Spinal stenosis

Spinal stenosis is a very common condition of the spine, the incidence of which has increased in recent years, along with the improvement in life expectancy in Western societies.

It is a condition that in its most severe forms, if neglected, carries several risks, which reach severe forms of paralysis.

Today, it is treated with modern surgical methods that focus on the points where there is stenosis through a small hole, unlike in the past when large surgeries were usually performed, with incisions along the spine, to decompress only a small area.

With this term we describe the narrowing of the spinal canal, which results in pressure on the nerves or even the spinal cord. Spinal stenosis can affect the cervical or lumbar spine with different symptoms in these two cases.
It occurs equally often in men and women, especially after the age of 50.

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 spines and osteoarthritis. When these bone structures develop, they take up space by pressing on the nerves.

Another common cause is intervertebral disc herniations, which can cause spinal stenosis in younger people or exacerbate the problem of a spine with osteoarthritis, further limiting the available space for nerves.

The thickening and hardening of the ligaments of the spine, also known as ankylosis, is also a common cause of spinal stenosis. In essence, it is a defense of the body, which through an inflammatory process causes the thickening of the ligaments that allow the movement of vertebrae to limit the mobility of the spine.

A rarer cause of spinal stenosis is tumors, which also take up space and put pressure on the nerves. Tumors grow much faster compared to spinal degeneration and require immediate surgery.

Finally,  spinal fractures can cause spinal stenosis either primary or secondary, as they result in the displacement of bone parts of the vertebrae, a condition that also requires immediate surgical rehabilitation.

The main factor is age, as spinal stenosis is a degenerative disease. In addition to age, there are genetic factors, such as when someone is born with a narrower spinal canal. In these cases, the vertebrae have congenital narrow lumens. In other words, the available space in these vertebrae is smaller than normal, resulting in spinal stenosis appearing shorter and with more severe symptoms.

Other causes that predispose to spinal stenosis are deformities of the spine, such as scoliosis, which also accelerate the onset of the disease.

Finally,  trauma  to the spine is a predisposing factor for spinal stenosis. Indicatively, a fracture can be repaired without any problems, but it can be a factor in the manifestation of the disease in the long term due to post-traumatic arthritis.

The danger of spinal stenosis depends on the area it affects. It does not manifest itself directly in its most dangerous form, however, if neglected, it can end up in severe disability.

In general, when it affects the cervical spine, it becomes more dangerous. In the cervical spine, stenosis can cause  damage to the spinal cord, a very fragile anatomical structure, which is the continuation of the brain within the spine. Any damage to the spinal cord is usually irreparable, which is why we should seek immediate medical advice in order to, at least, stop the progression of the disease.

When spinal stenosis affects the lumbar spine it can cause loss of control of urination and defecation and significant muscle weakness, which can reach the limits of paralysis.

In the lumbar spine, spinal stenosis begins with numbness and tingling in the legs and toes, as well as, some form of weakness in certain muscle groups of the foot.

It then causes pain and cramps in both legs, especially when the patient sits upright for a long time, but also when he tries to walk. The pain can manifest itself in the foot, calf, thigh, buttocks, depending on the nerve that is trapped. If all the nerves are trapped, then the pain can manifest itself everywhere, including the back.

In the cervical spine, spinal stenosis begins with numbness and tingling in the hands and fingers and then causes a feeling of weakness in the hands and legs. More progressively, the patient may have a loss of coordination of movements in his hands and his balance. This is a symptom that, if not solved immediately, the problem,  It may even stay forever.

When the disease worsens, neck pain, dizziness and headaches appear. In more severe forms of stenosis, in which the spinal cord is also pressed, there is a loss of coordination of movements and balance, as well as problems with the control of urination and defecation.

The diagnosis of spinal stenosis is made by clinical examination, history and imaging examination, which includes X-ray and MRI. In cases where the patient cannot have an MRI, a CT scan or CT myeloscopy is performed.

The treatment of spinal stenosis depends on the stage of the condition and its symptoms. If the symptoms allow it, then it is preferable for the patient to start with conservative treatment. However, when there are neurological symptoms, then surgical rehabilitation of the problem is the only way.

When is conservative treatment done?

In case the symptoms of spinal stenosis are simply numbness and pain, then conservative treatment is indicated. The patient is given painkillers and, as an adjuvant, some antidepressants and antiepileptic drugs, which have been shown to work very well in pain caused by nerve pressure. In more advanced cases, opioids are administered.

At the same time, physiotherapy is planned, which has three goals: to strengthen the muscles around the spine, to maintain their flexibility, e.g. with stretching exercises, and to improve the patient’s balance.

The next step in conservative treatment is steroid infusions into the spine. An infusion is an injection that is given right next to the nerves that are irritated, swollen or pressed by the stenosis in order to control the inflammation and remove the surgery in time.  However, as there is no room for nerves, the problem is not radically resolved.

The results of injections can be good to a large extent. Their duration, however, ranges between two weeks and six months, without being able to predict in advance.

What surgical restoration methods are there?

When conservative treatment is exhausted, surgical treatment follows, the goal of which is the decompression of the pressed nerves. How this is achieved depends on many factors, such as the technique and method applied by each surgeon, the  surgical skill and the ability to be able  to decompress areas through small holes and not large incisions.

In particular, there are the following surgical approaches:

Classic petalectomy is an obsolete operation, in 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 follow the same logic, but focusing exactly where the pressure is exerted, without removing those elements that do not pressure but contribute to the support of the spine. This approach has less surgical trauma compared to classic petalectomy.

Microdecompression is a surgical approach that leaves even less trauma. With this technique, decompression is achieved through a surgical hole – and not an incision – using a microscope, only on one side of the vertebra, even if the stenosis has occurred on two sides.

Which surgical method is best and safest for me?

Every case is different, and there is not one operation that is considered the best for all patients. However, the vast majority of patients have serious benefits from the quick rehabilitation and short hospitalization, of a single day, that the method of microdecompression allows, which has the same good or even better results compared to more traditional surgical approaches.