stay,
- Allows for a quicker return to normal life,
It also has advantages such as not requiring general anesthesia in some cases.
Screwless/Plate-free Canal Narrowing Surgery
In the closed method of canal narrowing surgery, the bone and ligament tissues causing pressure are not aggressively removed. In this case, risks that could damage the biomechanics of the spine, reduce its strength, and lead to displacements in the spine are eliminated. In rare cases, if these risks occur, special materials and bone support may be needed to support the spine. However, generally, the use of systems such as screws and plates is unnecessary. In spinal stenosis treatment performed with the closed method, plates/screws are not used except in special situations.
Recovery Process After Closed Canal Narrowing Surgery
After a complete closed spinal canal narrowing surgery, patients can usually walk and leave the hospital comfortably the next day. In open surgeries, the healing process takes longer, making the hospital stay more advantageous in closed methods.
Risks of Closed Spinal Canal Narrowing Surgery
The primary risk of spinal canal narrowing surgery is the rare possibility of spinal cord or nerve damage during the operation. To reduce these risks, it is important that the surgery is performed by an experienced team, that the operating room infrastructure and materials are adequate, and that the patient’s overall health condition is sufficiently evaluated before the surgery.
Non-Surgical Methods
If you are experiencing mild symptoms of spinal stenosis, you can try methods known to alleviate symptoms before medical treatment options. These methods include:
- Heat application: Applying heat to the painful area can be particularly effective in treating spinal stenosis caused by osteoarthritis. Heat application helps relax the muscles while increasing blood flow, aiding in the relaxation of the joints.
- Cold application: If heat application does not show any reduction in symptoms, you can try cold application. Ice is effective in reducing swelling and inflammation. You can apply it to the painful area for about 20 minutes.
- Physical activity: You can follow an exercise program recommended by your doctor to reduce symptoms such as weakness and difficulty maintaining balance, and to support the spine.
If you have persistent symptoms that do not improve with these methods, your doctor will inform you and refer you to non-surgical treatment options. These methods include:
- Oral medication: The first method your doctor will likely resort to is medication. The aim of the medications is to reduce inflammation and alleviate pain.
- Physical Therapy: You can implement an exercise plan that helps you gain strength and balance, and increases flexibility with the help of a physiotherapist.
- Steroid injections: These are administered near the spinal canal to reduce symptoms such as pain and inflammation. However, they can only be done a limited number of times as they may cause tissue weakening in the long term.
- Decompression procedure: Preferred in the treatment of spinal stenosis caused by thickening. It is an outpatient procedure. A small incision is made, and your surgeon removes a portion of the thickened tissue with special instruments. It does not require you to stay in the hospital, and you can continue your daily life on the same day.
Spinal stenosis, known as the narrowing of the spinal spaces, is a treatable condition. With multiple treatment options available, you can learn about the most suitable treatment option for you by scheduling an appointment with a healthcare facility as soon as possible.
