Physical Therapy and Rehabilitation Specialist Associate Professor Ahmet İnanır gave important information on the subject. It is very important to make the correct diagnosis and treatment in narrow canal disease, which is often confused with herniated disc and other problems that will occur in the waist. Pain, numbness, a feeling of fullness, burning, cramping, or pain with walking, standing, and bending the lower back often are among the symptoms of this disease. What is Narrow Canal Disease? What are the Symptoms of Narrow Canal Disease? Narrow Canal Disease is confused with which diseases? In whom is Narrow Canal Disease more common? How is Narrow Canal Disease Diagnosed? What is the Treatment of Narrow Canal Disease?
What is Narrow Canal Disease?
As a result of aging, degenerative changes cause narrowing in the main and lateral canals in the following years. As the height of the intervertebral disc and facet joint decreases, both as a result of aging and as a result of hernia surgery, the disc makes obligatory bulging (herniation), the enlarged facet joint and the thickened or forced ligamentum flavum narrow the canal. Soft tissue thickenings are responsible for 40% of the narrow canal. As the ligamentum flavum, which is thickened and folded by bending the waist back, bends into the canal and the facet joint becomes calcified, the patient feels various discomforts and has to lean forward. The shape of the spinal canal can be circular, oval or cloverleaf. This difference in shape can cause confusion in the expectation that the MRI image should be oval. Although it is said that disc degeneration begins with age, weight and heavy work cause stenosis more. In addition, although the explanations are generally attributed to aging, disc height loss caused by irregular waist use and narrowing of the disc space by surgery can reduce the height of the main canal and foramen (lateral canal), causing the canal to narrow and the nerve fibers to be compressed. The normal anterior-posterior diameter of the canal in the lumbar region is 15-25 mm. As classical knowledge, a diameter between 10-13 mm is called relative stenosis, and less than 10 mm is called absolute stenosis. However, the proportion of individuals who do not show any symptoms despite having these strictures is not low. Each person's resistance to pathological changes and their ability to adapt are different. In this regard, while there may be aggressive clinical conditions with very little compression image on MRI, there are many people who do not have complaints despite severe compression images. This difference cannot be explained scientifically enough.
What are the symptoms?
Pain, numbness, feeling of fullness, burning, cramping or weakness occur most frequently with walking, standing and bending the lower back. Back pain is also a common complaint. Neurological findings such as urinary and bowel problems or severe weakness are not common in these patients. Leaning forward, sitting, and lying down cause symptom relief. Patients try to protect themselves from symptoms in daily life by leaning forward. For these patients, climbing a hill, driving a car and riding a bicycle generally do not cause any complaints.
What diseases is it confused with?
These patients can be confused with vascular diseases. In addition, it should be carefully examined for the presence of pre-existing peripheral arterial occlusive disease, neuropathic diseases, hip problems, multiple sclerosis. It can be confused with herniated disc and Lumbar spondylosis. Lumbar spondylosis usually presents with low back pain, without severe pain or abnormal sensation in the legs. Disc height loss, end plate osteophytes, facet osteophytes, spondylolisthesis and disc herniations are among the causes of foraminal stenosis. It can be congenital (as in dwarfs, it can also be a normal event in society) and acquired. In congenital ones, the pedicles are shorter and closer together than normal, and the findings are less moderate and present at an earlier age. In degenerative stenosis, signs are seen in advanced ages and complaints occur most frequently with walking, standing and bending the waist back.
Who is it more common in?
Patients with degenerative narrow canal are more common in women around 60 years of age. L4-L5 level is most frequently involved and may occur at several levels.
How is it diagnosed?
Patients with lumbar stenosis often complain of leg pain, and neurogenic claudication usually presents as pain in both legs or unilateral leg pain. These patients may experience pain, numbness, a feeling of fullness, burning, cramping, or weakness. Neurological examination is often normal, and lateral canal entry site stenosis is responsible for the neurological changes. It is possible to diagnose with X-ray, MRI and CT after the examination.
What is the treatment?
Non-operative treatment is mostly based on clinical experience. We do not expect pain relief treatment to contribute to recovery. Especially the elderly and patients with hypertension, diabetes and cardiovascular disease are advised to stay away from the risks of cardiovascular system, kidney and gastrointestinal tract that may occur with the use of painkillers known as rheumatism drugs.
In addition to physical therapy applications, they should be subject to a flexion-based exercise program. Corset, Epidural steroid injection, Osteopathic Manual Therapy, Prolotherapy, Dry needling, stationary cycling, and spa treatment options can be offered to the patient. The majority of patients can survive with non-surgical treatments.
Scientific studies have shown that patients who are treated and taken precautions respond better to non-operative treatment in short and long-term follow-ups. However, it was determined that patients who had to receive a definitive diagnosis and had to undergo surgical treatment also improved. Considering that the hernia also narrows the canal, canal stenosis disappears if the hernia is retracted. If a definite diagnosis is made for bone and ligament enlargements, lumbar slippage or narrow canal due to tumor formation, surgery should be performed and this should not be avoided. Appropriate patient selection is the most important point in achieving success with surgical treatment. Our patients should continue to apply the necessary physical therapy procedures meticulously after surgical treatment. Otherwise, they may encounter new problems in the coming months-years.
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