Surgery for the narrowing of the spinal canal

The narrowing of the spinal canal may cause pain, reduced walking distance, and other symptoms. Surgical treatment may be necessary in this case, the aim of which is to release the compressed nerves.

What does the narrowing of the spinal canal mean?

The narrowing of the spinal canal means that the anatomical size of the spinal canal, the diameters of the bony canal are smaller than the expected, physiological sizes.

Nerve structures, which are located in the spinal canal, can adjust to the available space to a certain point, so the nerve function may be maintained to some extent, and an almost completely painless state can occur with an extreme narrowing of the spinal canal.

The nerve structures, which are located here, are more susceptible due to the extreme anatomical set up, which developed with the narrowing of the spinal canal. The symptoms develop with time, as the narrowing aggravates.

In terms of its location, the narrowing of the spinal canal may be central, lateral, and foraminal (at the roots), or the combinations of these. It may develop on one, or on both sides, at one or at multiple levels, it could be accompanied by the slippage of the vertebrae, or pathological curvatures, which developed due to the spinal joint wear.

In case of the congenital narrowing of the spinal canal (primary spinal canal stenosis), the secondary or acquired space reducing factors exponentially increase the patient’s signs and symptoms.

Narrowing of the spinal canal in everyday life

Low back pain is a widespread disease in the civilized world, this is one of the most common symptoms because of which people seek for a doctor’s help. Of the people living in developed countries, 70 80% experience at least one episode of low back pain in their lifetime, which can be fortunately well managed with conservative treatment.

In this case, the cause of the pain can be either of the anatomical structures (intervertebral discs, facet joints, ligaments, muscles).

Chronic low back pain is a more complicated, and larger public health issue. The narrowing of the spinal canal is the cause of chronic low back pain in the majority of the cases.

Which are the main symptoms of the narrowing of the spinal canal?

• Pain: It could be low back pain, pain presenting in a belt like pattern, and/or pain running down the back outer surface of the lower limb in the direction of the buttocks, thighs, and knees.
• Reduced walking distance: The walking distance may be reduced up to a few meters due to the lower limb symptoms, which are produced, and which increase during gait. In this case, the patient has to sit down or slouch forward for minutes, before becoming able to walk further.
• Weakness, numbness, and disturbed sensation of the lower limb. Pain may be accompanied by numbness but radiating numbness may also develop without pain too.
• Pain avoiding, the so¬ called antalgic posture and/or gait.
• The symptoms increase during standing, while they decrease, or even resolve when sitting down or lying down.
• The symptoms may present on one side or on both sides, they may be constant or recurring, and initially, they respond well to non surgical treatment.

The surgical process

• The level of the narrowing is marked by an X ray image intensifier.
• Usually, an incision of 5 15 cm is made above the pathological vertebral segment.
• Surgical hemostasis is performed after opening the skin and the tissues underneath it.
• The musculature is pushed away from the arches of the adjacent vertebrae, while minding its integrity, then a small opening is created on the back wall of the spine.
• The nerves are held away, then a special instrument is used to remove the bony cartilaginous plaques, and thickened ligaments that cause the narrowing, along with any potential narrowing factors, which potentially originate from intervertebral discs.
• One or two drains are inserted into the wound, which drain the accumulating blood.
• The wound is sewed (closed) in multiple layers and covered with sterile dressing.

What happens if the justified surgical treatment is not performed?

• The nerve root may get permanently damaged due to the long term compression.
• The pain of the spine and the lower limb may continue to increase.
• The movement disability may aggravate.
• The quality of life may deteriorate further.
• A surgery performed later may become more difficult technically, and its effectiveness may decrease.