Lumbar recalibration: The solution to the narrow lumbar canal?

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

Narrowed spinal canal refers to a condition called narrow lumbar canal. This decrease in space can compress the spinal cord and nerve roots emerging from the spine.

Among the treatments available, surgery to widen the diameter of the spinal canal can be done: this is lumbar recalibration. This article discusses this operation by mentioning its procedure, the associated risks, and the convalescence allowing the resumption of activities.

Definition

To better understand lumbar recalibration, you must first become familiar with the narrow lumbar canal.

As mentioned, this is a reduction in the size of the Spinal canal (also called vertebral canal) at the level of the lumbar vertebrae (qualified from L1 to L5). Normally this channel is around 15mm in diameter, but it is considered "narrow" when it is less than 13mm.

To learn all about narrow spinal canal (including symptoms, causes, and management), see the following article.

Indications for surgery

Treatment options include conservative techniques such as medication and exercises. If there is no relief, then more drastic options such as surgery are considered.

More specifically, surgery is considered in the presence of the following situations:

• Presence of red flags indicating a potentially serious injury
• cauda equina syndrome
• Persistent pain and disability (between 3 and 6 months) despite well-conducted conservative treatment

Lumbar recalibration

Lumbar recalibration is a surgical technique that precisely widens the spinal canal in the treatment of narrow lumbar canal. Essentially, we will seek to remove a small part (corresponding to the excess and the cause of nerve compression) of ligament or posterior joints in order to free the passage of nerves.

The results of a prospective series of patients confirmed the effectiveness of the method both on stenosis and on postoperative spinal stability.

Indications

First of all, you need to know what causes the narrowing of the lumbar vertebral canal to see in which case lumbar recalibration is suitable.

The spine extends from your neck to your lower back. The bones in your spine form what is called the spinal canal, which protects your spinal cord. There are many people who are born with a small spinal canal (congenital cause). But most spinal stenoses, or narrowings, occur when something happens to reduce the space at the spinal canal.

Causes may include:

Bony growth 

The damage caused by lumbar osteoarthritis ou zygapophyseal on the bones of the spine can cause the formation of bone spurs (or osteophytes), which can grow into the spinal canal. Paget's disease, a bone disease that usually affects adults, can also cause bone overgrowth in the spine.

herniated disc

We all have a kind of soft cushion between our vertebrae. These cushions are like shock absorbers, but with age they dry out. When there are cracks on the outside of a disc, the soft inner material leaks out of the spinal cord and begins to press on it or on the nerves.

The thickened ligaments

The tough cords that help hold the bones in your spine together can become stiff and thickened over time. Which causes them to bulge in your spinal canal. For example, a yellow ligament hypertrophy can reduce the size of the spinal canal.

Tumors

Surpluses or growths that are abnormal form in the spinal cord. Specifically in the membranes covering the spinal cord (the space between your spinal cord and your vertebrae).

Injuries to the vertebral column 

When you are the victim of a car accident, dislocations or fractures of the vertebrae can be provoked. Indeed, a fragment of bone that has moved can damage the inside of your spinal canal. Swelling of surrounding tissues immediately after back surgery can also put pressure on the spinal cord or nerves.

To know other causes of narrow lumbar canal, see the following article.

Procedure

Lumbar recalibration is an operation that takes place under general anesthesia. It is usually necessary to place a drain which will be worn for 2-3 days, in order to reduce the risk of formation of a hematoma. The procedure itself takes less than 90 minutes, depending on the case and the surgical procedure.

Essentially, the goal will be to increase the space in the spinal canal narrowed by one of the causes mentioned above. The orthopedic doctor can carry out one of the following operations:

• Laminectomy
• Laminoplasty
• Discectomy
• Corpectomy
• Foraminotomy
• Arthrodesis
• Flavectomy
• Ligament decompression

The first survey can usually be done the same day. In all, the length of hospitalization is 2-4 days, although some patients leave the next day. In case of complications, we will use a different approach where the patient will remain bedridden while healing.

The goal of the operation is to reduce pain and other symptoms (such as paresthesias) due to nerve compression. However, like any operation, there can be complications. This is what we will see in the next section.

to have more space can reduce the symptoms of your stricture. However, for other people the symptoms may get worse with surgery. And there are also other risks that you may face: such as infection, tearing of the spinal cord membrane, blood clot and neurological deterioration, etc.

Complications and risks

Possible complications include:

• an infection
• a tear in the membrane of the spinal cord
• a blood clot
• neurological deterioration, etc.

Unfortunately, surgery is not always successful. This depends in particular on the pre-operative condition of the patient, and his prognosis. Thus, the symptoms experienced before the operation may persist, such as:

• Numbness of the lower limbs
• Leg weaknesses
• Balance issues
• Incontinence disorders
• Paralysis

After the operation, it is essential to contact your doctor if you ever observe any of the following signs:

• Redness, swelling or foul odor near the incision site.
• Swelling or tenderness in the legs.
• Worsening of pain near the incision site, shoulder or stomach.
• Fever.
• Difficulty breathing or swallowing.
• Bowel or bladder control problems.

Recovery and rehabilitation after lumbar recalibration

After a lumbar recalibration operation, convalescence and rehabilitation are essential to regain a normal lifestyle. Indeed, you must follow rehabilitation sessions which will last on average 3 to 4 weeks at least.

You should know that the first objectives of rehabilitation after a recalibration are to help you manage your pain and limit any inflammation you may feel. It is also important to minimize muscle spasms. Painkillers, anti-inflammatories, or muscle relaxants may help control your symptoms.

A physiotherapist (physiotherapist) will show you exercises that strengthen the muscles and stabilize the back. Reducing pain and restoring full range of motion so you can be fully active again are the long-term goals of your therapy.

There are many exercise choices available to patients. If a therapist and patient work together, they can come up with alternatives that will greatly benefit the patient's physical condition and ability to return to activity on almost any level.

Patients often wonder if and when they will be able to resume certain activities after a recalibration. Much depends on how they respond to exercise and can prepare the muscles to protect the spine during this activity. The patient/therapist team works well in this situation because the therapist has the opportunity to observe the patient's movement and strength tolerances over time.