Spinal Stenosis
Spinal Stenosis
What It Is
In spinal stenosis, exactly what the condition’s name describes occurs: a narrowing of the spinal canal in the cervical, thoracic (more rarely), or lumbar spine, with simultaneous compression of the spinal cord and/or the nerves. Spinal stenosis is a result of spinal degeneration. Patients often present with no symptoms at the early stages of the disease, and what typically triggers symptoms is nerve compression, usually following some form of trauma.
Spinal Stenosis
Symptoms
The symptoms of spinal stenosis, depending on the affected region, may include:
1.
Pain, heaviness, and weakness in the legs that worsen with walking and are relieved when sitting (neurogenic claudication)
2.
Lower back pain that improves with forward bending and rest
3.
Tingling and burning sensation in the lower limbs
4.
Very rarely, patients may experience urinary or bowel dysfunction (incontinence)
Spinal Stenosis
Diagnosis
During physical examination, patients may exhibit weakness and decreased sensation, which are strong indicators that something is wrong. An MRI can show the extent of the damage.
Endoscopic Decompression
An advanced evolution of tubular microdecompression is endoscopic decompression. In this method, the microscope is replaced by a camera, and the working tube is reduced from 18 mm (typical for tubular microdecompression) to just 10 mm. The surgical trauma is even smaller; however, there is no significant difference in hospitalization or recovery time. When a surgeon is new to this technique or lacks sufficient experience, there is a risk of inadequate decompression and the need for reoperation.
Lumbar Spinal Fusion
Lumbar fusion is a surgical procedure used to treat instability in the vertebrae (e.g., spondylolysis, spinal stenosis). It is performed by a specialized spine surgeon who inserts rods and screws made from special metal such as titanium.
The ultimate goal is to stabilize the spine and minimize any existing neurological deficit.
Minimally Invasive Transforaminal Interbody Fusion (TLIF)
This is a minimally invasive technique where the spine is operated on percutaneously, without the need for an open approach. The result is less damage to bones and muscles in the area, shorter hospital stay, and rapid recovery.
Minimally Invasive Lateral Fusion
The primary aim of this procedure is to correct spinal curvature and restore alignment using special implants, secured with plates and screws. Bone grafting is also applied.
The operation is performed with a minimally invasive lateral approach (MIS XLIF) at the levels affected by scoliosis and spinal stenosis.
Percutaneous Microdecompression and Minimally Invasive (MIS) Fusion
A combined procedure that can offer significant benefits in spinal stenosis, provided the patient is an appropriate candidate.
Corpectomy
When vertebral body damage is such that it cannot be corrected otherwise and the spinal cord is compressed, the surgeon must intervene decisively by performing a corpectomy. It may be the procedure of choice for fractures, tumors, or cervical myelopathy. It is performed under general anesthesia and is considered a complex and demanding surgery, but one that can prevent disability.
Laminoplasty
Laminoplasty is a technique that effectively treats extensive cervical spinal stenosis and cervical myelopathy, particularly in younger patients.
With this method, a “door-like” mechanism is created at the back of the spinal canal by elevating at least three laminae—similar to opening a door. This expands the spinal canal and allows the spinal cord to revascularize.
It is a clever technique that preserves neck mobility (unlike spinal fusion), relieves spinal cord compression, and allows early patient mobilization.
