Lumbar Spinal Stenosis: Surgical Treatment

Your doctor may recommend surgery if conservative treatment options, such as physical therapy and medications do not reduce or end the pain altogether. He or she will talk to you about the types of spinal surgery available, and depending on your specific case, will help to determine what procedure might be an appropriate treatment for you. As with any surgery, a patient’s age, overall health, and other issues are taken into consideration when surgery is considered.

You may be considered a candidate for spinal surgery if:

• Back and leg pain limits normal activity or impairs your quality of life
• You develop progressive neurological deficits, such as leg weakness and/or numbness
• You experience loss of normal bowel and bladder functions
• You have difficulty standing or walking
• Medication and physical therapy are ineffective
• You are in reasonably good health

There are several different surgical procedures which can be utilized, the choice of which is influenced by the severity of your case. In a small percentage of patients, spinal instability may require that spinal fusion be performed, a decision that is generally determined prior to surgery. Spinal fusion is an operation that creates a solid union between two or more vertebrae. This procedure may assist in strengthening and stabilizing the spine and may thereby help to alleviate severe and chronic back pain.

Surgical treatment
The most common surgery in the lumbar spine is called decompressive laminectomy in which the laminae (roof) of the vertebrae are removed to create more space for the nerves. A neurosurgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. A spinal fusion with or without spinal instrumentation may be recommended when spondylolisthesis or scoliosis occurs with spinal stenosis. Various devices (like screws or rods) may be used to enhance fusion and support unstable areas of the spine.

Other types of surgery, including several methods of spinal fusion to treat lumbar spinal stenosis and associated conditions:

Anterior Lumbar Interbody Fusion (ALIF): Removal of the degenerative disc by going through the lower abdomen. Bone graft material or a metal device filled with bone is then placed into the disc space.

Foraminotomy: Surgical opening or enlargement of the bony opening traversed by a nerve root as it leaves the spinal canal, to help increase space over a nerve canal. This surgery can be done alone or together with a laminotomy.

Laminotomy: An opening made in a lamina, to relieve pressure on the nerve roots.

Laparascopic Spinal Fusion: A minimally invasive procedure involving small incisions in the abdomen, through which a graft is placed into the disc space.

Medial Facetectomy: Surgical procedure to remove part of the facet (a bony structure in the spinal canal), to increase the space.

Posterior Lumbar Interbody Fusion (PLIF): Removal of the posterior bone of the spinal canal, retraction of the nerves, and removal of the disc material from within the disc space, followed by insertion of bone graft and sometimes hardware in order to fuse the bones. This procedure is called an "interbody fusion" because it is performed between the “bodies” of the vertebral bones and across the diseased disc space. This procedure is typically performed on both sides of the spine.

Posterolateral fusion: Placing bone on the back and side of the spine to achieve a fusion.

Transforaminal Lumbar Interbody Fusion (TLIF): Removal of the posterior bone of the spinal canal, retraction of the nerves, and removal of the disc material from within the disc space, followed by insertion of bone graft and sometimes hardware in order to fuse the bones. Similar to a PLIF, but frequently performed from only one side.

The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of lumbar spinal stenosis patients report significant pain relief after surgery, there is no guarantee that surgery will help every individual.

NeurosurgeryToday.org
August, 2005

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