Spinal Stenosis 

Our spine is the column that helps and maintains the stability of the torso and keeps the upright posture of the human beings. The second purpose of the spine is to protect the spinal cord which is located in the spinal canal. It surrounds and protects the spinal cord. As a result of multiple factors that causes narrowing of the spinal canal the spinal cord itself of the nerve roots that originate from the spinal cord is compressed and as a result the condition is called spinal stenosis.

The main purpose of the intervertebral discs –consist of cartilage- which are located in the two adjacent vertebrae through the whole spine is to allow some degree of movement in the anterior-posterior and lateral planes and the second purpose is to absorb and transfer the axial load though the whole spine equally. The ligaments help the intervertebral discs to maintain the stability. Especially after the age of 45, the disc degeneration is accelerated and the intervertebral joint stability decreases with thickened ligaments. As a result of these whole processes the neural structures are compressed and unable to perform adequately with accompanying pain.

The clinical picture is defined like the; signal transduction is reduced or interrupted from the back to the legs. Most of the patients define this situation as ‘my legs go numb after walking some distance, I feel like I don’t have the control, I look some place to sit otherwise I feel like about to fall’. This condition is called the neurogenic claudication.

Spinal stenosis is very rarely related with congenital disorders and be diagnosed in relatively young patient population. Most of the time it is diagnosed at age of 50. The most commonly affected level is L3-4. Sometimes it can be seen in a single level or multiple levels can be affected. More commonly seen in males when compared to females.

Lumbar disc herniation and spinal stenosis are two very different pathologies. In lumbar disc herniation the nerve root on one side is effected on the other hand in spinal stenosis nerve roots for both sides are compressed. In lumbar disc herniation leg pain is prominent on the other hand in spinal stenosis numbness in both legs and shortening of the walking distance is prominent. Lumbar disc herniation is seen in relatively young patient population while spinal stenosis seen in the elderly. In spinal stenosis the patient feels normal when leaning forward or resting, on the contrary in lumbar disc herniation the pain continues during resting and even at night.

In spinal stenosis, the complaints can progress despite physiotherapy and effective pain medication as a result causing restrictions in the daily activities of the patient. The patients’ physical performance declines in time. Pyhsiotheraphy and pain medication can slow down the process but do not change the final clinical picture. The main solution is to widen the narrowed spinal canal and release the nerve roots by surgical intervention.

For definitive diagnosis after full neurological examination magnetic resonance imaging or computerized tomography evaluation is needed. The neurological situation must be compatible with radiological evaluation.

After pain medication and physiotheraphy surgical intervention is the next treatment option. As an experienced clinician my last option before surgical intervention is epidural steroid injections which can have positive outcomes.

As a final result; despite all treatment options if the patient has persistent complaints the surgical intervention is inevitable. First choice is microdecompression which nerve compressing bone and ligaments are reshaped for definite relief. If iatrogenic instability is present than, transpedicular screw systems are used for additional fusion induction.

My personal choice is epidural steroid injections followed by micro-decompression for this particular patient population.