Spinal canal narrowing...

A narrowing of the spinal canal is a common condition, which usually manifests itself only in old age. In principle, a narrowing can occur anywhere in the spine, but the most common places are in the neck or at the bottom of the back.
Anatomy of the spine

The spine has a central place in the musculoskeletal system. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae and the sacrum. Between two vertebral bodies there is an intervertebral disc, and these 23 discs increase the elasticity and movement of the spine. Although a narrowing can theoretically occur at any level, for practice only the cervical spine and lumbar spine are important. In the neck there is usually a narrowing between the 4th and 7th cervical vertebra, at the bottom of the back usually between the 2nd or 3rd and the 5th lumbar vertebra.
In the neck, the narrowing pressure on the spinal cord occurs. The spinal cord runs down no further than the first lumbar vertebra; underneath, there is only a bundle of nerve fibres, the ponytail or cauda equina. These nerve roots are pinched by a narrowing in the lower back.

The constriction

Wear or degeneration of the spine is a normal process that takes place in everyone to a greater or lesser extent. Some naturally have a narrower spinal canal than others. During the degeneration process, thickening of the ligaments (ligaments) between the vertebrae occurs. In addition, enlargement (widening and flattening) occurs of the small intervertebrate toggles, which form the connection between the vertebral arches at the rear. As a result, the space for the nerve roots becomes smaller and smaller, especially in the gutter where the nerve roots leave the spinal canal. Sometimes a bulge of the intervertebral disc contributes a little to the narrowing.

Complaints and symptoms
The complaints of narrowing in the neck and
bottom of the back are different: § narrowing in the neck. Because pressure on the spinal cord occurs, symptoms can occur both on the arms and on the legs. Often there are deaf or prickly feelings, powerlessness or an uncertain course. Sometimes, when the head is strongly reversed or bent backwards, the space around the spinal cord is reduced even further.
§ narrowing at the bottom of the back. At the bottom of the back, only the nerve roots still run. The symptoms are caused by pressure on them and can therefore be very similar to those of a hernia. Usually there is pain in both legs, often occurring or worsening when walking. The symptoms are therefore similar to those that arise from a vascular narrowing of the legs (e.g. shop window sickness). When walking, pain occurs, sometimes also a deaf feeling and/or a reduction in strength. At rest, especially in a somewhat stooped position, squatting or sitting, the pain disappears quite quickly. This is because when walking the curvature in the spine (the lordosis) increases somewhat and the space decreases. When bending down or squatting, the narrowing becomes a little less. Patients with a constriction can therefore often cycle well.
To show that the symptoms are indeed caused by a narrowing, further examination should be carried
out. There are 3 types of research
that are eligible: § CT scan. As a rule, this investigation is insufficient and only exceptionally provides sufficient information to be able to take an operation decision.
§ Contrast examination of the spinal canal (caudography), possibly supplemented by a CT scan. This research provides a lot of information about the root structures and also a beautiful image of the nerve roots. The research has now been almost completely
suppressed by: § MRI. This is the first-choice investigation. It gives good information about the location of the narrowing in three directions and shows the soft tissue (nerves, thickened ligaments) excellently. Bone is less well pictured.
Usually from the symptoms, symptoms and from the auxiliary examination it is clear that surgery is
required. A particular case is the narrow cervical vertebrae in "not so old" patients (40-50 years) with few symptoms. These patients run an increased risk of spinal cord damage, even a spinal cord injury, so that in these cases surgery will often be recommended as a precautionary measure. This risk does not apply to the lumbar spine.
Again, a distinction can be made between surgery at the level of the cervical spine or the lumbar spine.
Narrowing in the
neck Depending on whether most pressure on the spinal cord arises from the front or back of the spinal cord, and
of the operator's preference there are basically two approaches: § From the front. It is possible to approach the cervical spine from the front, via a cut to the left or right of the larynx. The operation takes place with the help of X-ray. From this approach, as much as is necessary is removed from intervertebral disc and vertebral body, in order to make room for the spinal cord. After this has been done, reconstruction takes place, for which different techniques exist, all of which do not subse to do for each other. One can choose a bone canfly from the patient's pelvic comb, for carbon cages, plates, screws, etc. Usually, but not always, with such an operation, sufficient space can be obtained. Patients can usually go home quickly after the procedure and most of the complaints are still reported at the donor site of the bone comb on the pelvic comb. The procedure has virtually no effect on the mobility of the neck.
§ From the
back. This is the "classic" operation, in which from behind it is released from the vertebral arches and then removed. Usually it's four arches. The procedure does not lead to a reduced mobility of the neck. Also, one does not have to be afraid that the spinal cord at the back is unprotected. There will be a thick layer of muscle over it that provides ample protection. The procedure is experienced as more painful in the first few days.
















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