Your backbone or spine contains the spinal cord, from which the spinal nerves emanate. The spine is composed of individual bones or vertebrae that are separated by intervertebral discs. The discs serve as a cushion to absorb shock and the vertebrae are joined together through facet joints. As you grow older, the spinal canal can become narrower and bone spurs or osteophytes may grow into it. The facet joints can also become arthritic. These changes make the spinal canal narrower, and this condition is called spinal stenosis.

Spinal stenosis causes extreme back pain, as well as numbness and weakness of the lower extremities. Treatment often involves physical therapy and anti-inflammatory and pain medications, but some people need spinal stenosis surgery. Surgery for spinal stenosis is therefore used as a last resort for patients who are not able to work or function normally because of their spine problem.

Why Do You Need Spinal Stenosis Surgery?

Spinal stenosis surgery is often reserved for people who do not respond well to conservative treatments. Conditions whenlower back surgery options are considered include:

• Persistent symptoms in spite of non-surgical treatments
• Chronic severe pain
• Radiculopathy, a condition characterized by pain, tingling and numbness in the arms/legs
• Loss of sensation in the arms/legs
• Weakness in the arms/legs
• Loss of bowel/ bladder control

The main goal of surgery for spinal stenosis is to decompress your spinal cord and the nerve roots. Spinal decompression gives the spinal cord and the nerve roots more space, which reduces pain and other symptoms due to nerve inflammation. Spinal stenosis surgery also increases motor strength and restores sensation in your arms/legs.

Considerations Before Spinal Stenosis Surgery

The most important consideration for spinal stenosis surgery is for the surgeon to have a detailed anatomical knowledge of the areas of the spine involved. The surgery must cause minimal destruction of other normal structures, which is why it is important for the surgeon to have adequate knowledge of the exact structures involved in the procedure. It must be done carefully, so as not to create new problems that may result from nerve injury or structural instability.

Finally, the patient’s physical and metabolic status must be given attention to because decompression surgery may require a long period under general anesthesia, which may not be well-tolerated by certain patients. Some patients undergo spinal stenosis surgery under epidural anesthesia, but this also requires special care.

What Are the Options for Spinal Stenosis Surgery?

The lower back or lumbar area is most commonly involved in spinal stenosis because this is the area that is most likely to receive a lot of stress from a person’s body weight and movements. Here are some of thelower back surgery options:

1. Foraminotomy

This procedure is done when a bone spur or intervertebral disc presses on a spinal nerve as it exits through a foramen (a hole in the vertebra). A foraminotomy makes the foramen bigger so that the nerve exits without compression.

2. Laminotomy

This procedure is similar to a foraminotomy in that it creates a bigger opening in the bony plate (the lamina) which protects your spinal cord. The lamina, which may be pressing on a nerve, is decompressed to make more room for your nerves.

3. Laminectomy

If laminotomy does not sufficiently cause decompression, the surgeon may remove part or all of the lamina, a procedure called laminectomy. This spinal stenosis surgery can be done at any level without harmful effects.

4. Spinal Fusion

In severe cases of spinal stenosis, the surgeon decides to join the spinal bones together using bone grafts or screws to provide stability to the spine. It can be combined with a laminectomy. This surgery usually lasts several hours and it uses one of these methods:

• Bone may be removed elsewhere in your body or acquired from a bone bank. The bone graft is used to stimulate the growth of new bone and form a bridge between the vertebrae.
• Adjacent vertebrae are secured together using metal implants (rods, hooks, screws or wires) to hold them together while waiting for new bone to grow between them.

What About the Risks of Spinal Stenosis Surgery?

Spinal stenosis surgery carries potential risks, which are common to other types of surgery. Consult your doctor about these risks before signing a consent form for surgery. Possible risks and complications include:

• Risks associated with anesthesia
• Spinal cord or nerve injury
• Failure of healing of the bony fusion (pseudoarthrosis)
• Lack of improvement
• Breakage/failure of instrumentation
• Infection
• Pain at the site of the bone graft

Recovering from Spinal Stenosis Surgery

Recovery after spinal stenosis surgery may take some time. You may be out of bed in 24 hours, but you will need pain medications for two to four weeks. You will receive instructions about how rise, sit, and standcarefully. It is important to allow your body to heal, so you will be advised to restrict your activities. You must avoid activities that involve too much spine movements such as twisting, heavy lifting, as well as contact sports.

Right after surgery, it is important to be vigilant and to report problems such as fever, infection, orworsening pain. Seek medical help immediately if you have any of these problems.

Practice healthy habits following surgery. Here are some tips:

• Always follow the treatment plan suggested by your doctor.
• Always stand and sit properly.
• Learn the proper way to lift correctly.
• Exercise regularly, but stick to low-impact aerobic exercises. Ask your doctor before starting a new exercise regimen.
• Use proper exercise/sports equipment.
• Eat a well-balanced, low-fat diet that is rich in fruits and vegetables. Get enough calcium.
• Maintain a healthy body weight.
• Avoid taking alcohol in excess.
• Stop smoking.