Spinal Stenosis: Surgical Treatment

Stewart G. Eidelson, MD
SpineUniverse Founder, Orthopaedic Surgeon
Asst. Professor - Univ. of Miami at FAU
South Palm Orthospine Institute
Boca Raton, FL, USA

What is the name of the surgical procedure?
There are several different surgical procedures used to treat spinal stenosis. Listed below are the names and a brief description of each procedure. Once again, your doctor will explain which procedure or procedures will be performed during your operation.

Laminotomy: The lamina is a small, thin bony spinal structure located at the back of the spine (posterior) that covers access to the spinal canal and spinal cord. A small portion of the lamina may be removed to relieve pressure on the nerve roots.
Decompressive Laminectomy: This is the most common surgical procedure performed in the lumbar spine. The lamina is removed to decompress or relieve pressure on the nerves.
Foraminotomy: During this procedure, the neuroforamen are enlarged. Sometimes this procedure is combined with a laminotomy.
Medial Facetectomy: One of the causes of spinal stenosis is one or more enlarged joints. The spinal joints are named facet joints. During this procedure part of the facet joint is removed to increase space.
Anterior Cervical Discectomy and Fusion (ACDF): This procedure removes a diseased disc (discectomy) through the front (anterior) of the neck (cervical). After the disc is removed, the spine must be stabilized. This is accomplished using a cervical plate and screws (instrumentation) and fusion (bone graft). Fusion is similar to glue that hardens over time to create a solid construct, which stabilizes the spine.
Lumbar Discectomy and Fusion: This is similar to ACDF, except entry into the spine may be gained through the front (anterior), back (posterior), or side (transforaminal).
Cervical Corpectomy: During this procedure, part of the vertebra and adjacent disc are removed to decompress the cervical spinal cord and nerve roots. Instrumentation and fusion are performed to permanently stabilize the spine.

Will the surgical procedure take away my pain?
This is a good question. Your doctor will provide you with statistics that help to predict your surgical outcome. These statistics are important and will help you to determine if surgery is the best choice.

If your nerves were badly damaged before surgery, you may experience some pain or numbness afterward. Sometimes there is no improvement at all. Unfortunately, as you age your spine will continue to change or degenerate. Sometimes symptoms reappear several years after surgery.

How long will it take me to recover and get back to my life?
This depends on the type of surgical procedure and your condition before surgery. Some spine procedures can be performed on an outpatient basis that allows you to go home the same day. A more comprehensive procedure, such as one involving fusion requires hospitalization.

At an appropriate time after surgery, your doctor will prescribe a course of physical therapy. This gives patients a good step forward in their recovery and return to everyday activities.

Continue this article...

Article written 04/14/2004
Published online 04/21/2004
Last updated 01/21/2008

Dr. Eidelson lists many surgical procedures that are chosen depending on the individual's exact diagnosis. The reader should understand that the main indications for surgery are failure of non-operative management to relieve the patient's symptoms over several months and the symptoms are significant enough to interfere with the patient's quality of life. Severe neurologic deficits such as bowel and bladder loss and marked muscle weakness need to be addressed by surgery earlier rather than later. The reader should understand that there are two main types of procedures for spinal stenosis: (1) decompression alone and (2) decompression plus fusion. The majority of lumbar spinal stenosis cases can be treated with decompression alone (laminectomy, partial laminectomy or minimally invasive decompressive techniques) unless there is concomitant instability conditions such as degenerative spondylolisthesis (slippage of vertebrae) or degenerative scoliosis (abnormal spinal curvature). In the cervical spine, spinal stenosis can be decompressed from the front (anterior discectomy/corpectomy and fusion) or from the back (posterior laminoplasty or laminectomy plus fusion). If the cervical spine has normal contour (lordosis) and more than 3 levels are involved, posterior laminoplasty is an excellent choice without the need to fuse the spine. If extensive decompression is needed (multiple foraminotomies in addition to laminectomy), fusion with bone and titanium screw-rod procedure is sometimes added. From the front, decompression (discectomy/corpectomy) should always be accompanied by bone fusion with or without titanium plating. Multi-level anterior fusion is a more extensive surgical procedure as compared to one or two level anterior fusion.
Again, Dr. Eidelson did an excellent job describing the spinal stenosis condition, and the reader should have a good understanding of the definition, clinical presentation, diagnosis, and available nonoperative and operative treatment options. However, one patient with spinal stenosis is slightly or vastly different from another, and it is up to the treating doctor to make the precise diagnosis and make the most appropriate recommendations for that specific patient.

Howard S. An, MD

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