The most common surgical procedures to alleviate symptoms for spinal stenosis in the lower back include the following.
Posterior decompression (laminectomy or partial laminectomy)
Also called a lumbar laminectomy, this surgery has long been considered the standard treatment for lumbar stenosis. The surgery removes the bone and soft tissue narrowing at a single or multiple affected levels, with the goal of relieving the pressure on the nerve root(s). The success rate is generally over 90% and it is considered a very reliable surgery.
Minimally Invasive Surgical (MIS) Decompression
This is a decompression procedure done through an endoscope or small tube. The surgery is designed to accomplish the same relief of nerve compression as an open laminectomy (discussed above), but with less tissue dissection, blood loss, and post-operative pain. The recovery from surgery is faster.
Combined with modern surgical technique, multiple levels of the spine and bilateral decompressions (on both sides) can be accomplished with one or two portals to access the operative site. This procedure is usually a day surgical procedure with rapid recovery and—with an experienced surgeon and the right indications—is considered a reliable surgery with good results.
Posterior Partial laminectomy with Coflex (interlaminar fixation) Motion Device
This approach combines a laminectomy surgery with a device that is added after the decompression with the goal of providing stability and preventing re-stenosis. Preventing re-stenosis is done to reduce the potential risk of needing an additional surgery in the future.
The device is indicated in stenosis secondary to arthritis and degenerative (arthritic) grade I spondylolisthesis (spine slip). In level I studies, the results are similar to a posterior fusion surgery, but with a more minimally invasive technique that has less blood loss, tissue dissection, and pain. Also, the potential secondary problems of fusion (adjacent level disease) are minimized. The patients typically return to activity faster than patients who have had a lumbar fusion.
There are several options for an indirect decompression, including:
Far lateral Interbody Fusion or Oblique Interbody Fusion
Both techniques decompress the spine by opening up, or distracting, the disc space, thereby alleviating pressure on the nerve by opening the foramen where the nerve root is located. This is generally used when a fusion is also required to treat the particular spinal condition. Both techniques are done as minimally invasive approaches using a tubular retractor.
Anterior Interbody Fusion
Also called an ALIF, this surgery is done as more of an open surgical technique but using small incisions and minimal dissection, so the recovery time is relatively fast. An ALIF also decompresses the nerve by opening up, or distracting, the disc space and inserting a fusion implant to maintain the space in the foramen for the nerve to pass through.
Decompression and Fusion
Sometimes the spine needs additional strength and stability, which can be achieved with a spinal fusion that may be done as part of the same operation as a laminectomy. For example:
Posterior laminectomy and Fusion, Posterior lumbar Interbody Fusion (PLIF), or Transforaminal Interbody Fusion (TLIF)
These procedures are performed when the spine is de-stabilized by the decompression (e.g. lumbar laminectomy), which is sometimes because a large amount of the bone has to be removed and/or bone at multiple levels needs to be removed.
They may also be done if the spine is unstable prior to surgery, such as from a spondylolisthesis, or has a deformity that requires correction.
These types of fusion can all be done with open or minimally invasive surgical techniques. The particular technique depends largely on the patient's spinal condition, anatomy, and the surgeon’s experience and preference.
All of the techniques described can be done separately or in combination with minimally invasive surgical (MIS) techniques utilizing-high powered surgical microscopes, endoscopic cameras, intra-operative CT navigation, robots, and intra-operative monitoring.