Question: What Surgery is Best for Spinal Stenosis and Sciatic Pain?

My 65 year old mother has had spinal stenosis and sciatic pain down her left leg for 6 years. She is otherwise in stable health. She experiences some numbness, coldness, tingling in her left leg and foot but mostly just horrific pain that doesn't respond to any treatment. She has nerve compression at L4/L5, and fusion surgery at one level with decompression has been recommended by a surgeon.

She has tried all of the conservative measures to avoid surgery, including multiple steroid injections, to no avail. She has mild osteoporosis and osteoarthritis in her spine. She also has scoliosis in her thoracic spine. She also has lumbar disc disease.

The spinal stenosis surgery would address only her pinched nerve and would not attempt to correct her spine in any way (due to the severity and complexity of her conditions). It would only be to relieve the leg pain, which is debilitating. She is only able to walk/stand for minutes at a time.

I have 2 specific questions. Would my mom be a candidate for an artificial disk with the decompression instead of the fusion? Next question - I read that waiting too long for stenosis surgery can be a mistake. We avoided surgery based on recommendations of the first surgeons we consulted. I want to know if you can give me any indication about the chances that the nerve down her left leg has been compressed so long (6 years) that even after the decompression is done, the nerve will continue to cause extreme pain.

This is my biggest concern - if she goes through the risk of the surgery, will it be for nothing if the nerve is severely damaged? Thank you so much for any guidance you can provide.

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Doctor’s Response: Decompression, Not Artificial Disc, for Spinal Stenosis

She would not be a candidate for an artificial disc. Artificial discs are designed only to treat pain due to degenerative disc disease. They do not stabilize the spine (as a fusion would) and do not provide for decompression of the nerve roots. They are absolutely contraindicated in anyone with osteoporosis or in patients over 65 years old as they will subside into the vertebral body.

From the information in your e-mail, it does sound as though a decompression would be reasonable at this time. In spinal stenosis cases, it is rare to see permanent nerve damage. The majority of time, the surgery for spinal stenosis works as well if it is done now or at a later date, and that is why a lot of physicians will encourage patients to wait until their pain becomes debilitating. The main goal of surgery is to relieve the pain and allow the patient to function better. In general, it is usually not necessary to do surgery to prevent nerve damage from spinal stenosis.

However, there is always a small chance that any surgery will not work. The most important thing is that the potential benefits of surgery outweigh the risks. A one level decompression and fusion is a reliable surgery for the most part, and if your mother has already had all other conservative treatments, and is now debilitated, I would think the potential benefits far outweigh any risks. Good luck.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.