Interview with dr Piotr Winkler

about a SPINAL STENOSIS and minimally invasive, endoscopic method of treatment.
02.01.2020

A patient sees the doctor and hears a diagnosis: the spinal stenosis. What does this mean for him?

A stenosis is a narrowing that concerns a spinal canal in which nerve roots are located, so-called “horse’s tail”, kind of a braid built of nerve endings. Here the most common pathologies occur. The lumbar spine is really overloaded- mostly by sitting and standing. The body is trying to solve the problem of this overload, trying to stabilize the spine through degenerative remodeling. Young people have the spine stabilized by muscles, so it is rare that this remodeling happens, but older people’s spine , whose muscles are weaker, tries to heal itself and the degeneration arises.

What happens next?

The most common is a decrease of spinal mobility. The spine enveloped outside by degenerative changes becomes less and less mobile. But this process can also occur inside the spinal canal and the channel becomes narrow. If it is only a little narrower, the body copes with it, but when the light of this channel gets very narrow or even disappear, patients start to feel it as a disease.

In the beginning it is kind of a discomfort and then a serious disease, which manifests by lumbar pain, often radiating to the lower limbs, and finally problems with walking appear. The person has to stop during even small walk because his legs are getting weaker and ache. Lower back starts to hurt. Only an inclination of the body forward brings some relief.

Is a stenosis like a sentence? Does the patient have to learn to live with pain?

It all depends on when the patient decides to see a doctor. If the stenosis is not very advanced, the pain is small or occur sometimes, the patient should use a rehabilitation first. Above all, the most important is strengthening of the muscles that support the spine. However, if we are dealing with a critical stenosis, i.e. one where this channel is blocked, the patient feels a severe pain, which despite the rehabilitation intensifies. In this case the only solution is surgical treatment.

Well, yes, but operations in close proximity to the spinal cord are a very high risk …

Standard operations always carry the risk of nervous system structure damaging, but with the development of spinal surgery and technology, the risk is still decreasing. There are several ways of operating spinal diseases and the stenosis can be treated endoscopically. During the endoscopic treatment only those areas that cause direct pressure on the nervous system structure are removed, leaving the rest of the spine intact.

How do patients feel after the surgery?

Usually our patients feel an immediate improvement. The patient gets up an hour after the procedure and returns to a normal life – sitting, walking and bending – all without any pain. This is the main difference, because after an open surgery patients get up few days later, are usually stuffed with painkillers and need a long term rehabilitation.
This quick recovery gives me the greatest satisfaction. Also the awareness that about 96% of treatments are successful and serious complications concern only 1% of operated patients.

We all know that the spine is important and we have to take care of it, but we remember about it when something bad happens. What can we do to prevent such diseases as the spinal stenosis?

The most important thing is a sport or physical activity. People who spend their lives on the couch or in front of the computer, will sooner or later face the problem. Absolutely every physical activity is better than nothing and it applies to people of all ages.