Do you also start to feel pain in your legs when you walk a little? Do you feel a tingling sensation that starts in your back and goes down your legs, and you feel like you're losing control of your legs? Your doctor may have told you about a condition called ' spinal stenosis '. Don't be scared when you hear this word. This is a condition that can affect many people, especially those in middle age and older. Let's take a simple look at what it is and whether it always requires surgery.
What is Spinal Stenosis?
Simply put, our spine is a continuous row of bones. Inside these bones, the spinal cord, which is the main part of our body's nervous system, and the nerves that come out of it are protected. The path through which this spinal cord travels, that is, the canal-like part inside the spine, we call the spinal canal.
Just as a water pipe becomes narrow over time due to dirt and rust, our spinal canal can also become narrow as we age, due to conditions like arthritis, or due to the formation of bone spurs. Then the spinal cord and nerves that run through that canal start to get compressed. We call the collection of symptoms caused by that compression of the nerves Spinal Stenosis.
The main symptoms caused by this are:
- Pain in the neck, back, or legs.
- Numbness, tingling, or muscle twitching in the arms or legs.
- Foot problems (for example, the foot hits the ground when walking).
- Sometimes the pain in my legs becomes so severe that I can't even walk a short distance.
Is surgery the only solution?
No. This is what scares many people. But the truth is, not everyone with spinal stenosis needs surgery. Your doctor will definitely try other treatments before referring you to surgery.
Remember, surgery is usually a last resort. A doctor will only consider surgery if other treatments have not been successful.
Let's see what non-surgical treatments are available in the table below.
| Treatment method | What happens to it? |
|---|---|
| Pain relievers | Pain can be controlled with common painkillers like Paracetamol and Ibuprofen. For neuropathic pain, your doctor may prescribe specific medications like Duloxetine, Gabapentin, Pregabalin (Lyrica). |
| Injection (Epidural Steroid Injection) | This involves injecting a steroid called cortisone directly into the area where the spinal cord is pinched. This can temporarily, and sometimes permanently, reduce pain and swelling. |
| Physical Therapy & Exercise | This is very important. By doing exercises that strengthen the back and abdominal muscles under the guidance of a physical therapist, you can control the pain and improve your ability to walk. |
If these treatments do not control your symptoms, and if the pain interferes with your daily activities to the point where you cannot function, then your doctor will talk to you about surgery.
How do you prepare for an operation?
If your doctor recommends surgery for you, there are a few things you need to do before it happens.
- Exercise: Don't be surprised. Engaging in appropriate exercise with your doctor's approval before surgery will go a long way in helping you recover faster after surgery.
- Stop smoking: If you are a smoker, you should definitely quit. Smoking delays the healing process.
- Be aware of your medications: Tell your doctor about all medications, vitamins, and supplements you are taking. Some medications that can cause problems with anesthesia may need to be stopped before surgery.
- Someone to help: Arrange for someone to take you to the hospital and back home.
What types of surgeries are performed?
There are three main types of surgery for spinal stenosis. Your doctor will decide which surgery is best for you based on your condition.
| Type of surgery | A simple explanation |
|---|---|
| Laminectomy | This is the most common surgery. In this procedure, the bone fragments, bone spurs, and ligaments that are causing nerve compression are surgically removed, allowing the nerves to move freely. |
| Spinal Fusion | Sometimes this is done in conjunction with a laminectomy. This is a procedure that reduces spinal instability by fusing one or more vertebrae together. Metal screws and rods may be used for this purpose. |
| Foraminotomy | If the foramen through which the nerves exit the spinal cord is narrowed, this surgery enlarges the foramen and reduces pressure on the nerves. |
What are the possible risks of surgery?
As with any surgery, these surgeries carry some risks. In particular, people who smoke, are elderly, obese, or have other medical conditions such as diabetes mellitus are at slightly higher risk of complications.
- Infections, bleeding, or blood clots may occur.
- There is a small chance of damage to the membrane covering the spinal cord.
- There is a risk of nerve damage.
- Sometimes the pain may persist.
Don't be afraid of these risks. Your doctor will explain everything to you and take every possible step to minimize the risk.
How long does it take to heal?
You will need to stay in the hospital for two to three days after the surgery. After some minor surgeries, you may be able to go home the same day or the next day. It depends on the type of surgery you had and your health.
After returning home, it can take 3 months or more to fully recover. It can take a while, especially if you had a spinal fusion. During this time, it is very important to walk as directed by your doctor and do exercises recommended by a physical therapist.
Many people have very good results after surgery. They have less pain in their legs and are able to walk better. But there is one thing to remember. This surgery does not cure conditions like arthritis that caused your spinal stenosis. Therefore, there is a chance that symptoms will return in the future.
Take-Home Message
- Spinal stenosis is a narrowing of the spinal canal that commonly occurs with age.
- This does not always require surgery. Treatments such as medications, injections, and physical therapy are tried first.
- Surgery should only be considered if other treatments have failed and the pain is making it difficult to live your daily life. Talk openly with your doctor about this.
- Recovery after surgery takes time and dedication. Follow the doctor's instructions and exercises exactly.
- Keep in mind that although surgery may provide significant relief from symptoms, it does not cure the underlying disease (e.g. arthritis).
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