Introduction
Spinal stenosis surgery aids in reopening the spinal canal, which is the channel in the backbone that accommodates the spinal cord and other nerves. Surgery is performed by the physician when the space in the canal narrows as a result of bone spurs, arthritis, or other problems. In such a scenario, the nerves can get pinched or squeezed. This usually occurs in middle-aged or older individuals. If non-surgical treatment and therapeutic injections do not offer relief from pain due to spinal stenosis, then surgery may be recommended to relieve pressure on the nerves and the spinal cord.
Which Two Areas Are Commonly Affected by Spinal Stenosis?
Though anyone may be affected by spinal stenosis, it most commonly affects people over the age of 50. The following are the two areas that are commonly affected:
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Lower Back (Lumbar Spinal Stenosis): The lumbar spine comprises five bones or vertebrae in the lower back. The lumbar vertebrae (L1 to L5) constitute the largest portion of the entire spine.
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Neck (Cervical Spinal Stenosis): The cervical spine comprises seven vertebrae in the neck. C1 to C7 form the cervical vertebrae.
The thoracic spine in the middle back may also be affected by spinal stenosis, but this is rare.
What Are the General Signs and Symptoms of Spinal Stenosis?
Depending on the location and how severe the spinal stenosis is, one might experience the following symptoms in the arms, legs, neck, back, hands, or feet:
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Pain.
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Tingling.
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Numbness.
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Weakness.
Spinal stenosis usually progresses gradually over time. Hence, one might not experience any symptoms for a while, even if the condition is detected on X-rays or other imaging tests. Symptoms may manifest on and off and can affect each individual differently.
Can Spinal Stenosis Be Managed Without Surgery?
Spinal stenosis can be caused by conditions like bone spurs, osteoarthritis, bulging discs, or thickened ligaments. Though nonsurgical treatments will not alter the structural component of spinal stenosis or relieve the pinching effect on the nerves, they may help improve one’s symptoms. Nonsurgical treatment is the first modality of treatment.
Nonsurgical treatment usually begins with physical therapy and home exercises. Improving endurance, muscle strength, and flexibility can provide relief from pain and make it easier for one to continue with their routine activities. Pain relievers like Ibuprofen, Naproxen, and Acetaminophen may be prescribed to relieve discomfort. In case pain medications do not work, epidural injections may be administered. Administering a steroid injection around the irritated spinal nerve minimizes inflammation and pain, usually for an extended period of time.
When Is Surgery for Spinal Stenosis Indicated?
A majority of patients with lumbar or cervical spinal stenosis respond well to non-surgical options like medication, so the need for spinal surgery may be reduced. However, one might require surgery in the following situations:
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Various nonsurgical treatments have been unsuccessful.
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Suffering from severe pain for a long time.
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Loss of sensation in the arms or legs.
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Decreased motor strength in the arms or legs.
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Loss of bladder or bowel control.
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Experiencing radiculopathy (pain, tingling, or numbness in the arms or legs).
The major goal of spinal stenosis surgery is to enhance the motor strength in the arms or legs. Decompression and stabilization are the two surgical techniques that are suggested for spinal stenosis surgery.
What Surgical Procedures Are Being Performed for Spinal Stenosis?
Decompression and stabilization are the two surgical techniques that are suggested for spinal stenosis surgery. Decompression surgery is done to relieve the tissue that impinges on the nerve. The following are some of the decompression techniques:
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Foraminotomy: If a bone spur or a part of the disc presses on a nerve as it exits the vertebra through an exit called the foramen, a foraminotomy procedure is performed. The term ‘otomy’ refers to ‘making an opening’. In a foraminotomy procedure, the opening of the foramen is made larger, so that the nerve can exit without being compressed.
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Laminotomy: Just like foraminotomy, a laminotomy procedure is done to make a larger opening. Laminotomy is done in the bony plate that protects the spinal cord and spinal canal (the lamina). If the lamina presses on the nerve, then the surgeon creates more room for the nerves through the laminotomy procedure.
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Laminectomy: At times, laminotomy may not be sufficient, and there might be a necessity to remove all or part of the lamina through a procedure called laminectomy. This is usually done at various levels without any harmful effects.
Another method of decompression is indirect decompression, wherein the pressure is relieved by spreading the bones apart instead of removing them. Indirect decompression is done using instrumentation through the use of interbody cages or interspinous process devices. Indirect decompression can also be achieved with the help of artificial discs by restoring the height between adjacent vertebrae.
Not everyone who undergoes surgery for spinal stenosis may require stabilization, which is also known as spinal fusion. Stabilization is ideal in cases wherein one or more vertebrae have slipped out of the correct position, resulting in an unstable and painful spine. In these instances, the slipping bones can impinge the nerves. The necessity for stabilization depends on how many vertebrae are involved. If a laminectomy needs to be performed on multiple vertebrae, then the spine may become unstable without those structures. Hence, one might need spinal fusion to stabilize the spine.
Spine stabilization surgery can be performed alone or along with a decompression surgery. In the spine stabilization procedure, the surgeon facilitates an environment wherein the bones in the spine will fuse together over a period of time. A bone graft or a biological substance will be used by the surgeon. Spinal instrumentation such as cables, wires, rods, screws, and plates may be used to enhance stability and to aid in bone fusion. The fusion will restrict movement between the vertebrae, enhancing long-term stability.
Are There Any Risks Associated With Surgery for Spinal Stenosis?
The following are a few complications associated with surgery for spinal stenosis:
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Injury to the spinal cord or nerves.
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Instrumentation breakage or failure.
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General risks of anesthesia.
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Pseudoarthrosis (non-healing of the bony fusion).
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Infection or pain at the site of bone graft.
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Failure to improve.
How Will the Recovery Be After Spinal Stenosis Surgery?
One might not get instantly better after spinal stenosis surgery. Though one might be out of bed within 24 hours, one might be on pain medications for two to four weeks. Following the surgery, one might receive instructions on how to carefully sit, stand, and do other things. One must refrain from doing activities that involve moving the spine excessively. Twisting, contact sports, and lifting heavy weights should be avoided. Any issues like fever, infection, or increased pain must be reported to the physician immediately. One must follow health habits after surgery like:
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Sitting and standing properly.
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Following the doctor’s instructions appropriately.
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Learning to lift correctly.
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Exercising regularly.
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Refraining from smoking and alcohol consumption.
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Using suitable sports equipment.
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Achieving and maintaining a healthy body weight.
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Consuming healthy foods rich in calcium.
Conclusion
Spinal stenosis is a condition wherein the space surrounding the spinal cord becomes too narrow. Surgery for spinal stenosis is indicated in certain situations that are mentioned above in the article. A good surgical outcome is influenced by the surgeon’s expertise, the overall health of the patient, and the extent of stenosis. Before confirming surgery, the risks, benefits, and alternatives to the procedure must be explained in detail to the patient. The results of spinal stenosis surgery are generally satisfactory. About 80 to 90 percent of patients obtain relief from pain following surgery.
