Spinal stenosis is often a painful condition. For many individuals, however, this pain can be relieved through lifestyle changes and non-invasive treatments, such as epidural injections. In severe cases, however, doctors may recommend that patients undergo spinal stenosis surgery.
Are you a good candidate for spinal stenosis surgery? Read on to learn more about the various treatment options available to you.
When to Have Surgery for Spinal Stenosis
Many individuals with spinal stenosis find themselves wondering “Should I have surgery for spinal stenosis?” Lower back pain, numbness and tingling in the legs, and limited mobility lead many patients to consider surgery as a treatment option.
Before considering surgery, patients should try a variety of non-surgical pain relief techniques. An appropriate exercise and stretching regimen can help relieve pain, for instance.
Modifying one’s behavior and environment can also reduce spinal stenosis symptoms. Working out on an exercise bike, for instance, is more comfortable for many patients than running or walking in an upright position. Patients may also benefit from using walkers. Individuals with spinal stenosis may also benefit from using recliners for everyday seating.
Perhaps the most popular non-surgical treatment option is epidural steroid injections. In epidural injections, cortisone is injected into the epidural space of the vertebra. Most patients undergo two to three injections over the course of a few months.
Though cortisone injections cannot eliminate spinal stenosis, more than half of all patients experience pain relief as a result of these injections. If these steroid injections are fairly effective, it may indicate that a candidate would also benefit from spinal stenosis surgery, should it be necessary at a later date.
Surgery should be a last resort for treating spinal stenosis. If a patient is unable to walk or drive for moderate distances, however, surgery should be considered. If non-surgical treatment options have failed and spinal stenosis symptoms are so severe that they are resulting in a poor quality of life, surgery is a viable option.
Types of Surgery for Spinal Stenosis
There are numerous types of surgery for spinal stenosis available today. A few of the most common procedures include:
- Lumbar laminectomy/decompression surgery
- Spinal fusion
- Interspinous process spacer insertion
Lumbar Laminectomy/Decompression Surgery for Spinal Stenosis
Lumbar laminectomy surgery, also known as lumbar decompression surgery, is the most popular type of lumbar spinal stenosis surgery. Laminectomy is occasionally used in cervical spinal stenosis surgery as well.
In this procedure, the back is opened with an incision, generally two to five inches in length. Next, the lamina, the covering of the spinal canal, is removed. The facet joints may now be trimmed to provide more space for the nerve roots.
Patients who suffer from spinal instability, such as degenerative spondylolisthesis, should not undergo decompression surgery due to an increased risk of further damaging the spine. For those who do undergo the procedure, the success rate is high. Laminectomies have been shown to improve symptoms in over 75 percent of patients.
There are many benefits to undergoing a laminectomy. The procedure generally requires only one to three days of hospitalization. Patients are generally able to walk and move about shortly after the procedure, though bending and lifting should be avoided. Patients who undergo decompression surgery are often impressed at how good they feel after treatment. Most individuals can move more freely without pain following the procedure.
As with many spinal procedures, laminectomy surgery comes with a number of risks. Though serious complications are relatively rare, patients should understand that spinal procedures come with inherent risks. The most common complications of decompression surgery include infection, blood clots, nerve injury, and recurring or worsening spinal stenosis symptoms. Rare but severe side effects include cerebrospinal leakage and paralysis. Risks are usually elevated in elderly patients. Patients who are in relatively good overall health will be less likely to suffer from these complications.
For patients with spinal stenosis stemming from just a single nerve, a facetectomy may be possible. A facetectomy is a minimally invasive surgery for spinal stenosis that is similar to a laminectomy procedure.
Spinal Fusion Surgery
Spinal fusion is generally recommended to patients who cannot or should not undergo decompression surgery. The fusion can be used in both lumbar and cervical spinal stenosis surgery.
In spinal fusion surgery, a bone graft is placed near the painful vertebral region. This bone graft is then triggered to grow between the two vertebrae, forming a bone fusion. This is done to prevent pain caused by joint movement between the two vertebrae. By creating a bone fusion, spinal stenosis pain should be reduced. Though bone graft fusion is the most common form of spinal fusion surgery, the procedure may also be performed using metal implants or plates.
Decompression is generally recommended over spinal fusion. Though spinal fusion can be an effective solution to spinal stenosis pain, it may lead to further instability or pain along the rest of the spine. Most doctors therefore recommend decompression surgery when possible.
Laminotomy surgery is a minimally invasive surgery for spinal stenosis. The procedure is almost identical to laminectomy surgery. The major difference is that a laminotomy is minimally invasive and involves only a microdecompression procedure. Though minimally invasive treatments like laminotomy may allow for faster recovery and shorter hospital stays, these treatments also offer less visualization for the surgeons involved. Consult with your surgeon to determine whether or not a laminotomy is best for you.
Corpectomy surgery is a common treatment option for cervical spinal stenosis. In this procedure, part of the vertebra is removed in order to reduce pressure on the spinal cord and nerves. This procedure is very rarely used for lumbar spinal stenosis.
Interspinous process spacer insertion
Interspinous process spacers are a relatively new spinal stenosis treatment tool. The interspinous spacers are placed between the bony vertebral protrusions known as spinous processes. The spacers widen the spinal canal opening, reducing spinal canal pressure.
The surgical process for inserting interspinous process spacers is minimally invasive and can be performed under local anesthesia. The procedure, however, is relatively new. Researchers are unsure whether the success rate is as high as with more traditional procedures, such as laminectomies. The surgery does appear to have many benefits and may become a more common procedure in the future.
Laser Surgery for Spinal Stenosis
Patients should note that laser surgery is not an ideal surgical technique for any form of spinal surgery. Manual surgery is much more effective and is less likely to result in nerve damage than laser treatments. Spinal surgeons promoting laser back surgery are generally doing so as a marketing gimmick.
Important Considerations Before Undergoing Spinal Stenosis Surgery
Spinal stenosis surgery is a serious operation. Patients should be sure to read reviews of surgeons online before selecting a spine surgeon for treatment. Before undergoing surgery, schedule a consultation with the surgeon. Through this consultation, you can evaluation the surgeon and his skills to determine whether or not he is the best match for you. It is important to find a trustworthy professional who is experienced in performing spinal stenosis procedures.
Consider experimenting with non-surgical pain relief techniques before undergoing surgery. Even with insurance coverage, spinal surgeries often have costs ranging from $5,000 up to $100,000 or more. Due to the high cost of surgery, it is especially important to do your research before committing to a procedure. Strive to find a surgeon who can perform the best procedure for you at a price you can afford to pay.
Though spinal stenosis surgery should not be taken lightly, it can be a powerful and life-changing procedure for individuals suffering from chronic pain. If spinal stenosis is limiting your quality of life, contact your doctor to see if you would be a good candidate for surgical treatment. Surgery just might be the solution to your pain.