Structures called vertebrae, spinal cord and nerve fibers
Bone structures that provide protection. spinal cord and nerve
fibers in the lower part of the head along the canal in the middle of the vertebrae.
They start from the top and go down. vertebrae
disc that connects the vertebrae to each other
There are structures called .
These discs lose their fluid amount as we age.
This causes the disk’s load-carrying ability to decrease and
hardens and moves from its location towards the spinal canal
This may cause the channel diameter to narrow.
Another cause of spinal stenosis is spinal stenosis.
is the enlargement of facet joints.
WHAT ARE THE SYMPTOMS?
Spinal stenosis may not always cause symptoms. Studies
have no symptoms but severe spinal stenosis
It turns out that there are many people.
Symptoms, if any; pain, numbness and cramps in the back or legs. Weakness may occur in the legs. Rarely, it may cause bladder and/or bowel problems.
Complaints occur with long periods of standing and walking
may increase. Symptoms are persistent or in the form of seizures
It may come and go. After walking for a limited time
then due to weakness and numbness in the legs
You may feel the need to stand and squat. Walk
The distance may gradually decrease. The pain may ease or disappear completely by bending or sitting.
HOW IS IT DIAGNOSED?
Your doctor will take a history from you and examine you.
will. Direct radiographs (x-rays) of narrowed discs
or may reveal the presence of weakened discs.
Magnetic resonance imaging (MRI) in the spine
The amount of stenosis can be determined in detail.
Computed Tomography (CT) is also used for detailed research.
available.
All these studies examine the stenosis of the spinal canal, nerve root
It allows compression and determination of the location of the stenosis.
WHAT ARE THE TREATMENT OPTIONS?
Your doctor will determine if you have a stenosis that is causing you pain.
is detected, non-surgical methods should be used first.
will try. These treatment options are anti-inflammatory
treatment (oral or injection) and pain control
They are painkillers to take.
When deciding on concrete treatment, your doctor will
your endurance and your complaints affect your quality of life.
It takes into account whether you dropped it or not.
Spinal injections (epidural injection of cortisone
etc.) can be done.
Medication and pain control:
Your doctor may choose a single drug or multiple drug therapy when planning your treatment. Medicines used to control pain are called analgesics.
Most pain can be treated with aspirin, ibuprofen, diclofenac, naproxen or
can be controlled with simple painkillers such as acetaminophen.
receivable. Some analgesics (painkillers) are called NSAIDs. These types of medications not only relieve pain, but also
It also eliminates any inflammation that may occur.
They are used for removal. In this group of drugs,
aspirin, ibuprofen, diclofenac, naproxen and others
has. If your doctor has recommended such painkillers for you
and if you use it, you may experience side effects such as stomach problems.
you may encounter. These types of painkillers do not last long
doctor in case of problems that may occur during use.
You must be under supervision.
If you are taking painkillers of the type mentioned above
If you have a persistent pain that does not go away; your doctor tells you
called narcotic painkillers (such as codeine-morphine)
may recommend medications. These types of painkillers, your doctor
Do not use unless recommended. These types of drugs have high
dose does not mean more and faster effect. This
medications such as vomiting, constipation, dizziness, drowsiness
They have side effects and these drugs can be addictive.
All medications should only be taken if your doctor recommends them.
How and how much to take the medications prescribed by your doctor?
Make sure you understand correctly what you will receive and
If you think your medicine is not working, see your doctor.
please consult.
There are other drugs that have anti-inflammatory effects.
Corticosteroids have strong anti-inflammatory effects
Therefore, it can be used orally or in injection form.
Corticosteroids, like NSAIDs, also have side effects. Yours
Discuss the risks and benefits with your doctor.
Conservative (non-surgical) treatment options other than drug therapy:
Symptoms of spinal stenosis are usually
causes movement avoidance. This situation
It causes a decrease in bending and endurance. Physical
treatment or exercise program, muscle strengthening
and is important in restoring bending ability.
Aerobics, cycling and walking are recommended. Because
Such actions increase the amount of blood coming to the nerves.
and thus reduces the symptoms of narrowing.
It also strengthens your back, abdominal and leg muscles.
Exercises may also be recommended. Which doctor is best for you?
will recommend an exercise program.
For many individuals, paying attention to home security is very important.
It is important. For example washing machine and dishwasher
It can be placed in a higher place. A more suitable bed
available. If necessary, changes can also be made in the bathroom.
Making the walk easier, if necessary
It is appropriate to obtain a walker or cane.
Unless significant and progressive leg weakness develops and
unless there are bladder or bowel problems
spinal stenosis, a dangerous condition in adults
It does not create. In such cases, the aim of treatment is to
to protect the patient’s quality of life and to relieve pain if there is
is to ensure control.
Non-surgical methods, spinal alone
It does not correct the stenosis in the canal and causes pain for a long time.
cannot terminate.
Surgical treatment:
Surgical methods, pain relief with non-surgical methods
It is applied to a small number of patients who cannot be controlled.
Surgical intervention also; It is a preferred option for those with progressive leg weakness, bladder and bowel problems.
It is a treatment method.
The purpose of the surgical intervention is to relieve the pressure
to expand the channel diameter. The name of this procedure is lumbar
is decompression. Laminectomy may be chosen
It is one of the surgical methods. In this method, the back
The bones are removed and the narrowed bone canal is widened.
Hemilaminectomy is the bilateral favectomy technique,
The bones in the back are removed from one side and the canal is widened.
Leg surgery with correct indication
Pain and loss of function of the leg improve. Today
Patients return to normal a few weeks after the operation.
can return to their lives.
In spinal stenosis, sometimes there is a gap between the weaker vertebrae.
slippage occurs and this is called spondylolisthesis. And such a
In this case, the stability between the vertebrae is lost. Like this
spinal fusion surgery in cases,
with decompression process to fix the vertebrae
can be done together.
The joining process involves bone formation between the two vertebrae to be joined.
It is done with some tissue or technical tools. Combining
It can be done from the front or back or both directions.
The success rate for fusion surgery is more than 65%.
Post-surgical hospital stay is only a few months away.
days. Most patients return to full activities in 6-9 weeks.
can return.
COMPLAINTS OF PATIENTS WITH CERVICAL MYELOPATHY
Cervical canal stenosis, usually nerve root (radiculopathy)
or complaints due to spinal cord compression (myelopathy)
It shows itself.
Neck pain occurs in approximately half of patients with cervical myelopathy.
or has arm pain. In most of these patients, arm and
Weakness and loss of function occur in the leg.
Due to cervical myelopathy; weakness in the arms and
Not being able to button your shirt, opening the door handle
hands such as not being able to close the jar lid, not being able to open the lid
Incompetence is a common complaint.
Complaints about legs include difficulty walking,
It manifests itself as weakness in the legs and can occur without assistance.
It may progress to the point of not being able to walk.
One of the complaints of patients with cervical myelopathy
The other is urinary incontinence. With the progression of the disease
incontinence of urine and stool, involuntary leakage occurs
may come.
The progression of all these complaints over time occurs in every patient.
may differ. Some patients’ complaints
While the progress is rapid in some, the progress is slow in some
is happening. In a group of patients, progress stops after a certain point.
EXAMINATION FINDINGS OF CERVICAL MYELOPATHY
The first examination finding is usually increased upper and lower
are extremity reflexes. Different levels of neurological
Deficits can be detected. Early diagnosis in this disease group
It is very important. Preventing the progression of patients’ complaints with treatment after early diagnosis.
passable.
Diagnosing the disease, examining the patient’s complaints
listening and asking questions from the physician accordingly.
It starts with asking. Following this listening and questioning
Some neurological deficits were detected upon examination.
These can be detected: increased reflexes in the arms and legs
(if radiculopathy is present, decreased reflexes in the arms
gait disturbance (clumsy or unbalanced)
walking), loss of feeling in hands and feet. Also in the examination
Clonus (after rapid bending of the foot towards the back)
continuing to beat quickly), babinski (foot
When the bottom is scratched with a sharp object, the thumb is placed on the back of the foot.
while curling your other fingers in a fan shape
opening), Hoffman (the tip of the middle finger of the hand
When it is quickly curled inwards and released, the thumb and
other fingers moving towards the palm)
Pathological findings may be observed. From all these findings
Detection of one or more of these may lead to the doctor’s cervical
This is enough to suspect myelopathy.
NATURAL COURSE IN CERVICAL MYELOPATHY
The clinic usually starts insidiously, the rate of progression varies.
and complete recovery after myelopathy develops.
It is rare. Attacks in stable periods in 96075 of the cases
deterioration, slow progression in 90-20% of cases,
Sudden deterioration was observed in 905 patients. myelopathy
As it progresses, both lower extremities become weaker and more spastic.
becomes. There may be problems with sphincter control,
Incontinence is rare. Walking in very advanced cases
Needs support. Movement, especially in elderly cases
sometimes it is impossible.
DIAGNOSIS OF CERVICAL MYELOPATHY
Direct x-rays of the neck can diagnose cervical stenosis.
may not provide enough information to verify. Generally
Magnetic Resonance Imaging to make this diagnosis
(MRI) is used. MRI shows narrow cervical canal and stuck
It shows the spinal cord in great detail. computerized
Tomography (CT) shows more bone structures protruding into the cervical canal.
Can be used to see well.
Electrophysiological evaluation of nerve conductions
cervical myelopathy can be differentiated from other diseases through tests.
diagnosis can be made. Electromyography (EMG) and nerve conduction
rate studies of peripheral nerve with cervical myelopathy
diseases, especially peripheral nerve compression
They are helpful methods in differential diagnosis. somatosensory
evoked potentials (SEP), delivered from the arm or leg
test performed by recording the stimulus from the brain
and disruption in transmission indicates spinal cord compression. This
The test also helps differentiate cervical myelopathy from other diseases.
helps in diagnosis.
TREATMENT OPTIONS IN CERVICAL Narrow CANAL
In cases with mild cervical stenosis
The first step in treatment is whether there are signs of myelopathy or not.
Options may be non-surgical methods. However, the arm
and increasing weakness and pain in the legs, walking
In case its capacity decreases, it is generally
Surgical treatment is recommended. Surgical treatment
Its purpose is to eliminate the pressure on the spinal cord and nerve root.
removal (decompression). Different for this purpose
can be achieved with surgical techniques.
Surgeries performed on the front of the neck:
If the spinal cord is compressed, the cervical disc, vertebrae
Why does the body of the bone and the ligaments in the front
If this happens, these parts compressing the spinal cord
spinal cord removed by surgery from the front
is relieved. In order to strengthen the spine, it
fusion to immobilize the segment
It is said. Replacement of removed parts
bone graft supports this segment of the spine and
strengthens. Most surgeons further develop this established structure.
to attach a plate and screw system to that segment to strengthen it.
may prefer.
Surgeries performed on the back of the neck:
– Laminectomy; It involves removing the laminae and ligaments that compress the spinal cord from behind. In some cases, the surgeon may add fusion surgery to laminectomy to strengthen the spine.
– Laminoplasty; It is based on the principle of widening the cervical canal by surgery performed from the back of the neck. In this operation, after some bone fragments are removed, the spinal canal is widened by lifting the laminae like a door on the hinge support and preventing them from closing again. After surgery, patients must stay in the hospital for at least a few days. Many patients can begin to return to their daily activities 6-9 hours after the operation. The rehabilitation program that the patient should follow after the surgery is determined by the doctor.
PAIN IN CERVICAL MYELOPATHY
MANAGEMENT
The purpose of drug use in cervical myelopathy is to relieve pain, muscle
To relieve spasm and other symptoms. Doctor
by recommending the use of one or more medications
to alleviate complaints and improve functional capacity
tries to increase it. Taking too much of these medications
does not lead to faster recovery, and unwanted medication
may cause side effects.
If the patient has pain, the doctor may prescribe a high dose
analgesics, non-steroidal anti-inflammatory (NSAID) and
may recommend the use of muscle relaxants. If the pain is too much
If it is strong and cannot be controlled with these drugs, strong
Narcotic drugs (0pioids) may be prescribed.
Other methods that can be applied for pain:
– Injecting local anesthetic (sometimes this is called steroid) into the area where the pain is triggered.
can be added). This injection is made directly into the painful muscle or soft tissue.
– Another trigger area injection is facet joint injection.
– Cold or hot applications to the painful area can be used for analgesic purposes.
PROGNOSIS
Slightly more than half of the patients who underwent surgery
An improvement is observed compared to preoperative conditions.
The ultimate goal of surgery is to prevent deterioration.
Factors that negatively affect prognosis: advanced age, serious
neurological deficit, multi-level compression, long-lasting neurological
presence of deficit and narrowness of the anterior and posterior diameter of the canal, MRI
the presence of signal changes within the spinal cord.
Eğer yara çok kirli ve açık bırakılacak ise sinir dikilmesi ilk operasyon sırasında yapılmayabilir. Eğer sinir defekti(eksikliği) varsa genellikle bacaktan alınan sinir grefti (parçası) araya yerleştirilerek sinirin devamlılığı sağlanır.
