Column What are the Various Complications Possible With Spinal Stenosis?

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11.01.2024

What is spinal canal stenosis?

Spinal canal stenosis can be broadly divided into 3 types: (1) Cauda equinea type, (2) foraminal type, and (3) mixed type.

If the root of the nerve that branches off from the nerve and exits between the vertebrae is compressed, this is called Cauda equinea spinal stenosis. If the foramen (a bundle of nerves that extends from the lower end of the spinal cord downwards) is compressed, this is called foraminal spinal stenosis, and if both of these conditions occur together, this is called mixed spinal stenosis.

The main symptoms of spinal canal stenosis are pain in the lower back and pain and numbness in the lower limbs. The most characteristic symptom is intermittent claudication. When walking, the patient feels pain or numbness in the legs and is unable to walk, but after taking a short rest, the pain eases and they are able to walk again, only for the pain to return after a while.

After-effects of severe spinal canal stenosis

The more severe the spinal canal stenosis, the more likely it is that the following after-effects will occur.

Bladder dysfunction, lower urinary tract symptoms

About half of the patients with intermittent claudication also complain of symptoms such as difficulty urinating, incontinence, frequent urination at night, and urinary tract infections. These symptoms occur as the cauda equina type of spinal canal stenosis progresses, and are one of the criteria for surgical treatment.

Sexual dysfunction

Severe spinal canal stenosis can also cause sexual dysfunction. This is one of the symptoms of cauda equina stenosis, and also occurs when the sacral nerve roots are compressed.

Renal osteodystrophy

One of the complications of severe spinal canal stenosis is renal osteodystrophy (a general term for a disease in which bone metabolism (the process by which bone cells, such as osteoblasts, osteoclasts, and osteocytes work together to maintain the structure and amount of bone tissue)fails due to a decline in kidney function). This occurs when kidney disease is also present, and it is said that the symptoms of spinal stenosis and kidney disease are more pronounced.

* : Jason Gandhi, et al. Neuro-urological sequelae of lumbar spinal stenosis. International Journal of Neuroscience. 2018, 128(6).

Surgery for spinal stenosis and post-operative complications

Surgical treatment for spinal stenosis

The most common surgical treatments for spinal stenosis are lumbar laminectomy and spinal fusion.

With lumbar laminectomy, a skin incision of about 18 to 20 mm is made in the back under general anesthesia, and a part of the lamina or the thickened ligamentum flavum is removed using an endoscope to relieve nerve compression and widen the spinal canal.

With spinal fusion surgery, the skin on the back is also incised under general anesthesia, the degenerated intervertebral disc is removed, and an artificial device called a cage filled with bone taken from the hipbone is inserted to reshape the spine, after which the vertebrae are fixed in place with screws and rods.

Post-operative Complications

After undergoing surgical treatment, there may be residual symptoms.

Pain around the surgical site

During surgical operations, the skin is incised, the muscles are peeled back and the bones are shaved, so there will be some pain after the operation. In most cases, this pain will gradually ease off over time.

If you continue to experience severe pain long after the operation, ask your doctor to prescribe painkillers or provide other appropriate treatments.

・Neuralgia

Surgery may involve cutting into the tissue around the nerve to relieve pressure on it. During surgery, the nerve may be stimulated, and after surgery, symptoms such as numbness or burning pain may occur.

Neuralgia usually heals naturally over time, but if the nerve damage is severe, pain and numbness may continue for some time.

・Fascia pain

After surgery, the muscles around the spine become tense and stiff, which can cause muscle pain. While ordinary muscle pain may be relieved by massage, it is better to avoid massaging fascia pain after surgery. If the pain persists for a long time, please consult a doctor.

・Joint pain

The operation may put a strain on the joints of the lower back and legs, causing pain. The pain worsens when you twist your back or stand for a long time, but eases when you rest.

The after-effects described above will improve over time, but if they persist or worsen, you may need to go through another operation.

The treatments at our clinic

Our clinic performs the Florence and Cellgel Methods on spinal stenosis.

Both of these procedures are minimally invasive and have a low impact on the body. We recommend them to patients who wish to avoid surgical procedures such as spinal fusion, which require general anesthesia.

The Florence Method

The Florence method is a low-risk, minimally invasive treatment for spinal canal stenosis.

A spacer is inserted percutaneously under partial anesthesia and sedation to widen the narrowed spinal canal. It remains possible to remove the spacer if complications should arise after the treatment has been performed.

The Lobster spacer is inserted inside the vertebral body to stabilize it while preserving spinal rotation and flexion, widening the spinal canal, reducing disc protrusion, and reducing the thickening of the ligamentum flavum. Thus, the narrowed spinal canal is widened, and the pain is relieved.

The Florence method

The Cellgel Method

Spinal canal stenosis occurs when a disc cracks, causing the central component to protrude and the protruding portion to cause the spinal canal to narrow. If the disc crack is not repaired, herniation can recur, and the spinal canal can become narrowed again.

The Cellgel method used at our clinics provides a fundamental treatment by injecting a drug that fills the cracks in the disc, which then forms a gel that replaces the cracks. It is characterized by the fact that the volume of the disc is not reduced, and the drug remains in the disc as a gel-like implant after treatment, thus preserving the disc.