Narrow Canal Disease

There are two types of stenosis disease, either congenital or acquired. The most common type; It happens due to degenerative arthritis of the spinal joint. In this joint arthritis, the cartilage tissue thins and the joint capsule loosens. Mobility increases and osteophytes appear. Although osteophytes restrict the movement of the mobile segment, the facet joint narrows the spinal canal. It is most commonly seen at L4-5 level.

The aging process with secondary changes is one of the most common causes of narrow canal. Two forms of arthritis affect the spine. These are osteoarthritis and rheumatoid arthritis. Osteoarthritis: It is the most common type of arthritis. It occurs in middle age and above. It is chronic. It affects many joints. It occurs in the cartilage tissue layer in the joints. It is accompanied by bone spur and excessive bone development. And it impairs cartilage function.

The degenerative process also affects the facet joints and disc. In disc degeneration, it causes enlargement of the facet joints and narrowing of the spinal canal. Rheumatoid Arthritis: It usually affects people from a young age. Although it is not directly related to the narrow canal, it disrupts the synovial membrane in the joint and affects joint function. In patients with rheumatoid arthritis, the most mobile parts of the spinal joints are the most frequently affected.

Spinal tumors exert their effects on the spinal canal with inflammation and tissue growth.

The occurrence of trauma, spinal fractures, or lumbar dislocation can narrow the canal.

Paget's disease is a chronic disease that causes bone growth. The canal may narrow as a result of excessive bone growth and deterioration in bone tissue.

The appearance of calcifications in the posterior longitudinal ligament can lead to widening of the ligament and consequent narrowing of the canal.

Narrow canal can be divided into two forms as central stenosis and lateral stenosis according to its axial views. In the central stenosis, while the dura and its inner neural elements are compressed; In the lateral forms, the nerve roots are especially compressed in the nerve exit holes, which we call the foramen. Foraminal height normally ranges from 20-23 mm. In the narrow channel, it goes below 15 mm. Compression, venous congestion and neuronal arterial ischemia in these neural vessels and nerves lead to neurogenic claudication in the patient.

It appears more often in women than in men. most frequently; It occurs in men and women over the age of 50. However, it can also be seen in younger people at birth or after trauma.

The spinal canal can narrow without any symptoms. However, if the spinal cord, nerve roots or cauda equina are compressed as a result of canal stenosis, symptoms of the narrow canal gradually begin to appear. In patients with narrow canal disease in the lumbar spine, narrow canal can also be seen in the neck spine. Physical and clinical findings do not develop suddenly. Low back and leg pain (sciatica) is observed in 95% of patients, and neurogenic claudication is observed in 91%. Neurogenic claudication usually affects both legs.

The extent of pain depends on the area of ​​the affected nerve. Patients feel pain and numbness mostly in the hip region or proximal thigh. While bending forward, sitting, lying down reduces the pain; Complaints increase with standing for a long time and bending the waist backwards (bending forward causes enlargement of the spinal canal and pain decreases). Numbness, cramps, weakness (paralysis) may be observed in the legs. Pain does not go away with rest, urinary incontinence may occur.

When the patient is asked to walk, the pain starts to intensify after a while and the patient prefers to walk in a forward-leaning posture. When asked to sit, pain complaints begin to decrease. It is very typical for patients with stenosis disease.

Rarely, in the advanced stages of the disease, cauda equina syndrome may occur. In the patient, urinary and stool incontinence, deterioration in sexual functions (impotence), weakness in both legs (paralysis), intense numbness and numbness occur. In this case, the patient should be operated on urgently.

Dr. Tamer Tekin