MIS Treatment of Spinal Stenosis
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About Spinal Stenosis
Spinal stenosis can affect the cervical (neck) and lumbar (low back) spine. It develops when the spinal canal and / or nerve passageways (neuroforamen) become narrow. It is a common cause of neck, back and leg pain in people over age 50.
If the spinal canal is narrowed, the disorder is called cervical or lumbar central stenosis. If the neuroforamen is narrowed, it is called cervical or lumbar foraminal stenosis. When either (or both) condition develops, the spinal cord and / or nerves are compressed.
Some patients are born (congenital) with this narrowing. However, most cases of spinal stenosis develop from growing older and wear and tear on the spine. Osteoarthritis, degenerative disc disease, and bone spurs (osteophytes) are common causes.
Pain is a predominant symptom usually accompanied by extremity weakness, numbness, and sensations such as tingling and pins and needles. Cervical spinal stenosis causes symptoms in the neck, shoulders, arms, and hands. Lumbar spinal stenosis causes symptoms in the low back and legs and includes sciatica and difficulty walking or standing. Bladder and bowel problems signal the need for urgent medical care.
Important to a proper diagnosis is the patient's medical history, physical and neurological examination, and diagnostic test results (i.e. MRI).
- Medical history includes symptoms (most often pain, weakness, numbness), their severity, and treatments already tried. In lumbar stenosis, pain in the legs occurs with prolonged sitting or walking.
- Physical and neurological examination includes evaluating movement limitations, balance problems, pain, extremity reflexes, muscle weakness, and sensation. The exam may include a series of movements such as turning the head from side to side and forward and backward, bending sideways, forward and backward at the waist, and walking.
- Diagnostic tests may include x-rays, CT scan, or MRI. Discography, myelography or electrodiagnostic studies (i.e. nerve conduction test) may be necessary.
When MIS is Recommended
Although the indications for surgery vary, MIS may be recommended if:
- Pain and other symptoms worsen
- Pain and symptoms are unresponsive to nonoperative treatment
- Neurologic problems develop, such as weakness, numbness, or bowel or bladder dysfunction
- Imaging tests demonstrate spinal instability
- Pain and symptoms significantly affect quality of life
Surgical goals include:
- Decompress the spinal cord and / or spinal nerves (relieve pressure)
- Stabilize the spine, if necessary
MIS may include procedures to decompress and stabilize the spine.
- Decompression procedures relieve pressure on the spinal cord and nerves. This involves removing or trimming whatever is causing compression.
- Discectomy (disc removal), laminotomy, laminectomy, and foraminotomy are common procedures. Laminotomy (partial removal) and laminectomy (complete removal) involve removing the vertebral body's lamina to increase the size of the spinal canal. The lamina is a section of bone near each facet joint covering access to the spinal canal. Foraminotomy enlarges the neuroforamen.
- Most MIS surgery avoids fusion, but if there is spinal mal-alignment, a fusion may be the best option. Specialized MIS fusion instruments are available if fusion is needed.
Minimally spine surgery procedures approach the spine from the front (anterior), back (posterior), side (lateral), or back and side (posterolateral). MIS procedures include:
- Cervical or Lumbar MIS Posterior Tubular Hemilaminotomy
This procedure utilizes muscle-sparing tubular retractors, inserted through a small incision made in the back (posterior). Instead of cutting through muscles and soft tissue, tubular retractors gently dilate and separate muscle and soft tissue minimizing soft tissue damage. As soft tissues are expanded, the operative field reveals the correct spinal level to be operated on. Using microscopic visualization, the spine's lamina (thin bone covering access to the spinal cord) and a portion of the facet joint are removed to decompress and make more room for the nerve.
- Lumbar Laminoplasty
The purpose of a lumbar laminoplasty procedure is to expand the size of the spinal canal and decompresses the spinal cord and nerve roots. One side of the lamina (thin bone covering access to the spinal canal) is opened. The other side is decompressed through the same single incision. The operating microscope and specialized instruments are used to remove hypertrophic ligaments and bone spurs.
MRI showing lumbar spinal stenosis
MRI showing NO lumbar spinal stenosis
Risks and Complications
No patients are identical and risks and complications vary. Your surgeon will explain possible risks and complications related to your specific MIS procedure.