It is mistaken for a hernia! If you have difficulty walking, this could be the reason.
Due to aging, degenerative changes in subsequent years cause narrowing of the main and side canals. 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 causes a mandatory bulge (hernia), the enlarged facet joint and the thickened or forced ligamentum flavum narrow the canal. Soft tissue thickenings account for 40% of the narrow canal. As the ligamentum flavum, thickened and twisted by the back bending of the waist, 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 round, oval or cloverleaf. This difference in shape can lead to confusion in the expectation that the MRI image should be oval. Although it is said that disc degeneration starts with age, weight and heavy work cause more stenosis. In addition, although the explanations are generally attributed to aging, loss of disc height caused by irregular use of the waist 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 are compressed. The normal anterior-posterior diameter of the canal in the lumbar region is 15-25 mm. According to classical knowledge, a diameter between 10 and 13 mm is called relative stenosis and less than 10 mm is called absolute stenosis. However, the percentage of individuals who have no symptoms despite these strictures is not low. Each person’s resistance to pathological changes and their adaptability are different. In this respect, although there are aggressive clinical conditions with very little compression image on MRI, there are many people who have no 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 most often occur 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 uncommon in these patients. Leaning forward, sitting and lying down provide relief from the symptoms. Patients try to protect themselves from symptoms in daily life by leaning forward. For these patients, driving uphill, driving a car and cycling generally do not cause any complaints.
What diseases is it confused with?
These patients can be confused with vascular disease. In addition, it should be carefully examined for the presence of pre-existing peripheral arterial occlusive disease, neuropathic disorders, hip problems, multiple sclerosis. It can be confused with a herniated disc and lumbar spondylosis. Lumbar spondylosis usually presents with low back pain where no severe pain or abnormal sensation is detected in the legs. Disc height loss, endplate osteophytes, facetosteophytes, spondylolisthesis, and hernias are among the causes of foraminal stenosis. It can be congenital (as in dwarves, it can also be a normal occurrence in society) and acquired. In congenital, the peduncles are shorter and closer together than normal, and the findings are less moderate and present at a younger age. In the degenerative narrow canal, signs are seen later in life and complaints most often occur with walking, standing, and backward bending of the waist.
Who is it more common in?
Patients with a degenerative narrow canal are more common in women around the age of 60. L4-L5 level is most often involved and can occur at different 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 stenosis of the entry site of the lateral canal is responsible for the neurological changes. It is possible to make a diagnosis with X-ray, MRI and CT after the examination.
What is the treatment?
Non-surgical treatment is usually based on clinical experience. We do not expect analgesic treatment to contribute to recovery. Especially the elderly and patients with hypertension, diabetes and cardiovascular diseases are advised to stay away from the risks of the cardiovascular system, kidneys and gastrointestinal tract that may occur with the use of painkillers known as rheumatism drugs.
In addition to physical therapy applications, they should be subjected to a flexion-based exercise program. Corset, epidural steroid injection, osteopathic manual therapy, prolotherapy, dry needling, stationary cycling and spa treatments may be offered to the patient.
The majority of patients can survive with nonsurgical treatments.
Scientific studies have shown that patients who are treated and take precautions respond better to non-operative treatments at short and long-term follow-ups. However, it was found that patients who had to receive a definitive diagnosis and undergo surgical treatment also improved. Since the hernia also narrows the canal, the canal stenosis disappears when the hernia is retracted.
If a definitive diagnosis is made for bone and ligament enlargements, lumbar slippage or narrow canal due to tumor formation, surgery should be performed and should not be avoided. Proper patient selection is the key to success with surgical treatment. Our patients must continue to follow the necessary physiotherapeutic procedures conscientiously after surgical treatment. Otherwise, they may encounter new problems in the coming months-years.