KOCHI: We are all aware of the heart attack. In simple words, it is a condition where the blood vessels supplying blood to the heart muscles are blocked resulting in chest pain and dysfunction of the heart itself. How many of us know that there is a similar condition affecting our spine?
Our spine consists of 33 vertebral bones with in-between intervertebral discs acting as shock absorbers linked by the ligaments and joints. Within this strong but flexible structure of the spine lies the most vital organ of our body - spinal cord. The spinal canal which carries the cord often gets narrowed or relatively blocked for various reasons and ends up in the compression of the spinal cord and nerves. In medical terms, it is known as Spinal Canal Stenosis.
The most important cause is the degeneration of the intervertebral discs, the bones, ligaments and joints forming the walls of the spinal canal. The discs protrude into the spinal canal causing direct compression of the spinal cord and nerves. Other less common causes include tumours, infections, cysts, bleeding etc.
This can affect both young and old. However, the disc disease commonly found in youngsters. Whereas, in older people, it is due to the degeneration of the disc with involvement of the bones as well as ligaments.
It can happen suddenly like a heart attack. Most commonly due to a very large disc in the lower back protruding into the spinal canal. This is a surgical emergency situation called 'cauda equina' syndrome. Here, the patient feels the sudden weakness of both legs with difficulty in walking and numbness in the perineal region. There would be difficulty in passing urine and constipation. This condition warrants urgent surgical decompression of the spinal canal.
The symptoms of the gradual narrowing of the spinal canal depend on the affected area. For example, if the neck or the cervical region is affected, the patient would have difficulty in buttoning a shirt, holding objects, difficulty in putting on footwear, unsteadiness during walking and frequent falls due to loss of balance. Gradually, patients need support during walking and if left untreated, they become confined to a wheelchair.
If the mid back area is affected, hands are spared and the patient feels a tightness around the chest. When the lower back for the lumbar region is affected, nerves supplying to the legs are affected. There will be discomfort in the buttock region with numbness from thigh to the calf and foot.
The condition is diagnosed from the patient's detailed history, clinical examination and with the aid X-rays and MRI scan.Once it is done, every patient should understand that their spinal cord is not normal anymore. Therefore, they should be very careful in preventing falls. When such patients fall down, the neck can move abnormally causing damage to the already compromised spinal cord resulting in weakness of hands and legs. They should avoid alternative medical treatment like massages on the neck.
If diagnosed at the beginning with minimum symptoms, medical treatment with regular follow-up is strongly recommended. If the condition has caused significant compression of the spinal cord and nerves, appropriate surgical treatment is needed.
Through surgery, the offending structures which compress the spinal cord can be removed. This can be achieved by microsurgery or open surgery depending on the levels of severity.
Early detection is the key in successful treatment outcome. As the spinal cord and nerves may not recover completely due to irreversible changes within the nerves in delayed cases.
Dr Krishna Kumar R is the Consultant Spine Surgeon at Medical Trust Hospital, Kochi.(The views expressed by the author are his own)