As we enter the age of aging, spinal stenosis, which is common in people over the age of 50, is attracting attention. Spinal stenosis is one of the leading causes of back pain, along with herniated discs, and is known to be severe and difficult to treat. According to 2012 statistics, 1.14 million people were treated for the disease nationwide, and it has been increasing by 15% every year since 2008.
What is spinal stenosis? First of all, let me tell you about the structure of the spine, the spinal canal is a tube-like space that runs up and down the spine. This is where the spinal cord, which is the main stream of the river, flows. The neuromuscular branches, which are tributaries, extend from small openings called intervertebral foramen in the nodes of the spine and are distributed throughout the body.
Spinal stenosis is a disease in which this spinal canal or intervertebral foramen narrows, causing the nerves to be compressed. This causes nerve degeneration, resulting in pain, abnormal sensations, and decreased motor skills in the lower back, buttocks, and legs
The most important symptoms of spinal stenosis are, firstly, a heavy and stiff back pain, and secondly, numbness in the legs when walking. In severe cases, these symptoms can be severe enough to cause a person to squat down after less than five minutes of walking. Even when standing, you have to hold on to the handle of the cart or lean your hands against the wall so that your back doesn't hurt.
In contrast to herniated discs, which are exacerbated by bending forward, spinal stenosis is relieved when you bend back. However, if you bend your back so often, it is easy to stiffen as it is.
The most common cause of spinal stenosis is aging. As we age and our joints wear down and small damages accumulate, our ligaments naturally thicken, our bones grow abnormally, and our spinal canals and intervertebral foramen become narrower. It's like when you have a cut on your skin, it leaves a scar or a callus.
In addition, excessive use of the spine, such as frequent heavy lifting or bending at the waist, is also one of the causes of spinal stenosis. The discs in our lower back act as a cushion between the vertebrae. When these discs fail and cannot absorb shock, the joints of the spine deform, causing the neural tube or intervertebral foramen to narrow.
In rare cases, they may be born with a genetically narrow spinal canal. In this case, spinal stenosis can also occur in the younger age group of 3-40. In general, if the anterior and posterior diameter of the spinal canal is less than 10 mm, the height of the intervertebral foramen is less than 15 mm, and the height of the disc is less than 4 mm, spinal stenosis occurs due to compression of the spinal cord and nerve roots.
First, lifestyle therapy
Patients with spinal stenosis need to quit smoking and abstain from alcohol. The most problematic thing about stenosis is that the blood vessels that supply oxygen and nutrients are compressed. The nicotine in cigarettes constricts blood vessels, making the blood supply even more scarce. In addition, the pain in spinal stenosis ultimately comes from inflammation caused by pinched nerves, and alcohol can make this inflammation even worse.
Losing weight is also important. The weight of our body is transferred directly to the spine, and the more obese we are, the faster the joints of the spine wear out. This accumulation of damage to bones, ligaments, and cartilage can further narrow the spinal canal and intervertebral foramen.
Second, exercise
For pain relief in spinal stenosis, it is recommended to bend forward at the waist. When you bend your back, the ligaments in your spinal canal loosen and irritate your nerves less. The baby pose movement, in which you sit on your knees with your arms extended and your upper body bent, is helpful.
However, over-bending at the waist can lead to disc damage. In particular, it is best to refrain from standing with your knees extended and bending your upper body forward excessively. When you need to do the exercise standing up, it is safe to distribute the load by placing your hands on the wall or lower back, and then bend lightly just enough so that the C-shaped curve of the spine straightens out.
Active prevention exercise is also recommended. Core exercises are one example. Core exercises are exercises that strengthen the muscles in the trunk around the spine. Muscles strengthened by core exercises can absorb shock and load on the spine, reducing damage to the joints.
Cycling is also one of the favorite exercises for spinal stenosis patients. Indoor cycling, in particular, can increase spinal canal space.
The most important thing when exercising is to avoid postures that cause pain. No matter how famous an exercise is, if you are experiencing pain, you should stop immediately or reduce the intensity of the exercise.
Third, drug therapy
For spinal stenosis, analgesics are used to relieve pain. In fact, the pain felt by patients depends on how much inflammation the surrounding nerves and joints are, rather than how much the nerves are compressed. Actively reducing inflammation through medication when there is pain is an important treatment to prevent the worsening of spinal stenosis. The more the patient is bedridden due to pain, the more stiff the joints of the spine can become, and the symptoms may worsen.
Which medication is right for you depends on the patient, but here are two: First of all, when the pain is not severe, aceclofenac-based drugs are recommended, which have less gastrointestinal disorders such as heartburn.
On the other hand, if the pain is severe, tramadol drugs with a strong analgesic effect are recommended. Tramadol is not a drug, but when it enters the body, it acts on morphine receptors, so it can exert an analgesic effect comparable to morphine. However, tramadol-based drugs can cause dependence when used for a long time, and side effects such as nausea, vomiting, and dizziness may occur, so they should be used only for a limited time when the pain is severe.
Fourth, non-surgical treatment
If medication doesn't work, injections and procedures can help.
Injection therapy, commonly referred to as a "nerve block," involves inserting a syringe into the epidural space surrounding the spinal cord to inject the drug. With health insurance, it is possible to receive treatment for around 100,000 won per time. The treatment is completed in just over 30 minutes, making it easy to use.
The procedure, on the other hand, is often referred to as 'neuroplasty', which uses a special thin catheter instead of a syringe. A catheter is inserted through the tailbone to the affected area, and then the patient is injected with medication. As the catheter enters, it loosens the adhesions in the tissues around the disc, which has the advantage of being able to deliver drugs more effectively than injection treatment. However, it is not covered by health insurance, so it is said to cost millions of won.
Fifth, surgical treatment
Non-surgical therapies have the limitation that while they can remove inflammation with medication, they do not address the underlying problem of nerve compression. However, if you choose surgical treatment, you can directly widen the neural tube and intervertebral foramen.
In the past, spinal stenosis surgery using screws was a heavy burden on patients. I had a 4-5 cm surgical scar, had to stay in the hospital for several weeks, and had to take about three months to get back to my normal life after I was discharged.
However, now it is easier to perform surgery using a microscope or endoscope. The skin is cut to a minimum, a microscope is inserted to remove the bones, ligaments, and discs in the spinal canal and intervertebral foramen. Unlike traditional surgery, you can be hospitalized for about a day and then discharged quickly. However, this method does not remove enough bone compared to traditional surgery, so it is said to be of little help in severe cases of spinal stenosis.
Which treatment is most appropriate in spinal stenosis depends on the patient's condition.
For example, 1-2 out of every 10 patients with spinal stenosis require surgical intervention. If these patients have surgery late, they may continue to experience pain due to the damaged nerve, even if the compression is removed later.
On the other hand, surgical treatment for patients with mild symptoms may be more expensive than beneficial. In conclusion, it is better to find a specialist who is familiar with the patient's condition and choose the appropriate treatment.
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