Surgery for spinal stenosis is recommended for patients who have failed to find symptom relief from non-operative treatments, or have poor quality of life due to pain and weakness. The goal of surgery is to simply widen the spinal canal and thus relieve the pain-inducing pressure on the spinal cord or the spinal nerves.
There are several surgical procedures available for the treatment of spinal stenosis. Your doctor will discuss your symptoms as well the advantage and disadvantages of each surgical method to help determine which is most appropriate for you.
Decompressive Laminectomy
This procedure creates more space for the nerves by effectively removing the roof (or lamina) of the vertebra with or without removing part of the disc or fusing vertebrae. Unstable areas of the spine may need to be fused with the use of rods and screws.
Laminotomy
This surgery specifically removes only a small portion of the lamina, thus relieving pressure on the nerve roots.
Anterior cervical discectomy and fusion
This procedure involves relieving the condition called nerve root compression by removing the intervertebral disc through a small incision made near the front of the neck. The removed disc is replaced by a bone graft between the adjacent vertebrae.
Cervical corpectomy
The removal of the vertebral body and adjacent intervertebral discs to allow decompression of the cervical spinal canal as well as spinal nerves. A metal plate and screws along with a bone graft is used to obtain a fusion.
Goal of surgery
Widen the spinal canal and thus relieve the pain-inducing pressure on the spinal cord or the spinal nerves.
Who qualifies?
- Patients who fail to find relieve of symptoms from non-operative treatments.
- Patients who have poor quality of life as a result of pain or weakness
Recovery
- After surgery, you may stay in the hospital for a short time, depending on your health and the procedure performed. Healthy patients who undergo just decompression may go home the same or next day, and may return to normal activities after only a few weeks. Fusion generally adds 2 to 3 days to the hospital stay.
- Your surgeon may give you a brace or corset to wear for comfort. He or she will likely encourage you to begin walking as soon as possible. Most patients only need physical therapy to strengthen their backs.
- Your physical therapist may show you exercises to help you build and maintain strength, endurance, and flexibility for spinal stability. Some of these exercises will help strengthen your abdominal muscles, which help support your back. Your physical therapist will create an individualized program, taking into consideration your health and history.
- Most people can go back to a desk job within a few days to a few weeks after surgery. They may return to normal activities after 2 to 3 months. Older patients who need more care and assistance may be transferred from the hospital to a rehabilitation facility prior to going home.
General complications/risks
- Bleeding
- Infection
- Blood clots
- Reaction to anesthesia
- Higher rates of complications are present if you are:
- Elderly
- Overweight
- A diabetic
- A smoker
- Have multiple medical problems
Specific complications from surgery for spinal stenosis
- Tear of the sac covering the nerves (dural tear)
- Failure of the bone fusion to heal
- Failure of screws or rods
- Nerve injury
- Need for further surgery
- Failure to relieve symptoms
- Return of symptoms
(complications/risks taken directly from orthoinfo.aaos)
Outcomes
- Procedures are successful in the majority of patients.
- After a period of recovery time, patients are able to resume a normal lifestyle.
