Narrowing (stenosis) of the spinal canal

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The prevalence of the narrowing (stenosis) of the spinal canal is increasing and in principle it affects all ageing Western societies. Generally, the condition affects the elderly, although it may happen to young people, in the course of other spine conditions, such as spondylolisthesis or instability. The main symptoms include numbing and pain in the lower limbs. Patients also feel tired after walking even a short distance. In extreme cases, lower limb paresis and urinary incontinence may appear. Unfortunately, conservative treatment of spinal canal stenosis is effective for only 30% of patients while 70% require surgical treatment.

Benefits:

  • After fast and minimally invasive surgical procedures patients can quickly return to work, and day-to-day activities are no longer painful.
  • Minimally invasive procedures also carry a smaller risk of complications associated with damage to nerve roots and wound healing.
  • Importantly, after procedures performed with the aid of the microscope or endoscope wounds measure from 5 mm to 15 mm, which translates into a much smaller trauma to the body. For the whole body a smaller trauma means a smaller impact on the immune system, a lower decrease in immunity and fewer general complications.
  • Minimally invasive procedures require a shorter hospital stay.
  • After our procedures you will be able to get up and move independently one hour after the surgery.

Indications and contraindications

  Indications:

absolute – requiring fast surgical treatment:

  • paresis/plegia of the lower limb, the feeling that a foot ‘gives way’, urinary incontinence, relative indications – depending on pain severity and its impact on day-to-day activities:
  • fatigue of the lower limbs, pain radiating to the lower limb (sciatica),
  • if a considerable narrowing of the spinal canal is visible on an MRI scan and causes acute pain, real recovery within a few weeks is rather unlikely. In such cases the patients may undergo a surgery directly after diagnosis is made.
  Contraindications:
  • medications which significantly decrease blood coagulation,
  • serious conditions of other system when general anaesthesia cannot be used.

FAQ

Is it possible that stenosis will improve after rehabilitation?

Intensive rehabilitation is effective in about 30 % of patients and the improvement is usually temporary.

Treatment options:

Laminectomy

This is an old treatment method in which the lamina (arch of the vertebral bone) is removed and the spinal canal is widened.

Laminectomy with transpedicular stabilization

This is an extensive procedure to widen the spinal canal by removing the whole backside of the canal and stabilizing the spine with pedicle screws inserted in the vertebra.

Microscopic microdecompression

A minimally invasive procedure performed under microscope guidance. In minimally invasive procedures we remove only the sections of the spinal canal with stenosis, and leave the rest of the backside of the spinal canal. The procedure removes the stenosis and does not destabilize the spine, so no additional implants are needed.

Endoscopic microdecompression

This fully endoscopic procedure with the use of the Vertebris endoscopic sets made by Wolf is one of the most modern and most effective techniques for spine stenosis treatment. This procedure can be applied in some patients, after the evaluation of an MRI scan. The procedure takes place under general anaesthesia.

ELIGIBILITY FOR THE PROCEDURE:

  • The patient’s eligibility is evaluated on the basis of the whole clinical picture.
  • Diagnostic imaging is necessary: the standard test is a 1.5 or 3-tesla MRI scan. If there are absolute contraindications for an MRI scan (strong claustrophobia, metal implants, others), the patient’s eligibility may be evaluated on the basis of an ‘open’, low-field MRI or computed tomography.
  • If there are any doubts as to the diagnosis, an EMG test is performed to precisely determine the level where the pain and other symptoms originate.

Before the procedure:

The basic laboratory tests include blood type and Rh factor, complete blood count, basic biochemistry tests (sodium, potassium, urea, creatinine, glucose), coagulation parameters (APTT, INR), ECG, a general chest x-ray (for patients over 40 or with a history of pulmonological problems). Additional tests or consultations with specialists may be required, depending on the patient’s condition, the underlying disease and other medical conditions (such as a thyroid profile test, urinalysis, consultation with a cardiologist). The meeting with the anaesthetist takes place a few days before the procedure if the neurosurgeon so recommended. Otherwise, the meeting takes place on the day of the procedure, during the admission process.
Please bring to the hospital only the necessary items, such as medical records, neurosurgeon’s consultation documents with the eligibility evaluation, imaging test results (MRI, CT, x-ray) on CDs with descriptions, laboratory test results, routine medications, toiletries, towel, socks, pyjamas and footwear as well as a change of clothes. Please do not bring any jewellery and other valuables. In each hospital room there is a wardrobe and a cupboard for your personal belongings (in two-person rooms each patient has his/her own wardrobe and cupboard).
The final evaluation of your eligibility for the procedure is done on the day of the procedure. You will be asked to give written consent to the surgical procedure and general anaesthesia (you can download samples from our site). You take your blood pressure medications, heart medications and hormonal medications if you take them on a regular basis.

Procedure:

The surgery is performed under general anaesthesia using one of the two procedures: microscopic microdecompression or endoscopic microdecompression.  Usually the procedure lasts from 60 to 120 minutes, depending on the extent of the intervention and the procedure used.

After the procedure:

After the procedure you wake up at the recovery room next to the operating theatre. Following your full awakening from anaesthesia you will be transferred either to your room or the recovery room (depending on your condition and the course of anaesthesia/procedure).
After 2 hours we make the first attempt to mobilise you (with a nurse’s or a doctor’s assistance). On the day of the procedure you may walk around your room and go to the bathroom. Activity is slightly limited. On the day after the procedure you get up in the morning and increase your activity level. Before midday you should be able to walk in the corridor or the balcony. During that time you will receive advice on post-operative rehabilitation from a qualified physiotherapist.
You will be discharged in the afternoon, after a medical examination.

While at home you should avoid effort for 2 to 3 weeks. During this period you should avoid straining your spine, lifting, bending, and rotating movements as well as other activities which involve dynamic torso movements. If the procedure involved only the removal of stenosis, without the removal of disc herniation, then you may return to full activity after a few weeks. Intensive rehabilitation and plenty of exercise are recommended. In the first week after the surgery you should schedule a follow-up appointment to check your wound. The next visit is scheduled for about 3 weeks after the procedure to evaluate preliminary treatment outcomes. During the whole post-operative period you can call your doctor directly.

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+48 61 62 33 111

Wielkopolskie Centrum Medyczne
Sp z o.o. S.K.A

st. Bolesława Krzywoustego 114
61-144 Poznań, POLAND

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