Lumbar spinal stenosis is the most common condition leading to spine surgery for patients over the age of 60.
Usually a result of the “wear-and-tear” changes in an individual’s spine that occur naturally with age, spinal stenosis of the lumbar spine typically produces pain, cramping, numbness, weakness and/or a pins-and-needles feeling in the legs that is worse with walking and better with resting or leaning forward. The patient may also experience low back pain and/or hip pain along with this activity-related leg discomfort (called neurogenic claudication).
The key question for many patients dealing with such pain is: how do I decide whether to have surgery for lumbar stenosis or live with the symptoms and manage them through non-surgical means? This article addresses this important question.
Categorization of Patients with Lumbar Stenosis
The leg pain associated with lumbar spinal stenosis can vary greatly in intensity. Once symptoms develop, patients usually fall into one of three categories:
- 15 to 20% get better
- 70% live with their symptoms and manage them through nonsurgical treatments
- 10-15% undergo surgery for lumbar stenosis, specifically a laminectomy 1
When to Consider Surgery for Lumbar Spinal Stenosis
The bottom line is that the time to see a surgeon about surgery for lumbar spinal stenosis is when an individual is unhappy with his or her restricted activity level, and has tried reasonable nonoperative treatments (like anti-inflammatory medication, physiotherapy, and epidural steroid injection).
If that is the case, and the spinal stenosis has been diagnosed on an MRI scan or CT-myelogram, then a surgeon may discuss surgical options with you.
Key Considerations with Surgery for Lumbar Stenosis
Additional important considerations to help with the decision include:
- Spinal stenosis is generally not progressive. The pain tends to come and go, but it usually does not progress with time. The natural history with spinal stenosis, in the majority of patients, is that of episodic periods of pain and dysfunction.
- There is usually not any urgency to having surgery for spinal stenosis, and there typically is not any window of opportunity that a patient will miss if they delay surgery. A patient will usually do as well having lumbar stenosis surgery sooner as he or she would if the surgery were done later.
- In the event of progressive weakness in the legs, then spinal stenosis surgery should be considered on an urgent basis rather than delayed in order to reduce the chance of long term nerve damage.
- While decompressive surgery (lumbar laminectomy) for spinal stenosis generally has a good success rate for relief of leg pain and leg symptoms (such as ability to walk), it is less reliable as a treatment for activity-related lower back pain.
- You may be a candidate for a less-invasive procedure (for example, insertion of an interspinous process spacer, such as an X-STOP spacer) that can relieve symptoms without the need for a laminectomy. Not everyone with spinal stenosis is a candidate for this type of surgery.
- Because spinal stenosis is caused by degenerative changes in the spine, symptoms may recur a few years after surgery for lumbar stenosis.
- Potential risks of the surgery for lumbar stenosis are greatly affected by the general health of the patient, such as diabetes, obesity, or cigarette smoking. Similarly, if the proposed surgery is more involved (e.g. if it includes a spinal fusion with or without instrumentation), the risks of the surgery increase.