Surgery for Spinal Stenosis

Spinal Decompression and Spinal Fusion: Will You Need Surgery for Spinal Stenosis?

Written by Jason M. Highsmith, MD

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

One main goal of spinal stenosis surgery in your neck or low back 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 2 surgical techniques for spinal stenosis surgery.

Decompression Surgery for Spinal Stenosis

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

Indirect decompression is a variation of decompression surgery where pressure is relieved by spreading the bones apart instead of removing bone. This can be done with instrumentation, such as interspinous process devices or interbody cages. Even artificial discs can accomplish some indirect decompression by restoring the height between adjacent vertebrae.

Stabilization Surgery for Spinal Stenosis

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). In these cases, the bones slipping can pinch nerves. 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 may 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 Spine Surgery or Minimally Invasive Spine 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 may use a microscope, endoscope, or 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.

Be Aware of These Surgical 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:

Recovery From Spinal Stenosis Surgery

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:

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.

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Decompressive Lumbar Laminectomy