Stenosis of the lumbar canal
When the spinal canal of the lumbar spine narrows, it is referred to as stenosis of the lumbar canal.
What is the spinal canal like?
The spinal canal, also called the vertebral canal, is space inside which the spinal cord passes, from the first cervical vertebra (called C1) to the first lumbar vertebra (L1), together with the nerve roots, with which the canal ends (at the level of the sacral vertebrae).
The medulla is part of the Central Nervous System together with the brain. The nerve roots, on the other hand, are part of the Peripheral Nervous System, which is involved in the stenosis of the lumbar canal.
Delimited above from vertebral bodies and intervertebral discs, laterally from the vertebral foramina e later from the ligament bone arch, the lumbar spinal canal contains the roots of the sciatic and crural nerves, directed towards the lower limbs. If compressed, the nerve roots cause particularly annoying symptoms.
The causes of lumbar canal stenosis
This pathology originates above all in a very natural condition: advancing age and the consequent arthritic alterations, which cause a thickening of the lumbar canal walls and a decrease in available space. It is therefore no coincidence that lumbar canal stenosis occurs especially in people over 60-70 years of age. Other causes can be:
- Lumbar disc herniation
- spinal tumors, whose masses can occupy the space intended for the medulla
- trauma to the spine
- lumbar spondylolisthesis, which alters the positioning of the lumbar vertebrae
- Paget's disease, which causes bone regeneration too fast, resulting in deformity
There are also more particular cases, in which the person it was born already characterized by a narrower stretch of the spinal canal of the norm: the symptoms therefore tend to present themselves well before advanced age. There are also some risk factors to consider: according to studies, people suffering from obesity or diabetes mellitus, As well as smoking, are more predisposed to the development of the pathology.
Lumbar canal stenosis: symptoms
As the nerve roots in the canal gradually deteriorate, symptoms gradually develop. Among the initial ones are:
- backache
- pain in the buttocks, which grows when walking or standing upright and fixed
- night cramps in the legs
As months and sometimes years go by, the following also manifest themselves:
- claudication (reduction of driving range)
- numbness and pain in the legs, which often force the person to stop while walking
The patient experiences a modicum of relief by stopping or bending forward: this is because the position allows the diameter of the spinal canal to increase by about 10%, so that the compression also decreases. This is why many people suffering from lumbar canal stenosis can cycle for entire kilometers, but paradoxically they can only walk for 10-20 meters.
How is a diagnosis made?
Despite the difficulties described, the patient often does not offer other particular signs during the physical examination. It is therefore essential for the diagnosis to resort to one magnetic resonance of the lumbar tract, which allows to detect the presence of the pathology and possibly associate it with others. You can also perform:
- x-ray of the spine
- TAC, especially to analyze the bone components
- electromyography, to measure the functionality of the nerves
Lumbar canal stenosis: therapy and intervention
To deal with lumbar canal stenosis with the right therapy, it is always necessary to rely on the individual situation of the patient. You can opt for one conservative therapy as well as for a surgery. The first way is preferable if the symptoms are not disabling or if there are no serious pathologies among the causes. Conservative treatment includes pharmacological treatments (with anti-inflammatory-analgesic and muscle relaxant drugs), physical rehabilitation (exercises to strengthen muscles, motor activities in water, stretching and exercise bikes, manual, postural and instrumental therapies) and lifestyle modification (stop smoking, regular physical movement, weight control).
If these therapies do not give the desired outcome, the lumbar canal stenosis can be treated through surgery, which provides forenlargement of the spinal canal through the removal of the occluded tract. It is possible to perform it with different methodologies, the opportunity of which is carefully evaluated by the neurosurgeon:
- laminectomy (bilateral approach)
- hemilaminectomy (one-sided approach)
Thanks to minimally invasive techniques, it is possible to decompress the canal without subjecting the tissues to excessive trauma, to the advantage of recovery times. In addition, a method of endoscopic decompression, further advantageous from this point of view, but not suitable for all types of stenosis.
Following the surgery, it is recommended to undertake a path of physiokinesitherapy (FKT), the practice that in physiotherapy involves motor rehabilitation activities.
