Surgery for central canal stenosis is indicated when the symptoms and signs of radiculopathy and/or myelopathy worsen and begin to interfere with daily activities.
Considerations for Central Canal Stenosis Surgery
An accurate diagnosis is essential to achieve a positive surgical outcome while treating central canal stenosis. The goal of spinal stenosis surgery is to relieve spinal cord and/or spinal nerve compression in order to provide pain relief and prevent worsening neurological deficits.
A few factors that may influence the outcome of the surgery are:
- It is essential to try to treat all the causative factors of the stenosis. For example, a bone spur removal and treatment of disc herniation at the same level may be done together.
- If multiple areas of stenosis are present, then surgery may be more extensive. Surgically treating several spinal levels may result in instability of the vertebral segments.
- Exposure of surrounding structures such as ligaments, arteries, nerves, and the adjacent vertebrae must be minimal, and an attempt to preserve ligaments and facet capsules must be made.
If the surrounding structures are affected, there may be a chance of degeneration of vertebrae and/or discs with or without the development of stenosis in the future. It is essential for this type of surgery to be performed by a trained surgeon who has experience in treating spinal stenosis.
Surgery for Cervical Central Canal Stenosis
Surgery on the cervical spine can be performed from the anterior (front) side of the neck or the posterior (back) side of the neck. The surgeon decides the approach based on the type and location of the stenosis. A few examples include:
- Surgeries on the anterior side of the neck. Anterior surgery is usually done when stenosis affects 1 to 3 motion segments of the spine and would usually compress the spinal canal from the front side. Examples of anterior surgeries include1:
- Anterior cervical discectomy and fusion (ACDF)—a surgery that is commonly performed to treat stenosis and includes removing a damaged disc to relieve spinal cord or nerve root pressure.
- Corpectomy—a surgery to remove parts of the vertebral body to relieve pressure on the spinal cord.
- Artificial cervical disc replacement surgery—a surgery that typically maintains good mobility in a spinal motion segment and includes replacement of a damaged disc with an artificial disc (prosthesis).
Among these procedures, ACDF is considered the gold standard in the treatment of cervical stenosis. Anterior procedures may help correct the curvature of the cervical spine, resulting in better stability of the neck. Potential risks include failure of fusion and damage to the spinal cord.
- Surgeries on the posterior side of the neck. A posterior surgery may include treatment of up to 4 motion segments at a time.2 Examples of posterior surgeries include1:
- Laminectomy. Laminectomy is the removal of a small portion of the vertebral bone or disc to relieve spinal cord or nerve root compression. Adjacent vertebrae may or may not be fused after this procedure.
- Laminoplasty. Laminoplasty is a procedure where the vertebra’s lamina is partly opened up to enlarge the spinal canal.
When more than one segment is treated, fusion surgery may be performed at the same time to improve the stabilization of the treated segments. Improper stabilization may lead to complications such as swan-neck appearance and/or post-surgical neck pain in some cases. Sometimes, both posterior and anterior surgeries may be performed together.
Surgery for Thoracic and Lumbar Spinal Stenosis
Stenosis affecting the thoracic and/or lumbar spine is usually treated with surgical procedures performed on the posterior side. A few examples include:
- Laminectomy. Laminectomy is considered as the standard surgical procedure in treating lower level spinal stenosis. A complete or partial laminectomy, with or without fusion may be done depending on the severity of the stenosis.
- Spinal Instrumentation. Sometimes, instrumentation to limit motion is added after the laminectomy is performed to provide stability and prevent the recurrence of stenosis. This device is indicated in stenosis secondary to arthritis and degenerative grade I spondylolisthesis.
- Anterior interbody fusion. This technique is approached from the anterior side through the chest or abdomen. The procedure typically involves removing the intervertebral disc and fusing the motion segment.
While spinal surgery tends to be a safe procedure, there is a low risk for serious complications, including excessive bleeding, infection, allergic reaction, and/or nerve or spinal cord damage. The recovery usually takes weeks to months depending on the procedure performed.
Before deciding on surgery, it is important that the potential risks, benefits, and alternative treatment options are carefully explained. It is also important for the patient to have all of their questions satisfactorily answered.