Dr. Muhammad Mahtab Hossain Mazed

Spine Day is celebrated worldwide. This year's theme is to raise global public awareness Move Your Spine” (Keep your spine moving). It aims to make people aware of the prevention of spine-related problems and the importance of an active lifestyle. We work sitting for long hours, some work standing for long hours. Everyone is suffering from spinal problems. We should take at least a 5-minute break every 45 minutes between prolonged standing or sitting work, but most of us don't, causing damage to our spine and back muscles. The normal curve in the spine is straightened, weakening the ligaments and muscles in the spine, resulting in phenomena such as Dix prolapse or Dix herniation. Today we will discuss the most common spine problems that patients come to us with.

> What is spinal stenosis?
Spinal stenosis is a narrowing of your spinal canal – the space that houses your spinal cord. To understand spinal stenosis, you may benefit from an anatomical overview of the spine. First, your spinal column consists of 33 vertebral bones stacked on top of each other, starting at the base of your skull and ending in your pelvis. The ITCS of each vertebra has a ring-shaped opening in the center, through which the spinal canal passes. Discs between each vertebra absorb shock and cushion the vertebral bone piles.

> The spinal cord – the highway connecting the brain to the rest of your body – runs through the spinal canal. The spinal cord is a column of nerve tissue covered by three protective membrane layers. Nerve roots exit the spinal cord through the spaces between each vertebra. These spaces are called neural foramina – nerves exit through each opening and travel throughout your body.

When spinal stenosis occurs, the narrowed spinal canal puts pressure on the nerves and spinal cord. Increased pressure can irritate, compress or pinch the spinal cord and nerves. Your spine and body may have extensive problems.

> Types of spinal stenosis
Different types of spinal stenosis exist depending on the location of nerve compression and narrowing. The type of spinal stenosis involves two defining differences. The first difference is whether it occurs in the cervical, thoracic, or lumbar spine. The second difference is if it occurs in the vertebral foramen or the neural foramen. Your vertebral foramen forms the spinal canal, while the neural foramen is the bony opening between each vertebra. Your nerves exit the spinal cord through this bony opening.

> There are four main spinal stenosis types:

1. Cervical Stenosis: Narrowing of the spinal canal around the spine in your neck.
2. Lumbar Stenosis: A narrowing of the lower part of your spine.
3.Central canal stenosis: Cervical canal stenosis occurs when the spinal foramen narrows.
4. Foraminal stenosis: Foraminal stenosis occurs when the neural foramen becomes narrow. This spinal stenosis type is also called lateral stenosis because the narrowing occurs on the sides of the spinal canal.
In some cases, foraminal stenosis and central canal stenosis may co-occur. Thoracic spinal stenosis – narrowing of the middle of the spine – is also possible but rarely occurs.

> What are the symptoms of spinal stenosis?

Symptoms of spinal stenosis vary with the type and severity of the condition. They also depend on location. You may experience pain and dysfunction at any point in your body below the compression level. If you have lumbar spinal stenosis, you may experience the following symptoms:

* Heaviness in the legs * Leg cramps * Pain in the lower back, which you may feel as dull, tender, electric or burning * Numbness or tingling in your hips, legs or feet * Pain that worsens when walking downhill or standing for long periods * When bending over, Bending forward slightly, walking uphill or sitting reduces the paingoesSciatica, or a pinched sciatic nerve, that travels from your lower back, through your hips, and down each leg
As the stenosis worsens, you may experience leg or foot weakness, which links spinal stenosis to walking problems. In severe cases, you may experience bladder or bowel incontinence. Lumbar spinal stenosis rarely causes cauda equina syndrome, which involves a compressed cauda equina nerve. This bundle of nerves, including the sciatic nerve, lies below the spinal cord. Cauda equina syndrome is a rare surgical emergency because it can cause permanent paralysis of the legs.

> With cervical spinal stenosis, you may experience symptoms such as: Neck pain. Numbness or tingling in your arms, hands, legs, or feet. Weakness or clumsiness in arms, hands, legs, or feetbalance problem.
Impaired hand function, which can affect activities such as buttoning a shirt or writing.
Bladder or bowel incontinence, in severe cases.
Symptoms of spinal stenosis occur slowly and intermittently. Symptoms are often experienced more as pain than as neurological deficits such as numbness, tingling or weakness.
> Causes and risk factors
Knowing the causes and risk factors of spinal stenosis helps prevent the condition. Let's go through the causes and risk factors of spinal stenosis below.

> Causes spinal stenosis
A variety of injuries and conditions can cause spinal stenosis, including simple wear and tear. Some common spinal stenosis causes include:

* Bone spurs: Bone spurs are usually the result of osteoarthritis, which wears away joint cartilage, causing your bones to rub against each other. As your bones grind against each other, the damage stimulates osteoblast activity. Osteoblasts are cells that form new bone tissue. The new bone tissue created in this situation forms the bone spur. Spinal stenosis results when bone spurs occur in the spine and expand the spinal canal.
* Herniated disc: A herniated disc is when part of the cushioning disc between each vertebra bulges into the spinal canal. When the outer edge of a spinal disc weakens or cracks, the gel-like center pushes through the edge from downward spinal pressure.
* Dense ligaments: Ligaments in your spine hold each vertebra together. Ligaments experience stress and inflammation from normal wear and tear, forming scar tissue. This scar tissue causes the ligament to thicken and lose flexibility. Thickened ligaments can put pressure on the spinal canal and cord, causing spinal stenosis.
* Spinal fracture or trauma: Fracture, inflammation or dislocation of the spinal cord can compress the spinal canal and create pressure on the spinal cord.
* Spinal cord cyst or tumor: Benign or cancerous growths in the spinal cord or between it and a vertebra can cause spinal stenosis.
* Congenital spinal stenosis: People born with a short spinal canal are diagnosed with a congenital spinal stenosis.
Spinal stenosis risk factors
Some people are at greater risk of developing or causing spinal stenosis. Risk factors for spinal stenosis include:

> Risk factors for spinal stenosis include: Osteoarthritis.
Age, especially those over 50.
Spinal deformities, such as scoliosis. Spinal cord injury.

>Prevention Tips
To reduce the likelihood of low back pain, consider the following preventative measures:

* Maintain proper posture: Ensuring good posture, such as sitting and standing with shoulders back and a straight back, can reduce the risk of lower back pain.

* Engage in regular exercise: Regular physical activity is beneficial for strengthening back muscles, reducing the risk of lower back pain and helping with weight management.

* Be careful when lifting heavy objects: When lifting heavy objects, bend your knees and use your leg muscles instead of your back. Avoid arching your back while lifting to prevent strain and possible lower back problems.
Home and Solution: Treat the patient not the disease. Homeopathy treatment is symptom based. Treatment is done by considering all aspects including the good and bad appearance of the patient, physical and mental ailments, so if an experienced homeopath selects the patient's symptoms and treats the spine patient, all these patients will get better by the grace of God. Medicines which are first selected by experienced doctors are Arnica Mont, Causticum, Erum Triphyllum, Calmia, Nyaja, Zimcum, Met, Iodum, Paris, Acidfluoric, Lysine, Stramonium, Lacases, Arnica, Cobaltum, Silicea, Ras Tox and many other medicines based on the symptoms. may comSo take the advice of an experienced doctor without using the medicine yourself.
Finally, the patient's history should be taken into account when diagnosing the cause of back pain. His age, occupation, history of heavy lifting, any past and present diseases etc. are known. Apart from this, doctors diagnose the disease through tests like blood CBC CRP, X-ray, MRI, biopsy etc.
Prevention of back pain requires attention to lifestyle.

The writer is a, physician, columnist and researcher Founder and Chairman, Jatiya Rogi Kallyan Society