Spinal stenosis surgery is typically a treatment of last resort, recommended only when nonsurgical options have failed to quell a patient’s symptoms. Fortunately, most of the patients who are diagnosed with spinal stenosis are able to relieve their pain and discomfort through the use of conservative, nonsurgical treatments. In the event that a patient is advised to consider surgery, he or she may have the option to undergo a minimally invasive procedure that offers many benefits over open spine surgery, including a very brief rehabilitation period.

An Overview of Spinal Stenosis

In order to understand why spinal stenosis surgery is sometimes necessary, it may prove beneficial to learn about the condition and its causes and symptoms. In the most basic of terms, spinal stenosis occurs when the spinal canal (also called the vertebral foramina), or the passageway through which the spinal cord travels, narrows. This is most commonly caused by the presence of anatomical debris that has been created as the result of a degenerative spine condition. As an individual ages, the anatomical components of the spine – vertebrae, facet joints, intervertebral discs, and others – begin to break down from the constant strain they have been subjected to. This can result in misaligned vertebrae, arthritic facet joints, herniated discs, and bulging discs, among other degenerative spine conditions, all of which can invade the spinal canal and cause spinal stenosis.

Interestingly, many patients who are afflicted with spinal stenosis experience no symptoms at all. This is due to the fact that the condition only becomes symptomatic when a spinal nerve root or the spinal cord is compressed by anatomical debris. When neural compression is involved, patients may experience symptoms of pain, numbness, tingling, and/or muscle weakness. The location of these symptoms will vary depending on the location of the compressed nerve. For instance, a pinched nerve in the cervical spine can cause discomfort in the neck, upper back, shoulders, arms, and/or hands. Neural compression in the lumbar spine can lead to discomfort in the lower back, hips, buttocks, legs, and/or feet.

Conservative Treatments that Typically Precede Spinal Stenosis Surgery

Every patient who is diagnosed with spinal stenosis will be given a conservative treatment plan that is tailored to their specific level of health, degree of discomfort, and other factors. This regimen is likely to include the use of medication, such as:

– Over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or naproxen

– Over-the-counter analgesics such as acetaminophen

– Narcotic pain relievers including morphine or codeine

– Muscle relaxants such as carisoprodol or cyclobenzaprine

The use of one or more of these medications is usually recommended in conjunction with physical therapy, which primarily aims to strengthen the muscles that support the spine. Increased musculature strength in the neck, back, and/or abdomen can relieve some of the strain that is being placed on the vertebrae, facet joints, and intervertebral discs, and can also help to reduce the pressure that is being placed on the affected spinal nerve. Physical therapy may also incorporate other treatment methods, such as hot/cold therapy, which is sometimes called thermotherapy and cryotherapy. This technique involves the alternate application of a heating pad and an ice pack to relieve muscle tension and reduce inflammation, respectively. Some of the other treatments that are employed by physical therapists are:

– Transcutaneous electrical nerve stimulation (TENS)

– Massage therapy

– Therapeutic ultrasound

– Posture modification exercises

Open Spine Surgery for Spinal Stenosis

Those who do not benefit from the use of medication, physical therapy, and other conservative treatments may be advised to undergo an open spine surgery called a laminectomy. This highly invasive operation requires that patients be placed under general anesthesia before a surgeon makes a large incision in the throat, neck, abdomen, or back. This incision usually requires the dissection of the muscles and ligaments that support the spine.

Once the surgeon has gained access to the patient’s spine, he or she will then remove a significant portion of the lamina (the posterior wall of the vertebral foramen) in the affected vertebra. Removing a portion of this bony plate opens up the spinal canal, creating more room for the spinal cord and the spinal nerve roots. In turn, this can relieve the pressure that is being placed on the affected nerve. While a laminectomy can effectively relieve neural compression, it can also destabilize the spine. For this reason, most laminectomy surgeries are accompanied by spinal fusion, which permanently binds two vertebrae together. This prohibits further movement in the affected area of the spine, helping to ensure the stability of the vertebra that has been the subject of the laminectomy.

Following the operation, most patients are required to remain in the hospital for a few days or weeks. A long and arduous rehabilitation usually follows to rebuild the strength of the muscles and ligaments that were dissected during surgery. Patients sometimes require additional surgery, especially if they experience failed back surgery syndrome (FBSS), or the worsening or continuation of symptoms following open spine surgery.

Minimally Invasive Procedures for Spinal Stenosis

Some of the patients who are advised to undergo spinal stenosis surgery may be candidates for a minimally invasive procedure instead. These procedures are performed on an outpatient basis, under deep IV sedation and local anesthesia. A surgeon makes a very small incision (typically less than one inch long) in a patient’s neck or back. A series of increasingly larger tubes is then fed through the incision, granting the surgeon access to the spine without the need to dissect any muscles or ligaments. Once the largest tube (approximately the diameter of a marker) is inserted, the surgeon feeds through an endoscope (a very small camera), rongeur (cutting device), and other surgical tools.

The surgeon then performs a laminotomy, which differs from a laminectomy in that only a very small portion of the lamina is removed. This still allows more space for the spinal cord, but does not compromise the stability of the spine. As a result, a laminotomy does not require the fusion of any vertebrae and the patient is able to retain full range of motion. Once the tube and surgical tools are removed, the surgeon gently places the muscles and ligaments back into place and closes the incision with a few dissolving stitches or surgical staples. Most patients feel slightly sore for a few days or weeks following surgery, but are able to return to daily activities within a matter of weeks. Some patients even experience immediate pain relief following the procedure.

Steps Before Surgery

Before consenting to any type of spinal stenosis surgery, patients should perform their own research to determine which procedure seems most desirable. It may also be advisable for patients to seek a second or third opinion to ensure surgery is necessary and that the correct diagnosis was initially made. Those who wish to learn more about spinal stenosis and its various treatment methods should consult a primary care physician or spine specialist for more information.

Patrick Foote is the Director of eBusiness at Laser Spine Institute, the leader in endoscopic spine surgery. Laser Spine Institute specializes in safe and effective outpatient procedures for spinal stenosis and several other spinal conditions.

Patrick Foote is the Director of eBusiness at Laser Spine Institute, the leader in endoscopic spine surgery. Laser Spine Institute specializes in safe and effective outpatient procedures for spinal stenosis and other spinal conditions. http://laserspineinstitute.com/back_problems/spinal_stenosis/

Author Bio: Patrick Foote is the Director of eBusiness at Laser Spine Institute, the leader in endoscopic spine surgery. Laser Spine Institute specializes in safe and effective outpatient procedures for spinal stenosis and several other spinal conditions.

Category: Medicines and Remedies
Keywords: Spinal Stenosis Surgery