Print This PageSpinal Stenosis Surgery
Spinal Stenosis Info:
In most cases of advanced claudication (spinal or vascular), decompressive surgery is required. There are several opinions and techniques used in spinal stenosis surgery, but there are key components common to all such approaches.
- First and foremost, a correct and very detailed anatomical diagnosis is required - knowing exactly where to go while considering the possibility of a double or triple location for choking of a nerve in it passages, on one or both sides.
- Secondly, the 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. This again points to 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 decompressive procedure - 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, a decompression surgery for spinal stenosis can be among the most rewarding surgical methods used on the spine (second only to removal of some herniated discs), because generally patients do well and are able to increase their activity and have a better walking tolerance postoperatively.
For more information on decompression surgery, please see Lumbar Decompression Back Surgery.
More recently, a few new surgical approaches have also been introduced and 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 treatment of spinal stenosis, principally of the central type. See also Interspinous process spacers.
- Facet replacement or total element replacement. This new class of devices is still principally investigational 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 in 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, see Posterior motion preservation spine surgery: alternative to spinal fusion.
