Before discussing spinal stenosis treatment, let us answer the question: what is spinal stenosis? The spinal cord and the nerves that branch from it lie inside a canal we call the spinal canal. With age, arthritis develops in the facet joints and discs surrounding the canal, and this process gradually begins to narrow it. As a result, the spinal cord and the nerves become compressed inside the canal. Spinal stenosis, whose main cause is advancing age, presents with neck and upper-back pain, morning stiffness and numbness in the arms, and progresses slowly over the years.
Advanced cases always require surgical treatment. In cases that have not progressed, conservative treatments and interventional pain methods are used. Because the disease tends to progress, the boundary between these treatments and surgery must be defined very carefully: in patients with spinal stenosis who need surgery, a delayed operation can lead to irreversible problems (such as permanent weakness in the arms and legs).
Treatment Methods for Spinal Stenosis
CONSERVATIVE TREATMENTS: applied in patients who do not yet require surgery. They comprise the first-line treatments used in spinal stenosis treatment: medication, physiotherapy, and patient education about what to do and what to avoid for a healthy spine.
INTERVENTIONAL PAIN TREATMENTS: interventional pain techniques are used in patients who do not improve with conservative methods, or in combination with them. Spinal stenosis is a chronic process, and the right approach is to carry out all of these treatments together. The interventional pain method we use in spinal stenosis treatment at our clinic is the epidural steroid injection. Patients whose complaints are caused by arthritis of the facet joints (facet syndrome) receive cervical facet denervation in the same session. (cervical facet joint treatment)
Surgical methods: our surgical team successfully performs the posterior cervical laminectomy, the most widely used operation in the world for spinal canal stenosis. Patients who have vertebral slippage, or who are considered at risk of slippage after laminectomy, receive lateral mass screw fixation in the same session. For detailed information about spinal stenosis surgery and our three-dimensional animation video, please click.
Appointments & practical information
How do I book an appointment?
You can send your appointment request via WhatsApp, by phone or through the contact form. Briefly describing your complaint and the times that suit you speeds things up; we respond as quickly as possible.
What should you bring to the consultation?
If available, bring your recent MRI and CT images, previous test and surgery reports, and a list of the medication you take regularly. This makes the assessment considerably easier.
What happens at the first consultation?
We listen to your complaints and history, perform a neurological examination and review your existing images together. Treatment options are then planned with you, taking your expectations and lifestyle into account.
Second opinion
If you have been diagnosed or advised to have surgery elsewhere, you can book an appointment for a second opinion with your existing images and reports.
Reach out for your questions and appointment requests. We reply as soon as possible.
Spinal stenosis — or, as it is popularly known, spinal canal narrowing — is the narrowing of the bony canal through which the spinal cord and nerve roots pass, due to aging or other factors. As a result of this narrowing, the nerves become compressed; it is a chronic process that causes pain and numbness in the arms and seriously restricts the patient's quality of life.
What Are the Symptoms of Canal Narrowing (Spinal Stenosis)?
Neck and arm pain, burning in the arms and permanent loss of strength in the arms are also seen.
What Causes Canal Narrowing (Spinal Stenosis)?
The most common cause is age-related degeneration. It occurs as the discs between the vertebrae lose water and collapse, the joints calcify and thicken, and the ligaments inside the spine (ligamentum flavum) lose their elasticity and thicken, narrowing the canal. Rarely, a congenitally narrow canal structure or past traumas can also lead to this condition.
What Happens If Canal Narrowing (Spinal Stenosis) Is Not Treated?
Untreated canal narrowing is unfortunately not a process that heals on its own; on the contrary, it is progressive. Chronic pressure on the nerves can cause wasting of the arm muscles and permanent numbness.
What Is the Treatment for Canal Narrowing (Spinal Stenosis)?
Treatment is planned according to the stage of the disease. At the initial stage, medication, rest and physical therapy are applied. In moderate narrowing, the area around the nerve is relieved with epidural steroid injections and nerve blocks. In advanced narrowing and in the presence of neurological loss, however, surgical intervention (decompression) is the definitive solution.
How Is Canal Narrowing (Spinal Stenosis) Diagnosed?
The diagnostic process begins with a detailed history and examination of the patient. For a definitive diagnosis, cervical MRI is the gold standard; the diameter of the canal is measured to the millimeter. Computed Tomography (CT) to see the calcifications in the bone structure more clearly, and an EMG test to check the conduction status of the nerves, also assist the diagnosis.
How Effective Are Non-Surgical Treatment Methods (Epidural Injection, Nerve Block) in Canal Narrowing?
Non-surgical methods are quite effective, especially in "mild and moderate" narrowing. The epidural steroid injection reduces the inflammation in the nerve roots and relieves the patient's pain. However, if the canal is completely closed off by bone and ligament tissue, these methods provide only temporary relief; the lasting solution is surgery.
At What Stage of Canal Narrowing Is Surgery Needed?
If noticeable loss of strength has begun in the arms and the injection treatments applied are not producing results, it means the time for surgical intervention has come. In making the decision, the degree of restriction in the patient's daily life is taken into account rather than the MRI image.
When Do Screws (Hardware) Need to Be Placed in Canal Narrowing Operations?
Placing screws is not required in every canal narrowing operation. In a stable spine, simply widening the canal (decompression) may be sufficient.
What Are the Risks of Canal Narrowing Surgery?
Thanks to modern microsurgical techniques and neuromonitoring devices, the risks have been greatly minimized. However, as in any surgery, infection, bleeding or, rarely, a tear of the dura (spinal cord membrane) can occur. With an experienced surgeon and the appropriate technique, these risks are managed successfully.
What Is the Difference Between a Cervical Herniated Disc and Canal Narrowing?
A cervical herniated disc usually starts suddenly and is the soft disc tissue crushing the nerve; it can occur at any age. Canal narrowing, on the other hand, is a chronic process spread over years, usually seen over the age of 50, caused by the thickening of bone and ligament tissue.
Does Canal Narrowing Cause Burning and Numbness in the Arms?
Yes, absolutely. Chronic pressure on the nerves leads to sensations such as matting/numbness in the arms and hands or an "electric shock" feeling. This is a sign that nerve damage has begun.
Is Surgery Always Necessary for Canal Narrowing?
Not every canal narrowing patient has to undergo surgery. If your complaints do not greatly disrupt your quality of life and you have no neurological loss, you can continue your life with weight control, exercise and periodic injection treatments. Surgery is a savior "when the end of the road is reached" and life becomes unbearable.
Is the Epidural Steroid Injection a Solution for Canal Narrowing?
The epidural steroid injection is the most powerful weapon before surgery. In a large proportion of patients with canal narrowing, it can provide relief lasting months, sometimes years, by easing the pressure and edema around the nerve. Even if it does not cure completely, it is a very successful method for delaying surgery or improving quality of life.
Can Canal Narrowing Cause Paralysis?
Since canal narrowing is generally a slowly progressing process, the risk of sudden paralysis is lower than with a cervical herniated disc. However, in neglected cases where the loss of strength in the arms is not taken seriously, nerve conduction can be completely interrupted and irreversible walking disorders can develop. Early diagnosis and proper follow-up eliminate the risk of paralysis entirely.
Does Nucleoplasty Help With Canal Narrowing?
Nucleoplasty is a treatment focused more on the "cervical herniated disc". In canal narrowing, the fundamental problem is not the disc tissue but the thickening of bone and ligament tissue. Therefore, unless there is a large accompanying herniation, nucleoplasty is not the first choice in the treatment of canal narrowing. In these cases, the epidural steroid injection achieves far superior success.
How Is Canal Narrowing Surgery Performed?
The most common method still performed as canal narrowing surgery is the posterior cervical laminectomy. In patients who have a vertebral slippage problem, or who are thought likely to slip after laminectomy, lateral mass screw fixation is performed in the same session. After the skin incision made at the back of the neck, the neck muscles are retracted to both sides. The bones we call laminae are removed from the levels with canal narrowing, thereby widening the spinal canal. If there is vertebral slippage (instability), screws are applied in the same session to the elements we call the lateral masses, achieving fixation (stabilization) and fusion of the vertebrae.
What Is the Success Rate of Canal Narrowing Surgery?
With the right patient selection and meticulous microsurgical planning, the success rate in canal narrowing operations is above 90%. Most of our patients state that they are freed from the complaints they experienced before surgery and that their comfort zone has increased dramatically.
Can Nerve Damage Occur in Canal Narrowing Surgery?
Thanks to advanced microscope technology and devices called "neuromonitoring", which track nerve functions in real time during the procedure, the risk of nerve damage has dropped below 1%. The combination of the surgeon's experience and these technologies makes the operation extremely safe.
How Many Days After Canal Narrowing Surgery Can I Get Up?
The greatest advantage of the closed/microsurgical method is that it mobilizes the patient quickly. Our patients can generally get up and walk in the corridor 4-6 hours after surgery, as soon as the anesthesia wears off, accompanied by a nurse and physiotherapist. The hospital stay is usually just one night.
Will My Canal Narrowing Complaints Disappear Immediately After Surgery?
Arm pain and cramps usually disappear the very day after surgery. However, the complete resolution of the numbness and tingling caused by long-term pressure can take a few weeks, depending on the nerve's speed of self-renewal. The moment the pressure on the nerve is lifted, the "healing clock" starts ticking.
Can I Bend Down and Get Up After Canal Narrowing Surgery?
During the first 4-6 weeks of the "tissue fusion" period, sudden bending and twisting movements should be avoided. After the first month, as the neck muscles strengthen, the patient fully regains normal daily mobility.
When Can I Return to Work After Canal Narrowing Surgery?
Our patients who work in desk-based and mentally oriented jobs can generally return to work within 10-15 days. In more active lines of work requiring physical strength, this period can extend to 4 to 6 weeks. Light walks taken in the early period speed up the return-to-work process.