Spinal stenosis (stenosis – waist, neck hernia)

Spinal stenosis (hernia) is the compression of the spinal cord and nerve roots passing through it, due to the narrowing of the canal between the vertebrae. It is a very common condition. Compression of the spinal cord and/or nerve roots causes pain, cramping, weakness, or numbness. Depending on the location of the narrowing, you may feel these symptoms in the lower back, legs, neck, shoulders or arms.

Often, narrowing is due to osteoarthritis, or “wear and tear.” At the same time, it is possible for the discs between the vertebrae to swell or a part to break off and press on the nerve. Spinal stenosis symptoms usually start slowly and worsen over time. Pain in the legs can be so severe that even walking short distances can be unbearable. Patients often want to sit up or lean forward a grocery basket to relieve pain or try to reduce weight by using a walker.


Spinal stenosis is a narrowing of one or more areas of the spine. It most often occurs in the waist or neck. Due to this narrowing, compression develops in the spinal cord or its branches. Usually, a person with this disease has pain that radiates from the hip to the leg, and this pain becomes severe, hitting the lower back with standing or walking. Pain may come more quickly when going uphill or climbing stairs.

They often say that they are relieved by sitting or leaning over it.

Pain is an important finding. However, there may be patients who do not have pain despite spinal stenosis. Therefore, strictures that do not cause any symptoms do not require treatment.


Some people are born with a small spinal canal. This is called “congenital stenosis”. However, it usually occurs over time due to age, which is called “acquired spinal stenosis.”


Those with congenital narrow spinal canal

in women

50 years old or older

Those who have had a previous spinal injury or surgery

Certain medical conditions can cause spinal stenosis. These include:

Osteoarthritis and bone spurs that develop with age

Inflammatory spondyloarthritis (eg, ankylosing spondylitis)

Spinal tumors

Paget’s Disease


When you apply to a rheumatologist, they will ask you about the symptoms of this disease and your medical history. Then you will be examined. These questions are:

Do you have numbness, weakness, cramping, pain, or difficulty walking in the legs, thighs or feet?

Does the pain go down the leg?

Is there any impairment of bowel and/or bladder function? (Incontinence of urination or stool, incontinence)

Is there a loss of sexual function?

Those with partial or complete leg paralysis are severe cases. A neurosurgeon or orthopedist (who deals with spine surgery) needs to be consulted by going to the emergency room or urgently.

Consulting a rheumatologist is the right address to distinguish other causes such as heart and blood vessel disorders (such as aneurysm, vascular occlusion), nervous system disorders or hip-knee arthritis that may cause similar symptoms.

Other tests may also be done to confirm the diagnosis and determine the severity of the condition. These:

Direct X-rays of the spine; to demonstrate osteoarthritis, bony prominence, and stenosis of the spinal canal

To view the channel inside the spine in more detail; computed tomography (CT) or magnetic resonance imaging (MRI),

ENMG (electroneuromyogram) to check the nerves going to your legs.

To control your blood circulation; Abdominal or leg Doppler ultrasonography can be performed to rule out other diseases that cause similar complaints.


Although there is no cure for spinal stenosis; Regular exercise, medication, and, in some cases, surgery can provide relief. A lot of mistakes are made about herniated disc. First of all, not every back and neck pain is a hernia. It is therefore important to distinguish between other diseases that may be involved. With the correct diagnosis; Treatment is planned according to the patient’s findings. In other words, not every lumbar hernia is the same. Medication, rest, pain blocking, physical therapy and rehabilitation are the most common treatments. Surgery is performed only in one out of ten patients. Even in patients who are scheduled for surgery, drugs (muscle relaxants, non-steroidal anti-inflammatory drugs-NSAII) and rest are given for 7-10 days.

Medicines: Acetaminophen (paracetamol) or non-steroidal anti-inflammatory drugs (usually NSAIDs such as ibuprofen or naproxen) can reduce pain. In addition, other pain relievers/or muscle spasm relievers may be prescribed.

Cortisone injections: Cortisone injections directly into the area around the spinal cord can provide temporary, sometimes permanent, great relief. These injections are given as an outpatient, usually in a hospital or clinic setting.

Surgical: “Decompression laminectomy” can be performed with surgical intervention in patients whose complaints do not go away despite the treatments suggested above, or who have severe nerve pressure. In this surgery, for the nerves and spinal cord, the canal space is emptied, the bone spur and bone formation in the spinal canal are removed. Next, doctors usually perform a spinal fusion (joining) of two or more vertebrae to provide better support.

According to the results of many recent studies, the short-term results of surgery are better than non-surgical treatments. However, as with all surgeries, although rare, this surgery carries some risks and results may vary. These risks are; clot formation in the brain and/or legs, tear in the tissue around the spinal cord, infection and nerve root injury. Although surgery may bring relief, spinal stenosis or osteoarthritis will not cure and symptoms may recur.

Exercise: Regular exercise will strengthen your arms and upper legs (such as hip adductor and abductors, quadriceps). This balance provides the ability to walk on slopes and flat roads, as well as control the pain. A physiotherapist can show you exercises that are suitable for you.


Spinal stenosis can cause a slow but progressive loss of strength in the legs. Although there is no muscle weakness, pain reduces the quality of life by causing limitation in movements, and it can be crippling with its progression.


There is no definitive cure for herniated disc, but there is much the patient can do to feel better. For example:

Be active. Regular exercise is very important, so do stretching exercises for 30 minutes at least three times a week that will strengthen your neck-waist and back muscles without too much strain. Start with slight forward bends at first. Add walking or regular swimming as you get stronger.

Change your habits. Avoid activities that increase or trigger your pain, such as heavy lifting or walking long distances.

Ask your doctor about alternative treatments such as massage or acupuncture to relieve pain, as well as pain medications.

Get rid of your excess weight.

Points to remember;

The history of the disease is of great importance in the diagnosis.

Anyone over the age of 50 is at risk.

The severity of the disease varies from patient to patient.

Regular exercise is essential to keep muscles strong and increase flexibility.

The choice of treatment depends on the severity of the herniated disc and how much it affects the quality of life.

THE ROLE OF THE rheumatologist in the treatment of spinal stenosis (hernia):

Spinal stenosis seriously affects a person’s life. The rheumatologist makes the differential diagnosis of other diseases that can be confused with this disease in the person who applies with low back or neck pain. After the correct diagnosis, he creates the treatment plan. This is not just medication, it helps to establish a treatment strategy such as physical therapy, algology (pain management-nerve blocks) or referral to surgery.

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