Advances in Surgical Options for Patients with Spinal Stenosis
Though the majority of patients suffering from back pain will never need to undergo surgery, some will in order to live life without the crippling effects brought on by a severe spine condition. And for those who do, some of them approach the notion with varying degrees of skepticism. Perhaps it’s due to a concerned family member with a “friend” whose spine surgery seemingly failed to fix the problem. For others, it may be a general fear that they won’t be restored to good enough health after surgery for the risk to have been worth the reward. We spine surgeons understand. The good news is that today’s technology has advanced in such a way that it endeavors not only to “fix” the underlying concern, but to protect and in some cases restore our patients’ range of motion.
In terms of spine surgery, nowhere is this technological advancement more apparent than in the case of facet joint replacement surgery. Ongoing degenerative changes in life result in increasing facet arthritis and instability with concomitant spinal stenosis. These joints serve an important purpose – they connect the spine’s vertebrae to one another. When stenosis occurs, it puts pressure on the spinal cord due to narrowing of the spinal column. Spinal stenosis has a number of other potential causes, besides wear and tear as a person ages, arthritis, a herniated disc, birth defects, tumors and traumatic spine injuries, just to name a few.
Historically, surgery to treat spinal stenosis and facet arthritis consisted only of an invasive spinal fusion procedure. While this type of surgery absolutely has its benefits, one of its downside’s is that it may inhibit spinal mobility. But today, advances in surgeon skill, surgical approach and technology have allowed patients and their doctors the opportunity to consider other options for an even better quality of life.
Facet joint replacement surgery strives to address the problems associated with spinal stenosis and correct them without creating compounding problems with spinal mobility in the future. Depending on the technology used, many facet joint replacement procedures now preserve spinal alignment and mobility, without placing undo stress on adjacent levels of the spine – which can sometimes create a domino effect of problems for some patients down the road.
Currently, artificial facet joints are being designed and studied to provide stability to the spine without the potential loss of motion sometimes associated with spinal fusion and to enable vertebrae to move naturally in relation to one another. The surgery is performed by trimming or removing parts of the vertebrae that are pressing against the spinal cord or nerves. This requires the complete removal of the inflamed facet joints. However, rather than “fusing” the vertebrae back together, and to avoid instability, the damaged facet joints are replaced with the artificial ones to mimic the motion and function of healthy facet joints. The artificial facet joints are sized to the patient’s anatomy and secured in place, helping to restore motion and stability to the lower spine.
In order to qualify for surgery to correct the condition, patients must meet a stringent set of requirements including duration of pain and concerted attempts at non-surgical treatment. But once those requirements have been met and the pain hasn’t subsided or for many, is getting worse, surgery becomes the next conversation. While I’ve discussed extensively the need for patients to research and “interview” the surgeons in whom they entrust their care – the next important discussion is on which spine surgery option is best for their unique set of circumstances.
If you or someone you care about has been told they require surgical intervention to resolve their spinal stenosis, be sure they locate a surgeon who will candidly discuss with them all of their options – including the pros and cons of each. While no patient should have to just “live with” any type of back pain, neither should they have to simply accept only one avenue for treatment. When deciding which surgical approach is right for spinal stenosis, a host of key factors comes into play and patients should be well informed of every avenue medicine has available today in order to make an informed decision.