Spinal stenosis surgery is usually the treatment of choice when all the conservative measures have exhausted, and symptoms of spinal stenosis still persist. Surgery is also an option in individuals who suffer from disability caused due to spinal stenosis. Aside from the chronic and persistent symptoms (such as excruciating pain), once spinal stenosis makes a person unable to perform basic activities of daily living and jeopardizes his life, surgery is indicated.
Nonetheless, symptoms such as numbness and weakness of the legs and loss of control of bladder and bowel are few symptoms that prompt immediate spinal stenosis surgery. With other symptoms, conservative treatments are sought first. Studies show that recovery for operated cases is better than those not operated. However, surgery is still the last resort. The spinal stenosis surgery is done under general anaesthesia; the patient is put to sleep during the length of the operation.
Together, both parties, the health care team and patient with his family, work to determine the best surgical option for the patient, which is highly dependent on the severity, cause, and type of spinal stenosis. Pre-operative counseling is crucial. This allows the patient to speak his heart and be enlightened of his doubts and fears. The procedures that will benefit the patient the most, along with their associated risks, and other aspects, are discussed.
What is the purpose of spinal stenosis surgery?
A spinal stenosis surgery aims to relieve the pressure off the affected tissues so as to alleviate the symptoms. This is done through a spinal decompression. By eliminating or cutting the affected parts of the spine, decompression and realignment of spinal structures is achieved. This makes the spinal canal or the neural foramen wider, decompressing the structures passing through them, such as the spinal cord or the exiting spinal nerves.
Risks associated with spinal stenosis surgery
Damage to the surrounding tissues, formation of thickened blood masses and infection are some of the associated risks. These are all treatable risks, but may delay recovery from a spinal stenosis surgery.
Studies reveal long-term symptom relief following surgical intervention. Patients are able to function better in society; become more active and more mobile. Most of these procedures relieve leg pain far better than back pain. Seven to 8 out of 10 operated cases attest to this. However, some patients still experience symptoms such as back pain and limb numbness, even after surgery.
The following are the most common spinal stenosis surgeries with their characteristics:
- Decompressive laminectomy – It is one of the most common spinal stenosis surgeries. In this surgery only the diseased lamina is taken out either partially or completely; done to decompress the spinal canal, giving more space for the tissues exiting from it. No union of spinal bones or removal of any disks is done, but spinal fusion may be performed simultaneously with laminectomy depending on the need of the patient. This is usually done in spinal stenosis caused by osteoarthritis and congenital spinal stenosis. Studies show that 9 out of 10 operated cases are successful.
- Diskectomy – It involves curettage of a bulging portion of a vertebral disc. This spinal stenosis surgery is advised for cases caused by narrowing of a vertebral foramen or by a slipped disc.
- Spinal Fusion – This procedure encourages the fusion of vertebral bones to bring back proper alignment and to prevent movement of a diseased part. It is performed to alleviate symptoms experienced by the patient. This surgical option is indicated for cases caused by severe medical conditions such as degenerative slipped disk and unstable spine fracture. It also targets cases of spinal stenosis that has come back with the feature of instability and also those which cause a neighboring structure to be disrupted/ diseased.
- Endoscopic Spinal Surgery – It involves lesser incisions and is done using an endoscope. Duration of the procedure is shorter and lesser pain is experienced post-operatively.
Spinal Stenosis Surgery Recovery
Following spinal stenosis surgery, full relief of symptoms is expected. However, this may not always be the case and the procedure may fail in some cases.
Recovery following surgery is another challenge a patient and his family need to face courageously and patiently. As a saying goes, ‘patience is a virtue’. It may actually take months for tissues in the body to heal and function normally again. A speedy pain relief may be achieved but other symptoms such as muscle weakness may take months to improve. Decompression surgeries may take 1 ½ – 2 months for full recovery. You will be referred for physiotherapy, where a physiotherapist will work with you, assisting you to become independent and resume your daily functions.
Recovery depends largely on the condition of the patient prior to the operation and the preparations (such as smoking cessation and weight reduction) made to prevent the deleterious effects of immobilization after the spinal stenosis surgery. There are operated cases wherein the condition recurs or complications happen, requiring a second surgical treatment.
Filed under: Spinal Stenosis