This results in a compression of the lower part of the spinal cord resulting in various symptoms, including painchronic such as low back pain, sciatica or cruralgia.
The narrow lumbar canal can be treated in two different ways, namely the non-surgical treatment (or conservative) for patients with moderate symptoms, and the surgical treatment (or radical) for patients with severe symptoms or functional deficits.
In this article, we are going to tell you about the surgical treatment of narrow lumbar canal (its indications, the different surgical techniques used, the length of hospitalization, the recovery period, etc.).
Contents
What is narrow lumbar canal?
Le narrow lumbar canal is a pathology, constitutional or acquired, characterized by the reduction in the diameter of the spinal canal (where the spinal cord travels) at the level of the Lumbar spine (less than 13 cm, instead of 15 cm normally).
This narrowness of the lumbar canal can go so far as to cause a spinal cord compression which crosses it. Results: chronic lumbar pain, sensory and/or motor disorders in the lower limbs and the perineal region, sphincter disorders, etc.
Sensory disorders in the seat area and lower limbs (loss of sensitivity, numbness, etc.),
Sphincter disorders (urinary or faecal incontinence),
Erectile dysfunction...
In many cases, the narrow lumbar canal goes completely unnoticed (no symptoms). He is then diagnosed fortuitously during imaging (MRI or scanner, etc.) for another pathology.
For more details on the narrow lumbar canal, its causes and symptoms, do not hesitate to consult our complete article: narrow lumbar canal.
Conservative treatment
Conservative (or non-surgical) treatment is always implemented before considering any surgical treatment. It is mainly based on corticosteroid injections and rehabilitation sessions at a physiotherapist or osteopath.
Rehabilitation usually consists of postural exercises, stretching and strengthening of the dorsal-lumbar muscles and the abdominal strap.
To these measures are added analgesic treatments and / or anti-inflammatory (NSAIDs) to best relieve pain.
This conservative therapeutic approach to the narrow lumbar canal will be implemented during at least three months before considering surgery.
Surgical treatment
Several studies have found that the majority of patients (80%) reported a significant reduction in pain after receiving treatment, whether conservative or surgical.
However, approximately 80% of surgically treated patients rated the results as « excellent » in the years following the operation. Against 50% for patients treated with the conservative approach.
Surgery would therefore give good results in the management of the narrow lumbar canal. It helps to stop the aggravation of symptoms, or even their regression to varying degrees.
When to operate a narrow lumbar canal?
We operate a narrow lumbar canal in case offailure of conservative treatment well behaved (for at least three months) or severe stenosiswith severity criteria.
Among these severity criteria, we can cite:
Sensitivity disorders,
motor disorders,
Abnormalities of the osteotendinous reflexes,
gait disorders,
sphincter disorders (incontinence),
Nocturnal back pain.
What are the surgical techniques used?
The surgical approach of the narrow lumbar canal consists in increasing the diameter of this canal in order to lift the compression of the elements it contains, to leave more room for the spinal cord and the nerves.
This is usually done using a surgical technique called «laminectomies ». The latter represents the intervention of reference when it comes to lifting a compression of the spinal cord or its nerve roots.
It consists of widen the lumbar canal by removing the elements that narrow it back, i.e. the spinous processes, spinal blades (lateral parts of the vertebrae) as well as the yellow ligament that connects these structures.
Laminectomy aims to become less and less dilapidating. We try to preserve as many anatomical structures as possible and we gladly talk about « lumbar recalibration ».
This intervention can be supplemented by a «spinal arthrodesis ». That is to say the fusion of two or more adjacent lumbar vertebrae (using metal rods, screws and bone grafts) in order to stabilize the spine (weakened by laminectomy).
Today, there are many other procedures that provide comparable results to laminectomy while being lessinvasive. Among them, we can cite the « laminotomy ».
La laminotomy also aims to decompress the nervous elements of the lumbar canal. It consists of removing only part of the spinal blade.
Indeed, unlike laminectomy, the blade is not completely removed during the laminotomy. Secondly, once the access has been freed, the surgeon performs a foraminotomy. That is, it widens the narrowed vertebral foramen to make more room for the spinal cord and its roots.
In addition, there is an even more innovative technique in the treatment of the narrow lumbar canal: the placement of a percutaneous interspinous implant under scanner control.
This interventional radiology technique consists of placing a lumbar spinal implant in percutaneous (through the skin and muscles of the back) between two spinous processes. This is used to reopen the lumbar canal and prevent pinching of the nerves. All under scannographic control.
Thanks to this minimally invasive technique, the patient to get up and go home the day after the intervention.
What are the modalities of narrow lumbar canal surgery?
The surgical methods differ according to the technique used:
Procedure : laminectomy, minimally invasive laminotomy or percutaneous implant under scannographic control.
Surgical approach: regardless of the technique used to treat a narrow lumbar canal, the surgeon generally approaches the lumbar spine via the posterior approach (an incision opposite the seat of the canal stenosis). The patient is then in the prone position.
Type of anesthesia: general anesthesia for laminectomy or laminotomy, deep local anesthesia and sedation if it is a percutaneous implant placement under scanner.
Duration of hospitalization: the duration of hospitalization in the case of minimally invasive laminotomy or placement of a percutaneous interspinous implant is very short. The patient can get up a few hours after the operation and go out the next day. On the other hand, for a laminectomy, it takes approximately 4-5 days before considering the patient's discharge (depending on his initial condition, his ability to regain autonomy, pain, possible complications, etc.).
What are the possible complications after narrow spinal canal surgery?
The complications of laminectomy are quite rare, especially when performed in a reference center by an experienced surgeon.
In addition to the risks associated with any other surgery (risk of parietal infection, pulmonary embolism, deep vein thrombosis, urinary tract infection, etc.), there is a risk of dura-merian breach (can be treated on site with a simple suture and cause no sequelae).
La long-term destabilization of the lumbar spine subsequent laminectomy is also one of the possible complications of this surgery. Fortunately, it is prevented by performing arthrodesis in subjects at risk – despite the fact that arthrodesis itself is a source of complications. It is also reserved for special cases.
Minimally invasive techniques such as interspinous implant placement have the advantage of having virtually no no complications (extremely rare).
Recovery after narrow spinal canal surgery
After typical narrow spinal canal surgery recalibration, the patient is lifted and re-educated to walk very early, the day after the operation. The surgical drain can usually be removed after 48 hours.
After 3 or 4 days of hospitalizationpostoperative, the patient regains his autonomy and can return to his home. He is then encouraged to walk often and resume moderate activity, but carrying heavy loads and exertion will be strongly discouraged.
He can also be referred to a physiotherapist to benefit from some rehabilitation sessions.
The recommended occupational rest is 6 weeks for office workers, 3 months minimum for professions involving intense physical effort.
Moreover, with regard to minimally invasive surgical approaches (percutaneous interspinous implant or minimally invasive laminotomy), hospital discharge is usually the next day of the intervention, and the recovery period is significantly shortened.
The results of the narrow spinal canal surgery vary from one patient to another (depending on their initial condition, the degree of stenosis, the surgical technique used, etc.). They can be judged around the 6nd the 8nd week after the intervention. The patient generally notes an improvement in sciatica, lower back pain and intermittent claudication.
References
[1] AA Faundez, “Surgical treatment of narrow lumbar canal: scientific evidence in 2008.”, Swiss medical journal, No 194, p. 582, 2009.
[2] YP Charles and J.-P. Steib, "Diagnosis and treatment of narrow lumbar canal", Therapeutic medicine, flight. 23, no 3, p. 136-144, 2017.
[3] N. Aldahak, WC Chang, JD Laredo, AL Bernat, T. Passeri, and S. Froelich, “The transspinous approach, a new corridor for the surgical treatment of the degenerative narrow lumbar canal: technical note”, Neurosurgery, flight. 64, no 3, p. 239, 2018.
[4] J.-P. Vallée, A.-M. Baqué-Gensac, F. Armangau-Turck, G. Bergua, and J.-C. Grall, “Narrow lumbar canal: to operate? », Medicine, flight. 4, no 3, p. 102-102, 2008.
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My name is Katia, I'm 27 years old and I'm a web writer specializing in writing medical articles. Being passionate about medicine and writing, I have set myself the goal of making medical information accessible to as many people as possible, thanks to the popularization of even more complex scientific notions.
