Is Surgery Effective for Spinal Stenosis?
Sometimes, patients do not obtain enough relief from their symptoms from these nonsurgical treatments. If the patient is unable to function or do his or her normal activities due to pain, surgery could be an option. Additionally, patients with severe spinal cord compression (myelopathy) or increasing weakness of the muscles should consider surgery to help prevent permanent nerve damage. The surgeon customizes the surgical options for each person.
There are several types of surgeries to treat spinal stenosis. The goal of each of these surgeries is to provide more space for the spinal cord or nerves that are being compressed due to spinal stenosis. This is accomplished by various procedures that involve the removal of bone and/or tissues that are compressing the spinal nerves in the low back, referred to as decompression. These operations all require diligent management of postoperative care.
Surgical procedures for spinal stenosis in the spine of the low back that are somewhat less invasive than traditional lumbar decompression have become available. Interspinous devices that have been used in certain patients for this purpose include X-Stop and Coflex devices, but these are considered investigational devices by many practitioners at this time.
In the lumbar spine, this is most commonly treated with a laminectomy. This surgery removes a portion of the vertebra (lamina) to create additional space for the nerve. If a small portion of the lamina is removed it is called a laminotomy. If too much of the bone has to be removed, or if there is too much motion remaining between the bones, the decompression may need to be combined with a fusion to help stabilize the spine.
In the cervical spine, the most common treatment is an anterior cervical discectomy and fusion (ACDF). With this surgery, the disc is removed from between two vertebrae along with any bone spurs pushing on the nerves or spinal cord. A bone graft is then used to replace the disc, and a metal plate is attached to the front of the vertebrae to help the bone grow together or fuse.
If multiple levels are involved in the neck, one or more vertebrae can be removed. This is called a corpectomy. After the bones are removed, a bone graft replaces them along with a plate.
Cervical spinal stenosis can also be treated surgically from the back side of the neck. A laminectomy can be performed as in the lumbar spine but is typically combined with a fusion in the cervical spine to prevent any abnormal motion from instability after the surgery.
A final procedure for cervical stenosis is laminoplasty. This involves creating more space in the back of the spinal canal by opening the back of the spine like a door and leaving it open with a combination of bone grafts or plates.