In most cases of advanced claudication (spinal or vascular), a decompression surgery is required to treat the symptoms of spinal stenosis.
There are several opinions and techniques used in spinal stenosis surgery, but there are key components common to all such approaches, as explained in more detail below.
Important Considerations for Spinal Stenosis Surgery
- First and foremost, a correct and very detailed anatomical diagnosis is required - knowing exactly where to go during stenosis surgery while considering the possibility of a double or triple location for choking of a nerve in its passages, on one or both sides.
- Secondly, the spinal stenosis surgery should not create a new problem, such as nerve injury or a structural instability that might require additional surgeries.
- Thirdly, the approach to correcting spinal stenosis should be minimally destructive of normal structures. The surgeon should strive to leave as much as possible of the normal or slightly abnormal tissues alone during spinal stenosis surgery. This point again confirms the importance of exactly identifying the offending stenosis.
- Fourthly, the metabolic and physical status of the patient is important. Even in the hands of an experienced surgeon, a decompression surgery - especially if more than one level and if bilateral procedures are needed - may require a few hours of anesthesia, and this is not well tolerated by some patients. Some surgeons will perform the spinal stenosis surgery under an epidural anesthetic instead of a general anesthetic.
Fortunately, spinal stenosis surgery outcomes for decompression can be among the most rewarding surgical methods used on the spine (second only to removal of some herniated discs). Generally patients do well after decompression surgery and are able to increase their activity following recovery from spinal stenosis surgery. Many patients have a better walking tolerance following back surgery for spinal stenosis.
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Developments in Spinal Stenosis Surgery
More recently, a few new surgical approaches have also been introduced while other devices are in various stages of development and clinical trials. At least one has been approved for use in the treatment of central spinal stenosis.
- Interspinous process devices. The goal of these devices is to help take the bucking out of the ligaments and disc that together are pressing on the central canal and hopefully also a widening of the nerve foramen. In cases of true bone spur foraminal or far lateral stenosis, however, this method is less likely to help. This device does limit backwards bending at the segment, thus limiting the ligament and posterior disc buckling. The X-STOP is a device that has been approved for stenosis treatment, principally of the central type.
- Facet replacement or total element replacement. This new class of devices is still in the investigative stages and hopes to replace the facet joints in the back of the spine (or the total segmental element of the back of the spine). Whether or not this will assist patients with spinal stenosis depends on the extent of the central decompression, as yet to be proven. It is more likely that they might be of benefit in degenerative arthritis of the facet joints, which can contribute to foraminal stenosis, however.
For more information on the above newer approaches to surgery for spinal stenosis, see Posterior Dynamic Stabilization Systems.