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Canal Stenosis

Thanks to the development of modern medicine, human life is getting longer and longer, and due to this situation, we are encountering more and more patients with spinal stenosis due to aging. Problems in our spinal joints that negatively affect the quality of life can be due to a variety of reasons.

He was the first Turkish doctor to draw attention to the fact that spinal canal stenosis and compression of the spinal cord could cause numbness and loss of strength in the legs. Prof. Dr. Münir Ahmet Sarpyener published his scientific article on this subject in 1945 in the prestigious journal J of Bone and Joint Surgery, which still maintains its prestige today.

Dr. Yunus Aydın and his team have closely followed the Turkish surgical knowledge on canal stenosis and have contributed to it for many years. We have gained a great deal of experience with the high number of surgeries we have performed.

1

How Does Canal Stenosis Occur?

Our spine, which is made up of thirty-three vertebrae on top of each other, with structures called discs in between, held together by ligaments that create meaningful indentations and protrusions, provides us with the ability to walk on two legs, which distinguishes us from other living beings, with the support of our muscles and rib cage. This stance of humans is against gravity, as we age, gravity pulls us down. We can resist this as much as the strength of our spine. The main purpose of the Pilates sport, which has become very popular recently, is to delay this bending. As the diameter of the spinal canal narrows, the protective mechanism present in our body from creation comes into play. It prevents the canal from narrowing further by bending us forward. On the contrary, if we bend backward, the thickened yellow ligament makes the canal more curved and increases the narrowness. The protective mechanism of our body comes into play and puts us in the fetal position.

2

What are the symptoms of canal stenosis?

A patient with spinal stenosis usually sees a doctor with a herniated disc. However, it can bother people even without a hernia. Stenosis means that the nerve cannot receive as much blood as it needs to when it needs to. Like every tissue in our body, the nerve is fed by blood. Just as a car uses different amounts of gas when it is stationary than when it is going, the energy the nerve spends is different when it is walking or running. Energy comes with blood, and the vein that brings blood must be able to expand according to the need. Volume is needed to expand. The normal spinal canal differs in the neck, back and waist regions. There are also congenital differences between individuals. Those with wide canals have an advantage against possible subsequent invasion of neighboring organs. The nerve has additional volume to tolerate herniations or thickened ligaments that move towards its own area. A hernia or stenosis of the same size does not cause the same discomfort in everyone.

The ligaments and spinal joints that connect our vertebrae thicken due to aging, trauma, etc. This is basically a reaction to the stress we are exposed to, which is present in our factory settings. It is like the callus formation of skin exposed to irritation. Factors that put a load on the spine, such as heavy lifting, reverse movement, and excessive weight, cause wear and tear in the intervertebral discs and the intervertebral joints called facets, and subsequently cause repair processes, thus thickening the ligaments and joints. These thickened extra-nerve structures occupy the area belonging to the nerves they are responsible for protecting. Our factory settings take all possible precautions against this event: they melt the fatty layer on the spinal cord membrane, we develop a hunchback on our back to widen the canal, we lean forward, it narrows the area belonging to the cerebrospinal fluid in the spinal cord, and finally the nerves that should be in a floating position in the water come together back to back and try to make room for the nerve. Unless a sudden hernia occurs during this process, the development of these events bothers us very little. When we start to feel mild back pain and temporary leg numbness, it means that a certain critical threshold has been passed. Patients who have reached this stage first feel tingling in their legs after a long walk, then weakness. These complaints first pass with a few minutes of rest. It is also known as window disease among the public, when the patient gets tired, he watches the window and continues on his way when the pain passes. As the disease progresses, the distance that causes the complaints shortens. In its advanced form, walking indoors is also painful. If it progresses further, the nerves can no longer do their job, paralysis and numbness begin in the relevant muscles, and the patient limps while walking. Even more advanced is being stuck in bed and becoming incontinent of urine and stool.

3

What is the treatment for canal stenosis?

The solution starts with the least harmful one. Bed rest means doing the job with factory settings. 15-20 days of strict bed rest will eliminate the complaints that come with simple hernias. When the pain is gone, a weight loss and gymnastics program will be useful as a preventive measure. This part is the most difficult and inefficient part, considering our culture, because it requires the patient's participation.

If rest alone is not enough, medication or physical therapy methods can be used in addition. If this is not enough (I rarely use it), cortisone and narcotics can be given by injection. If this is not enough, then it is time for surgery. When it comes to surgery, do not immediately think that there is a standard recipe, every brave man eats his own yogurt, every surgeon has a different approach.

4

Dr. Yunus Aydın's canal stenosis surgery technique:

The first choice is to perform surgery with the least damaging microsurgical technique. If the stories of patients with canal stenosis are examined carefully, it is seen that the duration of the main complaints requiring surgery usually does not exceed a few weeks or months. Only a certain part of the deviations from normal expressed by the radiologist in the film have overcome the body's own healing mechanism and disturbed the patient.

Here, we need to make a professional self-criticism; an experienced surgeon treats the patient, that is, solves the problem in a simple way; a less experienced one adds every abnormality in the film, that is, unnecessarily exaggerates the problem. As the surgery grows, the patient's risk increases. A surgeon cannot be brave at the expense of the patient's life. Being too afraid is harmful, and being too brave is harmful. It should not be forgotten that there is no gain without taking risks. The surgical technique and the practitioner should reduce the risk to acceptable levels.

It is not right to operate on lumbar curvatures (scoliosis) in elderly people with the techniques applied to young people. If the patient has been living with the existing curvatures for 30-40 years without any problems until recently, it is sufficient and less risky to resolve the last event that disrupted the balance and bring the patient to the pre-pain state. The real need of the patient is to expand the area of the nerve.

While solving the canal stenosis of the elderly, which is our main subject, with the help of surgery, we need to know that we will encounter certain risks and try to reduce them. After all, canal stenosis does not kill a person, but anesthesia or surgery complications can. Thankfully, anesthesia is very advanced today. Putting people 90 years of age and older to sleep is now an anesthesiologist's daily occupation.

Surgical technique is the most important factor that increases the risk of anesthesia. If we roughly list the situations that the anesthesiologist does not like: there should be no excessive bleeding, blood transfusion should not be performed if possible, the surgery should not take long, there should not be any lung or heart problems that will require intensive care, etc. The technique we choose can increase or decrease these risks. The surgeon is naturally pleased if the patient accepts the surgical technique suggested by the surgeon. For this reason, I have preferred the easy-to-accept microsurgical technique since my assistantship and have struggled for over 20 years to reach the technique I have been using for the last 12 years. In the meantime, the widespread use of high-speed rotary instruments, bone cutting tools that work with air pressure and of course the advanced surgical microscope have made this possible.

5

How does recovery occur after microsurgery for canal stenosis?

How does the technique of bilateral spinal canal opening with a unilateral approach through a small wound provide the advantages that reduce the risks mentioned above?

  • Since the spine is accessed from one side, the lumbar muscles are stripped from the bone on one side. This means less scarring.

  • Since the carrying capacity of the spine is not damaged, there is no need for screw and rod systems (presented with a pompous and unrealistic name such as ring platinum) used in other techniques to strengthen it. This means less blood and shorter time.

  • In the presence of all types of hernias, multiple events at distant intervals can be reached through two small wounds. This means avoiding a second surgery and saving money.

  • There is no obstacle for a person who has had this surgery to have a screw surgery in the future, there has been no need for it in over a thousand cases performed so far. This means preserving the natural movement in the spine.

  • The patient can walk and do all kinds of movements three hours after this surgery. This means reducing the risk of embolism, which is a very feared condition in the elderly after surgery.

  • The patient can leave the hospital on the same day and return to normal life after 15 days. This means both economy and quality of life.

6

Does nerve compression cause immediate paralysis?

This is a question we encounter frequently. Our factory settings prevent the press from causing immediate paralysis. Pressure on the nerve can cause numbness, then tingling and pain, and if it continues, partial and then complete paralysis. The paralysis here should not be confused with cerebral palsy. The nerve that is compressed at the spinal cord level causes limited power loss in the hand. In football terms, our body first warns with numbness, shows a yellow card with pain, and if the problem is still not solved, shows a red card with power loss. In other words, the press does not cause immediate paralysis. However, we have to take the warning into consideration and take precautions.

7

How is canal stenosis diagnosed?

An experienced physician can easily make a diagnosis with classical medical knowledge. The patient walks bent forward, cannot lie on his back during sleep, and prefers the fetal position because it reduces his pain. Neurological examination shows the extent of the disease to the physician. The gold standard examination method is MRI. MRI provides the physician with the necessary information. If present, it also shows events such as hernia, cyst, and calcification that may occur with this disease.

8

Does every patient need surgery?

Beginning and intermediate level canal stenosis do not require immediate surgery. They are directed to preventive and conservative methods. If these methods do not solve the problem, they may undergo surgery. In these patients, the patient should make the decision to undergo surgery himself. If the pain is greatly disrupting the quality of life and the MRI findings are consistent with the complaints, the request for surgery is accepted.

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Zorlu Center T1 D:116

34340 Besiktas Istanbul Türkiye

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Acıbadem Fulya Hospital, Hakkı Yeten Street, Dikilitaş, Yeşilçimen Street No:23, 34349 Beşiktaş/İstanbul, Turkey

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