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
A correct diagnosis is essential to achieve a positive surgical outcome. Imaging studies are necessary to identify the areas of narrowing. Not addressing all the areas may result in an inferior result. Too many areas of stenosis may also be a reason not to perform elective spinal stenosis surgery.
For the most part, the days of the “exploratory” spine surgery is over. Once in a while, an intraoperative finding may significantly differ from the imaging studies, but with modern imaging techniques, there should be few surprises. One exception would be the presence of more instability of the spine unit. Unexpected instabilities may be identified as the patient is usually given muscle relaxants during the operation, and the surgeon may detect excessive mobility of a spine unit. The frequency of surprises, however should be rare, as higher-quality MRIs and thin-slice CTs should provide information about underlying instability conditions. If the imaging study demonstrates fluid in the facet joints, or excessive facet wear, there is a strong possibility of instability. Concerned surgeons may order dynamic flexion extension X-rays to try to identify the instabilities prior to the operation.
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Current surgical techniques try to minimize exposure or violation of nearby tissues. Most surgeons try to preserve the spine ligaments and facet capsules in an attempt to reduce the chance of developing next-level or adjacent-level degeneration or stenosis in the future.
Medical care overall has improved, but medical risks such as prior heart disease, diabetes, and osteoporosis must also be weighed when making the decision for surgery. Sometimes, the prudent decision may be to not operate, considering the medical risks, and the otherwise chance of a successful outcome.
Fortunately, spinal stenosis surgery outcomes for decompression can be among the most rewarding surgical methods used on the spine. 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.