Acıbadem Comprehensive Spine Center

Aging Spine

Lumbar Narrow Canal

Lumbar narrow canal (spinal stenosis)

Lumbar Narrow Canal With advancing age, the discs between the vertebra lose their spongy structure and begin to harbor less water. This change results in decreased disc height and bulging of the hardened disc into the spinal (spinal cord) canal. The spinal cord carries the nerves that give sensation and power to the legs. The bones and ligaments of the spinal facet joints thicken due to arthritis ( loss of cartilage tissue), and make pressure on the spinal canal. These changes cause the lumbar spinal canal to narrow and this condition is called narrow lumbar canal (spinal stenosis).

Lumbar narrow canal can be resembled to the accumulation of lime inside a garden hose in time. (figure 1). Identical to the lime narrowing the diameter of the garden hose, narrow canal narrows the diameter of the spinal canal.

Lumbar (lower back) spine consitutes of a series of interlinked bones that are called vertebrae. The bones surround the spinal canal inside the vertebrae through which the spinal cord passes. Other structures that consitute the boundaries of the spinal canal are intervertebral discs between the vertebrae, facet joints, and connective tissues.

What are the signs of lumbar narrow canal?

Lumbar narrow canal does not always cause symptoms.

Pain or loss of sensation in the back, pain in the legs, cramp, numbness, weakness, urinary incontinence may be present. The symptoms may worsen when sitting or standing for long periods. The current symptoms may come and go or their severity changes in time. Bending forward or sitting will increase the spinal canal’s diameter, causing the pain to decrease or totally disappear. The most typical complaint of the patients is weakness, sensory changes, numbness-tingling in the legs, and inability of the legs to move step any longer. Patients in such condition search for a place to sit. After sitting and bending forward for some time the legs regain their power and the patient begins to walk again. However after a certain distance, the symptoms recur and the patient feels the need to sit again.

How is lumbar narrow channel diagnosed?

You should first give detailed information to the questions asked by your doctor regarding your complaints. An X ray may be obtained to examine the disc spaces or thickened facet joints. Magnetic resonance imaging (MRI) provides very detailed information on the narrowness of the spinal canal and compression of the spinal cord. Similarly, computer tomography (CT) or lumbar myelogram may be used to obtain detailed images. All of these studies can provide information on the presence, location, and severity of the narrow spinal canal and nerve root compression.

What are the treatment methods for lumbar narrow canal?

After your doctor establishes the diagnosis of narrow lumbar canal, he or she will first try nonsurgical treatments.

What are the nonsurgical treatment methods in lumbar narrow canal?

Nonsurgical methods in lumbar narrow canal include are anti-inflammatory drugs that decrease inflammation or analgesics. Physical therapy for facilitation of your daily activities by increasing your elasticity, strength, and overall conditioning may be also considered. Spinal injections (epidural cortisone injections) may be also offered.

Medical treatment in lumbar narrow channel

One or more drugs may be prescribed by your doctor to decrease the symptoms of the disease and to increase your ability to move. Drugs used in pain control are named analgesics. In most cases the pain responds to commonly used (nonprescribed, over the counter) painkillers such as aspirin or acetaminophen.

Some analgesics named non-steroidal anti-inflammatory drugs (NSAIDS) may be added for the control of irritation and inflammation. These include ibuprofen, naproxen, and various drugs sold with prescription. If your doctor prescribes painkiller or antiinflammatory drugs, you should watch out for side effects such as gastric upset or bleeding. You should be under the follow up of your doctor against the problems that may occur with long term use of over the counter painkillers or NSAIDs.

If you have intense and persistent pain that is not relieved by other analgesics and NSAIDs, then your doctor may prescribe narcotic analgesics (like codein) for a brief period of time. You should use only the recommended amount. Taking higher doses of drugs will not accelerate your healing. Besides, use of high doses have side effects such as nausea, constipation, lightheadedness, dizziness, and also their use may lead to addiction. All drugs should be taken the way they are described. Report to your doctor all the drugs you are using (including nonprescription drugs you used), and if your doctor recommended painkillers tell your doctor whether you tried any of them before, tell if you had gotten any beneft or not, and the side effects they created.

There are other drugs with anti inflammatory effects. Corticosteroid drugs (in tablet or injection form) are sometimes prescribed in very intense low back and leg pain for their potent antiinflammatory effects. Corticosteroids may have side effects like NSAIDs. You should discuss the benefits and risks of these drugs with your doctor.

Selective spinal injections or “blocks” may be used to relieve very intense pain. These are cortisone (corticosteroid) injections performed into the epidural space (the space around the spinal nerves) or into the facet joints by a doctor trained for the technique. The first injection may be supplemented with one or two more injections later. These are generally performed as a part of a rehabilitation and treatment program.

Lumbar narrow canal operation

Patients suffering from lumbar narrow canal often avoid activities. This results in decreased mobility, flexibility, strength, and cardiovascular conditioning. This situation can be improved by a physical therapy or exercise program. Physical therapy and exercise program generally begins with stretching exercises to make the tightened muscles flexible again. You may be asked to repeat the stretching exercises frequently to preserve your flexibility. Cardiovascular exercises such as fitness bicycles, treadmill, swimming may be added to the program to increase the conditioning and and improve the blood circulation in the nerves. Increased blood flow in the nerves may decrease some of the symptoms of narrow canal. Also, exercises directed toward strengthening the back, abdominal, and leg muscles can be given.

Your daily activities will be easier if your flexilibity, strength, and conditioning are maintained and increased. Your physiotherapist or doctor can tell you how you can add a constant exercise program to your life by using simple devices at home or by going to a sports center.

Changes performed in the home setting and house safety are important for some people with lumbar narrow canal. Some of the devices at home like the laundry machine may need to be transported to more suitable locations. A nightstand next to the bed may be useful. If necessary, bathroom safety tools are also recommended. Plans for cooking, timing of activities and decreasing the workload should be reassessed. It is important that all required aids like the walking stick or walker fit the patient exactly. Unless there is an evident or increasing weakness in the legs or the occurence of bowel and urinary problems, the presence of a narrow canal does not constitute a dangerous situation in adults. Therefore the aim of treatment is to decrease the pain and increase the functionality of the patient.

Nonsurgical treatments do not correct the narrowing in the spinal canal however they provide long term pain control and increase functionality without the need for surgery. A rehabilitation program requires treatment under supervision that takes three months or longer.

When is surgical treatment necessary in lumbar narrow canal?

In patients with lumbar narrow canal, surgery is offered to patients whose pain and complaints have not responded to nonsurgical treatment methods, or functions like walking-moving have been seriously damaged.

Surgical treatment in lumbar narrow canal patients is also applied to patients with progressive leg weakness or problems with bladder or bowel control. Surgical treatment may be considered as a viable option also in patients with progressive decrease in walking distance or detoriation in the quality of life. Rehabilitation support should be obtained after the operation to facilitate transition to daily life.

Spinal fusion treatment in lumbar narrow canal

Lomber Dar Kanal In some cases of narrow canal, the vertebra may be slipped over one another (spondylolisthesis). In some conditions there may be a scoliosis (curve to the side) in the lower back. This condition may create abnormal movement (instability) between the vertebrae. In addition to decompression surgery, spinal fusion surgery may be also performed in these conditions to stabilize the vertebrae. Bone pieces, bone substitutes and/or metal devices (instrumentation) may be inserted between the vertebrae that will be fixed with fusion. (figure 2)

The fusion may be carried out from the front, back, or both. The front versus back approaches in fusion operations is determined by a number of technical factors including the need for removal of bone prominences, anatomic variations between patients, and the degree of instability.

In most patients with lumbar narrow canal, pain decreases after the operation, and significant improvement and increases in all activities are observed 6 to 9 months after the operation. A postoperative rehabilitation program is often initiated for the return to daily activities and a normal life.

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