Options to Treat Lumbar Spinal Stenosis: Medication, Physical Therapy, Surgery

In addition to medications, physical therapy can help to restore flexibility and strengthen back and abdominal muscles to provide substantial relief from symptoms of lumbar spinal stenosis. If non-surgical measures do not offer adequate relief, your doctor may recommend back surgery.

Who is a Candidate for Surgery to Relieve LSS?

Patients who are generally in good health should have no problem undergoing surgery. Age alone is not a major limiting factor however, if you have other medical conditions such as high blood pressure, or diabetes that typically accompany old age, surgery may pose greater risk.

Surgical Procedures

The operations typically used to treat Lumbar Stenosis include the classic laminectomy, laminotomy, and foraminotomy. For patients who meet the proper indications, these procedures can also be combined with a spinal fusion operation. The most commonly used decompressive surgery is the laminectomy. To perform a classic laminectomy a 3-4 inch incision is made in your lower back (Figure 5a), though it may be longer depending on how many levels of your lamina are affected.

Figure 5a

A laminectomy involves removing the bony extensions (lamina) from the backside of the vertebral body which are causing pressure on the spinal sac and/or the nerve roots (Figure 5c-e).

Figure 5c

Figure 5d

Figure 5e

Often, only a portion of the lamina needs to be removed to relieve the pressure on the nerve roots (laminotomy). The ligaments (ligamentum flavum) and soft-tissue (facet capsules, herniated or bulging discs) in the affected area are also removed to increase the canal space. At the same time, a portion of the facet joints at the sides of the lamina may also be removed since they also cause increased pressure on the central and foraminal areas (Figure 5b).

Figure 5b

The goal of a foraminotomy is to enlarge the space where the nerve roots exit the spinal canal thus decreasing pressure on them. Foraminotomies can be done by themselves or often in conjunction with a laminectomy.

Some patients may develop instability of the spine with surgery. This occurs when a lot of bone needs to be removed and/or when multiple levels are operated on in order to provide adequate decompression. As such, many surgeons prefer more limited lamina removal (laminotomy) and only partial facet removal (medial facetectomy). Others may already have instability from their disease as in cases of spondylolisthesis. For all these patients, a spinal fusion is needed in addition to decompression. Spinal fusion involves grafting bone onto the spine and using instrumentation, such as screws and rods, to support the spine and provide stability. Your neurosurgeon can usually determine whether you will need a fusion prior to surgery so that you will be able to discuss this possibility beforehand.