The gold standard of surgery to treat spinal stenosis is a laminectomy. Modern techniques may use smaller access incisions to the narrowed bones, but the goals are the same. The area of bony compression is removed, and soft tissues such as hypertrophic ligamentum flavum are peeled off the thecal sac and out the neuroforamen. This technique can be used in the lumbar or cervical area.
In the cervical spine, sometimes much of the compression is located from the front of the spine, or, if there is a more forward bend to the neck (kyphosis), anterior decompression of the spine via anterior cervical discectomy/corpectomy with fusion (ACDF) may be the preferred surgery.
For patients with spinal instability as well as stenosis, or for patients that require such a decompression that they will become unstable after the decompression, the standard is to perform both a laminectomy decompression procedure as well as a fusion, which involves stabilizing the vertebrae so they will come together as one bone.<
More recently, a few new surgical approaches have also been introduced. For example:
Interspinous process devices. This procedure has had some success for central canal stenosis patients, but the procedure has not benefited all spinal stenosis patients. In addition, it has no use in patients with more than two levels of central stenosis, and depending on the imaging studies, the various devices may not accommodate certain anatomies.
Facet replacement or total element replacement. This is a newer class of devices and remains experimental. Several of the devices studies have had discontinuation of the research. While there may have been some merit in the concept, the devices are no longer available for more patients.
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The bottom line is that surgical treatment for spinal stenosis can be effective for the right patient, with the right diagnosis, right imaging studies, and the right procedure. The goals will always be the same: Remove the narrowing on the nerves without creating other longer term issues for the spine. If there is an instability pattern (spondylolisthesis) along with the narrowing, fusion is likely necessary to achieve an acceptable surgical outcome.