Spinal stenosis is a very common disease of the spine, the incidence of which has been increased in recent years, along with the improvement of life expectancy in western societies.
It is a condition which in its most severe forms, if neglected, involves several risks, ranging up to severe types of paralysis.
Today, it is treated with contemporary surgical methods that focus on areas with stenosis through a small hole, unlike in the past when major surgeries were usually carried out, with incisions along the spine in order to decompress just a small area.
What is Spinal Stenosis?
With this term we mean the narrowing of the spinal canal, which results in pressure on the nerves or even on the spinal cord. Spinal stenosis can affect the cervical or lumbar spine with different symptoms in each case.
It occurs just as often in men and women, especially after the age of 50.
What causes spinal stenosis?
The main cause of spinal stenosis is the normal wear and tear of the vertebrae over the years. In other words, spinal stenosis is a degenerative disease, which results in the development of so-called bone spurs and osteoarthritis. When these bone structures develop, they take up space by pressing on the nerves.
Another common cause is intervertebral disc herniation, which can cause spinal stenosis in younger people or worsen the problem of a spine with osteoarthritis, further limiting the space available for nerves.
Thickening and hardening of the spinal ligaments, also known as ankylosis, is also a common cause of spinal stenosis. In essence, it is a defensive mechanism of the body, which through an inflammatory process causes the thickening of the ligaments that allow the movement of vertebrae in order to limit the mobility of the spine.
A less common cause of spinal stenosis is tumors, which also take up space and press on nerves. Tumors grow much faster compared to spinal degeneration and require immediate surgery.
Finally, fractures of the spine can cause spinal stenosis, either primary or secondary, as they result in displacement of bony parts of the vertebrae, a condition that also requires immediate surgical restoration.
What factors predispose to Spinal Stenosis?
The main factor is age, as spinal stenosis is a degenerative disease. Beyond age, there are genetic factors, such as when someone is born with a narrower spinal canal. In these cases, the vertebrae have congenitally narrow lumens. In other words, the space available to these vertebrae is smaller than normal, and as a consequence the spinal stenosis appears sooner along with more severe symptoms.
Other causes that predispose spinal stenosis are deformities of the spine, such as scoliosis, which also accelerate the onset of the disease.
Finally, spinal cord trauma is a predisposing factor for spinal stenosis. Indicatively, a fracture can be repaired without any problem, but it can be a cause for the appearance of the disease in the long run due to post-traumatic arthritis.
How dangerous is Spinal Stenosis?
Spinal stenosis risk depends on the area it affects. It does not evolve immediately in its most dangerous form, however if neglected it can lead to severe disability.
Generally, when spinal stenosis affects the cervical spine, it becomes more dangerous. In cervical spine the stenosis can cause damage to the spinal cord, a very sensitive anatomical structure, which is the continuation of the brain within the spine. Any damage to the spinal cord is usually irreparable and we should seek immediate medical advice in order to stop the progression of the disease.
When spinal stenosis affects the lumbar spine, it can cause loss of bladder and bowel control and significant muscle weakness, which can reach the limits of paralysis.
What are the symptoms of spinal stenosis?
In the lumbar spine, spinal stenosis begins with numbness and tingling in the feet and toes, as well as some kind of weakness in certain muscle groups of the foot.
It then causes pain and cramps in both legs, especially when the patient is standing for a long time, but also when trying to walk. Pain can occur in the sole of the foot, calf thigh, buttock, depending on the trapped nerve. If all nerves are trapped, then the pain can occur everywhere, including the waist.
In the cervical spine, the spinal stenosis begins with numbness and tingling in the hands and fingers and then causes a feeling of weakness in arms and feet. More progressively, the patient may experience a loss of balance and loss of coordination of hand movements. This is a symptom that, if not solved immediately, may last forever.
When the disease worsens, neck pain, dizziness and headaches occur. In more severe cases of stenosis, in which the spinal cord is compressed as well, loss of movement coordination and balance, as well as bladder and bowel control problems occur.
The diagnosis of spinal stenosis is made by clinical examination, history taking and imaging tests, which include x-rays and MRI. In cases where the patient can’t have an MRI, then a CT, or CT-Myelography can be performed.
How is Spinal Stenosis treated?
The treatment of spinal stenosis depends on the stage of the disease and its symptoms. If symptoms allow it, then it is preferable for the patient to start with conservative treatment. But, when there are neurological symptoms, then the only way is the surgical restoration of the problem.
When is conservative treatment chosen?
If the symptoms of spinal stenosis are simply numbness and pain, then conservative treatment is indicated. The patient is given painkillers along with antidepressants and antiepileptic drugs, which have been shown to be very effective in treating the pain caused by nerve pressure. In more severe cases, opioids are given.
At the same time, physiotherapy is provided, which has three goals: strengthening the muscles around the spine, maintaining their flexibility e.g. with stretching exercises, and improving patient’s balance.
The next step of conservative treatment is the injection of steroids into the spine. The injection is done right next to the irritated, swollen or pressed nerves by the stenosis in order to control the inflammation and avoid surgery for as long as possible. This does not solve the problem, as it does not create space for the nerves.
The results of the injections can be beneficial to a large extent. Their duration, however, ranges between two weeks to six months, without being able to predict it in advance.
What are the surgical restoration methods available?
When conservative treatment has nothing else to offer, then surgical treatment follows, which aims to decompress the pressed nerves. How this is achieved depends on many factors, such as the technique and method applied by each surgeon, his surgical ability and his ability to decompress areas through small holes rather than large incisions.
In particular, there are the following surgical approaches:
The classic laminaectomy is an outdated operation, during which all the posterior elements of the vertebra are removed in order to give space to the nerves, turning the tube into a lumen.
More modern methods are similar, but they focus exactly where the pressure is exerted, without removing those elements that do not exert pressure but contribute to the support of the spine. This approach entails less surgical trauma compared to conventional patellectomy.
Microdecompression is a surgical approach that entails even less trauma. With this technique, decompression is achieved through a surgical hole – not an incision – through the use of a microscope, only on the one side of the vertebra, even if the stenosis has appeared on both sides.
Which surgical method is better and safer for me?
Each case is different and there is no surgery that is considered the best for all patients. However, for the vast majority of patients there are important benefits due to rapid recovery and short (same day) hospitalization, thanks to the micro-decompression method which has just as good or even better results than more traditional surgical approaches.
Frequently asked questions
How many years of experience does Dr. Starantzis have in this particular method?
Dr. Starantzis has extensive experience with the method of microdecompression having operated on hundreds of cases .
What kind of anesthesia will I receive?
All surgeries for the restoration of spinal stenosis are performed under general anesthesia.
For how many days will I need to be hospitalized?
Microdecompression surgery requires maximum one day of hospitalization, unlike the traditional method, which requires the patient to stay in the hospital for four days. A significant percent of the patients (70-80%) don’t even have to stay in the hospital overnight.
When can I return to work?
It depends on the type of job. The patient can return to manual work six weeks after the surgery. In case of an office-based job the patient can return after two weeks.
When will I be able to lift weights and exercise?
As in the case of manual work, the patient can return to sports activities and physical exercise or weight lifting after six weeks.
What is the success rate of this surgical method?
If applied with the right indications to the right patients, the success rates are over 90%-95%.
What are the postoperative complications?
Surgical restoration of spinal stenosis is generally a very safe operation, one of the safest spine operations. However, there is a minimal chance of complications related to surgery.
The most serious complication of all is partial paralysis, which however occurs in significantly less than 1% of the cases.
Another complication, as in all surgeries, is the risk of an infection, against which antibiotics are taken prophylactically.
Rarely, cerebrospinal fluid leak can cause problems in wound healing, but – normally – does not affect the outcome of the operation and does not cause problems in the long run.
Can I have a relapse and what happens in this case?
There is a possibility for the reappearance of the symptoms due to the recurrence of the condition, this time in another part of the spine. However, once the stenosis has been decompressed properly, it is extremely rare for the stenosis to reappear in the same area.
Why choose Dr. Starantzis?
Dr. Starantzis has been highly trained in centers abroad and has extensive experience in numerous surgeries at the University Hospital of North Midlands, in the United Kingdom.
Dr. Starantzis offers patients with spinal stenosis the most contemporary and safe method to deal with this problem.