SPINAL STENOSIS AND LUMBAR DECOMPRESSION SURGERY
The spine is one of the most complicated and fragile parts of the body. It is made up of many segments, perched one on top of another. Within each segment of the spine there exists a spinal canal that is the path for the nerves and spinal cord.
When the spinal canal compresses an area—thus inhibiting the path for the nerves and the spinal cord—an extremely debilitating condition called spinal stenosis
occurs. This can result from a number of conditions, including overgrowth of bone from arthritis in the spine or displacement of disc material into the spinal canal, where it does not belong.
Often patients with spinal stenosis have a developmentally small spinal canal. In these individuals, the spinal canal never quite developed into a normal size, so any disc hernia, displacement or bone spur immediately compresses nerves.
To understand the concept of spinal stenosis, imagine a pipe that is partially blocked by sediment. Within the pipe, the area is stenotic or tighter than it should be. The spinal canal in most people should be at least 100mm². This is the approximate area encompassed by the width of a “Sharpie®” marking pen. In patients with spinal stenosis, the pressure exerted on the spinal cord and nerves can inflame the neurological tissue and lead to pain in the back and/or down the legs, which impairs the patient’s movement.
Inflammation of the nerves and pain associated with spinal stenosis can be reduced by taking medicines such as steroids or NSAIDs. The stenosis is still present, but the patient can be pain free.
In some cases, the nerves can accommodate themselves to function normally, despite the compression. Unfortunately, however, that does not always happen. Often patients with spinal stenosis can experience excruciating pain from the simple act of bending or lifting. Patients who suffer in this regard may choose to have their spinal canal decompressed with surgery in order to alleviate their pain and maximize their mobility.
Surgery to remove the stenosis of the spine can be performed in several ways. A common term for this procedure is “laminectomy
” which means removing the lamina. In this technique the majority of the back side of the spine is removed to take pressure off the spinal nerves.
Surgeons perform lumbar laminectomy surgery through an incision in the low back. The surgery involves the pedicle and lamina bones attached to the back of the spinal column which form a bony ring enclosing the spinal canal. Surgeons may remove bone spurs from the facet joints
along the back of the spine during the laminectomy procedure, taking pressure off the spinal nerves.
As with all major surgery, there can be complications. Some of the more common complications following lumbar laminectomy surgery include but are not limited to:
- Problems with anesthesia
- Thrombophlebitis (blood clots)
- Nerve damage
- Segmental instability
- Ongoing pain
Patients are usually able to get out of bed within a few hours after surgery. However, you will be instructed to move your back only carefully and comfortably. Most patients leave the hospital the day after surgery. They are safe to drive within a week or two. People generally get back to light work by four weeks. Many surgeons prescribe outpatient physical therapy within six weeks after surgery. Physical therapy after lumbar laminectomy is generally only needed for a total of four to six weeks. You should expect full recovery to take up to four months.
Laminoforaminotomy is another surgical technique for individuals with spinal stenosis. In this procedure, the majority of the anatomical structures are kept intact and the area surrounding the joint, where the compression is present, is shaved down to give the spinal canal more room.
This type of decompression surgery requires an incision in the back—usually in the middle or just off to the side. The surgeon typically uses a microscope or magnification glasses (loupes) to see the nerves in detail. A fiber optic light provides a strong narrow beam of light exactly where the surgery is performed. With fiber optic light, surgeons can create very small incisions and still see very well, thus performing minimally invasive surgeries. Minimally invasive techniques limit the trauma to the muscles and ligaments of the spine and patients can usually go home the same day of the surgery. Most patients with more than one spinal level decompressed need one to two days in the hospital. The patient walks immediately, and most feel well within two to three weeks. Pain that is present down the legs usually resolves very quickly following surgery. Most patients have back pain from the incision for two weeks. Following surgery, x-rays are taken to make sure the spine has not shifted abnormally.
Post surgery physical therapy may be necessary for some patients who have stiffness, weakness, and difficulty walking or standing erect. In other instances, patients who remain weak and unable to go home may require rehabilitation at an appropriate facility.