Surgery for Spinal Stenosis

Most patients with spinal stenosis respond well to non-surgical treatments (such as medication), so you may not have to have surgery. However, there are situations when you may want to go ahead with spine surgery:

• You've tried non-surgical treatments, and they haven't been successful.
• You've been in severe pain for a lengthy period of time.
• You're experiencing radiculopathy, which is a medical term used to describe pain, numbness, and tingling in the arms or legs.
• You've lost sensation in your arms or legs.
• You have decreased motor strength in your arms or legs.
• You've lost bowel or bladder control.

One main goal of spinal stenosis surgery is to free up area for your spinal cord and/or the nerve roots. That's called decompression. By giving your spinal cord and nerve roots more space to pass through, your spine surgeon hopes to decrease your pain from nerve inflammation.

Another goal of spinal stenosis surgery is to increase your motor strength in your arms or legs. If you've lost sensation in your arms or legs, your surgeon also hopes to restore that.

Typically, surgeons use two surgical techniques for spinal stenosis surgery:

• Decompression: The surgeon will remove tissue pressing against a nerve structure, which makes more room in the spinal canal (for the spinal cord) or in the foramen (for the nerve roots)
• Stabilization: The surgeon works to limit motion between vertebrae.

Decompression Surgery
To remove the tissue that's pressing on a nerve, your spine surgeon may perform one of the following types of surgery:

• Foraminotomy: If part of the disc or a bone spur (osteophyte) is pressing on a nerve as it leaves the vertebra (through an exit called the foramen), a foraminotomy may be done. Otomy means "to make an opening." So a foraminotomy is making the opening of the foramen larger, so the nerve can exit without being compressed.
• Laminectomy: At the back of each vertebra, you have a bony plate that protects your spinal canal and spinal cord; it's called the lamina. It may be pressing on your spinal cord, so the surgeon may make more room for the spinal cord and/or spinal nerves by removing all or part of the lamina.
• Laminotomy: Similar to the foraminotomy, a laminotomy makes a larger opening, this time in your bony plate protecting your spinal canal and spinal cord (the lamina). The lamina may be pressing on your nerve, so the surgeon may make more room for the nerves using a laminotomy.

Stabilization Surgery
Not everyone who has surgery for spinal stenosis will need stabilization, which is also known as spinal fusion. It's especially helpful in cases where one or more vertebrae has slipped out of the correct position, which makes your spine unstable (and painful). The need for stabilization also depends on how many vertebrae your surgeon needs to work on. For example, if he or she needs to remove the lamina (using a laminectomy) in multiple vertebrae, your spine will be unstable without those structures. You'll need to have spinal fusion to help stabilize your spine.

Spine stabilization surgery has been common for many years. It can be done alone or at the same time as a decompression surgery. In spine stabilization, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from your own body) or a biological substance (which will stimulate bone growth). Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability and help fuse the bones. The fusion will stop movement between the vertebrae, providing long-term stability.

Open Surgery or Minimally Invasive Surgery?
If your surgery is performed through a relatively large incision in your back, that's called open surgery. Another option is minimally invasive surgery, which is done through several small incisions. The surgeon will use a tiny camera and very small surgical instruments.

However, minimally invasive surgery is not for everyone. If your surgeon needs to work on many vertebrae, you'll probably need to have open surgery.

Risks
As with any operation, there are risks involved with surgery for spinal stenosis. Your doctor will discuss potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:

• general risks of anesthesia
• injury to your spinal cord or nerves
• non-healing of the bony fusion (pseudoarthrosis)
• failure to improve
• instrumentation breakage/failure
• infection and/or bone graft site pain

Recovery from Surgery for Spinal Stenosis
After your surgery, you aren't going to be instantly better. You will most likely be out of bed within 24 hours, and you'll be on pain medications for 2 to 4 weeks. After the surgery, you'll receive instructions on how to carefully sit, rise, and stand. It's important to give your body time to heal, so your doctor will probably recommend that you restrict your activities: in general, don't do anything that moves your spine too much. You should avoid contact sports, twisting, or heavy lifting while you recover.

After surgery, be vigilant. Report any problems—such as fever, increased pain, or infection-to your doctor right away.

You should always take good care of your body and practice healthy habits, but you should be especially healthy following surgery. You should:

• follow your doctor's treatment plan
• sit and stand properly
• learn to lift correctly
• exercise regularly (low impact aerobic exercise is especially good, but check with your doctor first)
• use proper sports equipment
• attain and maintain a healthy body weight
• eat healthy foods (a well-balanced, low-fat diet rich in fruits and vegetables) and get enough calcium
• stop smoking
• avoid excessive use of alcohol.

And take heart: the results with surgery to correct spinal stenosis are usually good. Generally, 80% to 90% of patients have relief from their pain after surgery.