Spinal Stenosis Surgery
Surgery for spinal stenosis is designed to decompress pinched nerves, relieve spinal cord compression, and/or to address a structural defect in the spine that is causing central canal stenosis or a reduction in the space through which spinal nerve roots pass. Spinal stenosis can be caused by a mechanical obstruction, such as bone spurs or fragments of herniated disc, or by inflammation or edema in the spinal canal.
Where a mechanical obstruction is the cause of the spinal narrowing it is likely that back surgery will be necessary to provide long-lasting relief from symptoms. Conservative treatment is preferable for relief of spinal stenosis symptoms but where back pain, paraesthesia, or other symptoms are resistant to such therapy, or where cauda equina syndrome or other acute symptoms such as incontinence or severe pain or weakness arise, spinal stenosis surgery is usually necessary.
Why Spinal Stenosis Surgery?
Spinal narrowing can be caused by a variety of issues, including disc bulging and herniation, spinal slippage, fracture, congenital foraminal stenosis, and other conditions both chronic and acute. In order to determine the cause of the symptoms and identify the site of stenosis in the spine, a physician will carry out a number of tests, possibly including diagnostic imaging such as a x-rays, magnetic resonance imaging or computed tomography (CT) scans. Patients will also undergo electromyelograms in some cases in order to determine nerve function, and epidural steroid injections or selective nerve root blocks may be used to help isolate the exact source of the pain.
Careful assessment of spinal stenosis symptoms is vital to reduce the risk of unnecessary back surgery and complications from spinal stenosis surgery at the wrong level. For some patients these tests can go on for weeks or months and it can be difficult to appreciate the need for caution over risky surgery when pain is worsening and chronic.
Types of Spinal Stenosis Surgery
The most commonly performed spinal stenosis surgery is for lower back pain and leg pain due to sciatic nerve compression in the lumbar spine. Patients with leg pain tend to have a better outcome than those with lower back pain. Cervical spinal stenosis is the next most common type of surgery, although spinal fusion in the cervical spine is normally avoided where possible as this is a highly mobile area of the spine that can become more problematic when made unnaturally rigid.
Thoracic spinal stenosis is less common than lumbar or cervical spinal stenosis as the thoracic spine is less mobile and, therefore, less susceptible to the wear and tear. Symptoms of spinal stenosis that usually prompt a recommendation for surgery include:
- Weakness, numbness, or altered sensation in the legs or arms
- Difficulty walking or standing
- Little or no relief is found with medications or other conservative therapies
- Mobility and quality of life are reduced due to pain or dysfunction.
Common Spinal Stenosis Surgeries
It is also important to note that patients must be in generally good health in order to undergo spinal stenosis surgery. Those who smoke are advised to quit in advance of spine surgery as smoking severely impairs bone health and healing and dramatically increases the risk of infections after spine surgery. In some cases patients who smoke and/or who have obesity will need to delay surgery for spinal stenosis.
Common procedures to address spinal stenosis include foraminotomy to open up the spaces through which the spinal nerves exit the spinal column, laminectomy to decompress the spine, laminotomy, and spinal fusion. Open back surgery has been used for many years but increasingly minimally invasive procedures including endoscopic spine surgery are available to reduce operating time and tissue trauma and encourage earlier recovery.
Spinal Stenosis Surgery Success Rates
The success of spinal stenosis surgery depends largely on the extent of existing damage and the longevity of the condition. Protracted spinal stenosis may have resulted in irreversible nerve injury, meaning that even though surgery may offer relief from some symptoms the patient might not ever fully recover nerve function and could be left with persistent pain, weakness, or even paralysis or incontinence.
Other factors influencing surgical outcome include the patients’ age, the presence of other medical conditions, whether they smoke, drink to excess, take certain medications, eat well, have other medical conditions, and their general health. In addition to affecting surgical outcome, smoking also increases the risk of pain after back surgery.
Spinal stenosis surgery is not a quick fix and comes with a variety of possible complications. However, without surgery many patients face untreated spinal stenosis complications including serious nerve and spinal cord damage that may result in paralysis, bladder and/or bowel incontinence, or progressive weakness, muscle-wasting, and even breathing difficulties and death. Anyone considering spinal stenosis surgery will need to weigh the risks and potential benefits of the procedure against their current quality of life and the likelihood of their condition worsening without surgical intervention for spinal stenosis.