Spinal canal stenosis
Between the vertebrae of the spinal column, there are intervertebral discs, acting as a shock absorber, and joints allowing movement between each level in flexion, extension and rotation.
In the center of these, the spinal cord passes into the lumbar canal, and distributes nerve roots on each side, on each floor, which come out between each vertebrae. As we age, the cartilage becomes thinner and the discs gradually sag.
1) A bit of anatomy:
The lumbar region of the spine is made up of 5 vertebrae. Between these vertebrae, there are intervertebral discs in front, acting as a shock absorber, and joints behind, allowing movement between each level in flexion, extension and rotation.
In the center of these, the spinal cord passes into the lumbar canal, and distributes nerve roots on each side, on each floor, which come out between each vertebrae.
As we age, the cartilage becomes thinner and the discs gradually sag. The degeneration of the joints also leads to bone and ligament thickening, in particular the yellow ligaments, which close the canal behind.
All of these changes can gradually reduce the intracanal space, causing compression of the nerve elements. This can then lead to pain and sensory and/or motor disorders in the back and/or lower limbs.
2) LUMBAR CANAL STENOSIS OR NARROW CANAL?
This pathology is degenerative. This means that it generally occurs in the elderly, often after 50 years.
It is therefore differentiated from the so-called “narrow” lumbar canal, of congenital origin and already diagnosed and already symptomatic in young subjects. On an elderly subject, we will rather speak of a “narrowed” lumbar canal.
In practice, this lumbar canal stenosis, when diagnosed in older adults, often results from the combination of these two pathologies: the congenitally narrow canal is aggravated by the degeneration of the structures.
3) WHAT ARE THE SYMPTOMS?
Lumbar canal stenosis is usually manifested by:
Pain in the back and/or lower limbs, most often during walking or prolonged standing
Decreased or even loss of sensation in one or both lower limbs
Motor disorders or even paralysis in the lower limb
Note that a symptomatology including the last two points will represent a surgical emergency.
4) HOW TO DIAGNOSE IT?
The diagnosis of this pathology is based on the combination of the questioning of the subject, the clinical examination carried out by the health professional, as well as medical imaging.
If the x-ray sometimes shows limitations in the analysis, the scanner or the MRI are often revealing. An EMG may be requested to confirm neurological deficits.
5) IS IT SERIOUS?
It all depends on the stage of evolution of the pathology. In the initial stages, lumbar canal stenosis may prove to be asymptomatic.
However, it is important to understand that in the absence of treatment, the symptoms generally worsen gradually, leading to long-term major problems and loss of autonomy.
Neurological complications are rarer but exist, and must be treated surgically as soon as possible.
If you experience symptoms similar to those mentioned above, it will be important to consult a doctor to determine the extent of the lesion and the resulting therapeutic choice.
6) IS SURGERY MANDATORY?
Lumbar canal stenosis generally responds positively to medical and physical treatments.
Surgery will therefore not be considered first-line, and offered as an option if your symptoms do not improve significantly with conservative treatments or if the pain becomes intolerable and is not relieved with analgesics.
It will also be essential if you have nerve damage, such as weakness or loss of sensation in your legs or urogenital disorders.
7) HOW DOES THE REHABILITATION TAKE PLACE?
The initial treatment will combine medical aid (analgesics, anti-inflammatories) with rest and physiotherapy. The latter will focus on different points:
Joint mobility recovery
Progressive global and specific muscle building
Improved motor control
Educating the patient about their pathology and potential risks
In the event of surgery, physical rehabilitation will begin after a few weeks, and the return to physical activity will be considered a few months after surgery.
8) WHAT CAN I DO TO SPEED UP THE PROCESS? WHAT SHOULD I AVOID?
In order to speed up the healing process, be sure to follow the recommendations of the health professionals with whom you work.
Laziness or, on the contrary, overzealousness, will be your enemies.
Conversely, discipline, rigor, perseverance as well as a positive and voluntary state of mind will help you get back in top shape as soon as possible!