Everything you should know about canal stenosis

Canal stenosis is the leading cause of spinal surgery in people over the age of 65, although it is also a disease that can affect younger people.

Normally, the origin of canal stenosis is degenerative, although it can be caused by many types, from traumatic to neoplastic origin. If it is degenerative in origin, the articular facets of the spinal canal increase in size, causing degeneration of the surrounding tissues and ligaments in the area.

As a result, the enlarged tissue occupies part of the spinal canal, resulting in a narrowing of the space through which the nerve roots and spinal cord pass. If this ‘occupation’ is prolonged over time, nerve roots and spinal cord may become compressed, resulting in the signs and symptoms of canal stenosis.

Types of canal stenosis

At Clínica Dr. Mosqueira we treat both lumbar canal stenosis and cervical canal stenosis. In the case of lumbar canal stenosis, it is located in the lower back, and may be associated with the appearance of one or more herniated discs, which further compresses the nerve roots. Cervical canal stenosis affects the neck, where the spinal cord may be completely compressed, which may damage it.

In the cervical area, narrowing is less common, although there are many cases.

Canal stenosis changes the place of origin and the area where the symptoms occur, but usually the solution is the same.

It is considered that 8 out of 10 patients aged 50 or more suffer from lumbar canal stenosis, which makes this pathology one of the main causes of disability.

What are the symptoms of canal stenosis?

If the compression of the nerve roots is prolonged, pain often increases and may become constant and symptoms appear.

They are usually progressive and gradual. Here, just as there are two types, they must be differentiated according to the area in which the canal stenosis occurs.

In lumbar canal stenosis, the first pains occur in the lower back and progressively move towards the lower extremities: pain, tingling, numbness in the legs when walking… In more severe cases, there is also a loss of strength.

The neck is usually another of the parts of the body most affected. Initially, the signs may progressively and upwardly increase, producing some pain in the neck, as well as tingling, numbness and loss of sensation. The upper extremities are also affected, as well as the legs: numbness and/or weakness in the arms, hands and legs, complications such as difficulty in walking, difficulties in maintaining balance, coordination problems, incontinence problems and, in the most severe cases, a reduction in strength.

How is canal stenosis treated?

In mild cases, neurosurgeon Dr. Bernardo Mosqueira always opts for conservative treatment, which can be effective. The case is studied in depth in order to make a diagnosis before considering surgical intervention.

What does this type of treatment for canal stenosis consist of? On the one hand, the patient receives a series of recommendations on ergonomics and postural hygiene, and drugs such as analgesics, muscle relaxants and corticosteroids can also help to improve the problem. And, on the other hand, there is the figure of the physiotherapist, who focuses the activity of stretching, strengthening, conditioning and postural education in the affected area with the aim of alleviating and providing a solution to the problem.

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When is surgery necessary?

When conservative treatment does not respond, or when there are very severe cases of stenosis, it is necessary to resort to surgery. First of all, it must be said that this is a minimally invasive intervention, which is performed through a microscope and through tiny incisions of only four centimeters, so that the affected area will have a minimal extension.

Thus, the neurosurgeon can focus as much as possible on the intervention, enlarging his field of vision up to ten times and acting only on the damaged area, which also allows a much faster recovery.

Depending on the characteristics of each patient, it will be decided which surgical method to use, although decompressive microlaminectomy is normally used. Thus, thanks to the surgical microscope, a small incision -about three or four centimeters- is made in the back, following the line of the spine, and just over the area where the pain is located, in order to remove a part of the vertebra that is causing the compression of the nerves.

Another treatment option is microlaminaminotomy, releasing pressure on a nerve while widening the opening in the back where the nerve roots exit the spinal canal. Everything will vary depending on the level, location and situation where the narrowing is located.

What are the benefits and results of non-invasive microsurgery?

Non-invasive or minimally invasive microsurgery has multiple benefits for the patient both during and postoperatively, as it causes less pain for the patient and, in turn, fewer complications, resulting in shorter recovery times. When working with the microscope in a specific point the incision is only three or four centimeters, so no trace of a conspicuous scar is left on the body part.

Although it may seem surprising, with this type of intervention patients are discharged from the hospital in just 24-48 hours, which means that in a matter of days they are walking without pain. Microsurgery is positioned as a safe technique with a high success rate that moves away from the use of plates and screws.

The recovery of the quality of life entails the beginning of a normal life. The next step is to have a check-up at Dr. Mosqueira Clinic. After 21 days the stitches are removed, the condition of the incision is examined and the area most affected by the pathology is explored.

The next visits are usually at three and six months, although in some exclusive cases the patient may be seen after one month for a more in-depth follow-up of the problem. The return to work will depend on the type of profession, since some jobs will require more physical effort. After three months of recovery, the average time to return to work is three months.

For more information, contact a neurosurgeon.