What is Spinal Stenosis?
The spinal canal refers to the space formed by the combination of vertebrae that surrounds the spinal cord—a nerve structure that transmits signals from the brain to the arms and legs—and is surrounded by soft tissue, bone tissue, and ligaments, resembling a tunnel. The front of this canal is enclosed by the vertebral body and the intervertebral discs, while the back is surrounded by ligaments and the bony structure of the vertebra called the lamina. With aging, wear and tear in these structures can cause calcification and thickening of the ligaments, leading to a narrowing of the canal. Spinal stenosis is diagnosed when the canal's anteroposterior diameter, which should normally be more than 13 mm, falls below 10 mm. When it drops below 7 mm, there is a severe stenosis.
Who is More Likely to Experience Spinal Stenosis?
Since it is a condition that develops with the aging process, it is most commonly seen in individuals over the age of 60. However, narrowing can also occur at earlier ages due to traumatic causes that can lead to deformation of the canal, infections, tumors, or spinal fractures. The type of spinal stenosis we are referring to here is the one that occurs due to aging.
Which Part of the Spine is Affected by Spinal Stenosis?
It is most commonly seen in the lower back (lumbar region), but it can also occur in the neck (cervical region) and, rarely, in the upper back (thoracic region).
What Are the Symptoms of Spinal Stenosis?
Depending on the area of stenosis, symptoms may vary. In cases where stenosis occurs in the lower back, the following symptoms may be observed:
- Reduced walking distance
- Pain and/or cramping in the legs
- Burning, numbness, or loss of sensation in the legs
- Weakness in the legs in severe narrowing
- Urinary incontinence in advanced cases
- Difficulty maintaining an upright posture and leaning forward while walking
- Lower back pain
Is Surgery Always Necessary for Lumbar Spinal Stenosis Treatment?
No. Except for cases that require mandatory surgery, initial treatment should always be non-surgical methods.
In Which Cases Is Surgery Definitely Required for Spinal Stenosis?
If the patient is experiencing progressive weakness, indicating paralysis, or if neurological symptoms such as urinary incontinence have begun, surgical treatment should be planned in the early stages.
In Which Situations Should Surgery Be Considered for Spinal Stenosis, Aside from Critical Cases?
Surgery should be considered when non-surgical treatments fail—meaning if the patient's symptoms do not improve despite effective physical therapy or pain management treatments and if they experience pain severe enough to hinder daily activities.
What Types of Surgeries Are Performed for Spinal Stenosis?
In patients requiring surgery for spinal stenosis, the goal is to relieve the pressure on the spinal cord by removing the compressing tissues. This can be done using either minimally invasive or open surgical methods. Minimally invasive techniques involve endoscopic visualization, while open surgeries are performed with the aid of a microscope. Both methods have their advantages and disadvantages; the important factor is the surgeon's expertise. Experienced surgeons can achieve successful outcomes with both techniques.
Is It Always Necessary to Place Implants in Spinal Stenosis Surgeries?
In some cases, connecting the vertebrae with screws and metal rods can improve surgical outcomes and patient satisfaction. These cases may include:
- Significant scoliosis along with spinal stenosis
- Spinal stenosis accompanied by spondylolisthesis and abnormal vertebral motion
- Structural flat-back syndrome that is unlikely to improve after spinal decompression
- Revision surgeries (especially if previous screws have loosened or metal rods have broken)
- Severe lower back pain in the patient
In Which Patients Should Non-Implant Surgeries Be Preferred in Spinal Stenosis Surgery?
If patients have complaints only related to stenosis and are unable to endure a long surgical procedure due to poor overall health conditions—such as kidney failure, heart failure, chronic cardiovascular diseases, uncontrolled diabetes, or morbid obesity—non-implant surgeries may be preferred, considering the patient's general condition. However, the important point here is to remove the pressure without damaging the normal anatomy of the spine or compromising its stability. Additionally, in patients with severe osteoporosis where implant surgeries are necessary, medical treatment should be used to improve bone quality, and special reinforced screws should be utilized. Studies have shown that non-implant surgeries in patients who require implants have a lower long-term success rate compared to surgeries with implants.