What is spinal canal stenosis?
When the spine deteriorates the body responds by accumulating calcium, which causes enlargement of bones and thickening of the tendons to accommodate this added weight. This extra bone and tendon can, in some cases, lead to narrowing (stenosis) of the spinal canal, which houses a number of nerves. These nerves can then become compressed. Usually the nerves that branch out from the spinal canal are compressed first; if the condition becomes more severe, stenosis will occur to the spinal cord.
What are the symptoms of spinal canal stenosis?
There are three types of symptoms of spinal canal stenosis: pain, weakness, and numbness.
Pain caused by the compression of nerves will occur in the arms or legs, and may feel like an ache that travels along the path of those nerves. Depending on which nerves are compressed, pain will be unique to those nerves.
The nerves of the spine control movement of muscles. Compression of these nerves causes a disruption to the electrical signals that are transmitted, leading to weakness of the muscles.
Compression of the nerves can lead to loss of sensation on the surface of the skin to which the nerves are connected.
What many people believe is that conditions that affect the spine cause back pain, but in reality, symptoms that are more important are those that affect the limbs as these demonstrate that the nerves have been disturbed.
The symptoms of spinal canal stenosis is different from those of spinal disc herniation in that the former often occurs gradually and manifests as aching and heaviness of the legs, especially after walking a long distance or standing in one place for a long time. Symptoms may improve when bending over or squatting, which leads to the misunderstanding that the symptoms were caused by natural fatigue caused by age rather than a spinal condition that is curable.
If medication and regular physical therapy do not alleviate the symptoms of spinal canal stenosis, and the patient does not meet the criteria for surgery, steroid injections into the spinal canal
may be another option.
Treatment by Endoscopic Surgery
Using a microscope, the surgeon can avoid healthy tissue to access and trim the excess bone or disc that is compressing the nerves. Sometimes it is necessary to expand the incision to allow for a better vision field for surgery.
In endoscopic surgery the surgeon will insert an endoscope through an incision of just eight millimeters. The lens at the tip of the endoscope is similar to the eyes of the surgeon inside the patient’s body, allowing more clarity and accuracy in detecting abnormalities. The surgeon can then remove only the problem area without unnecessarily damaging the surrounding healthy muscle and tissue.
For spinal canal stenosis the surgeon will use a slightly larger endoscope and specially developed instruments for the most effective surgery that will allow patients to recover more quickly from the procedure.
An endoscope is a surgical tool that includes a camera and is “smaller than your fingertip.” It is a small tube with a diameter of just eight millimeters, with a lens at the tip. The lens is slightly angled for better view of surrounding organs. Furthermore, an endoscope has fiber optics allow brighter lighting for improved vision and a small water pip. All surgical instruments will pass through this tiny pipe, which means that the incision required will only be eight millimeters wide.
Advantages of Endoscopic Surgery
- Smaller incision site
- Less pain from surgery
- Low risk of infection
- Less damage to healthy tissue surrounding the surgical site
- Quicker recovery; patient is able to return home within 24 hours
- Lower cost
Spinal Endoscopic Surgery Procedure
Once the patient is under anesthesia the surgeon will insert the endoscope through an incision of eight millimeters directly to the nerves that are being compressed, without damaging any of the healthy tissue surrounding the site. The endoscope will allow the surgeon to clearly see the nerves so they may trim only the area where the nerves are compressed, whether compression is caused by a bulging disc or constriction due to joints and tendons. The entire procedure takes approximately 30 to 45 minutes. The patient can walk immediately after surgery.
Indicators for Spinal Endoscopic Surgery
Generally the indicators for surgery include: unsuccessful treatment by alternative methods, chronic pain, clear weakness of the legs, or the inability to control bladder and bowel.
The Spine Institute at Bumrungrad International
The team of physicians at the Spine Institute of Bumrungrad International has received training from Dr. Sebastian Rütten (the inventor of the tools and pioneer of this type of surgery) has performed spinal endoscopic surgery on more than 600 patients in Thailand with good to excellent outcome rates of up to 95%.