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SPINAL CORD NONDOMENT

WHAT IS LUMBAR SPINAL STENOSIS?

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.
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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.
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