Spinal stenosis surgery

Spinal stenosis surgery — an overview of surgical treatment

Spinal stenosis surgery is generally recommended as a last resort for patients whose neck or back pain is severe enough to reduce their quality of life. Spinal stenosis usually results from age-related wear and tear and commonly develops in the cervical (neck) or lumbar (lower back) region of the spine. To learn more about the causes, symptoms and treatments of spinal stenosis, including surgery, visit our diagnosing spinal stenosis and spinal stenosis treatments pages.

Spinal stenosis surgery options

Spinal stenosis, or narrowing, most often affects the lower back because that region is subject to significant stress from facilitating a wide range of motion and supporting much of the body’s weight. Because the space available for sensitive neural tissue within the spinal canal is very limited, even a small degree of narrowing in the lower spinal canal can sometimes lead to symptoms related to sciatic nerve compression. The longest nerve in the body, the sciatic nerve originates in the lower back and extends through the buttocks, down the backs of the legs and into the feet. When compressed, the sciatic nerve can produce a set of uncomfortable symptoms known as sciatica. These symptoms can include radiating pain, burning sensations, tingling, numbness or muscle weakness in the lower back, buttocks, legs or feet. In many cases, sciatica can be managed effectively with a regimen of conservative treatments, such as nonsteroidal, anti-inflammatory drugs (NSAIDs), exercise and stretching.

If sciatica does not respond to several weeks or months of conservative treatment, a physician might recommend spinal stenosis surgery. One common approach is a laminectomy, which is often performed as an open spine procedure. The goal of laminectomy is to create more space within the spinal canal to relieve pressure on the part of the spinal cord or the nerve root that is causing the symptoms. To accomplish this, a surgeon removes a spinal lamina. The laminae are thin plates of bone that extend from the pedicles of each vertebra and collectively form a protective arch over the spinal cord. When performing this type of spinal stenosis surgery, a surgeon can also remove bone spurs or herniated disc material, if necessary.

While a traditional laminectomy can be effective, open spine surgery has several disadvantages. For instance, in order to adequately view and access the spinal components, a surgeon must make large incisions that affect the surrounding musculature. Therefore, the procedure is typically performed in a hospital setting and most often requires postsurgical hospitalization. Additionally, a patient’s recovery and rehabilitation can be long and difficult.

Minimally invasive decompression surgery for spinal stenosis

For certain patients, minimally invasive spine surgery can be an alternative to traditional open spine surgery for spinal stenosis. Because this innovative technique involves much smaller incisions than traditional open spine approaches, patients often report that they experience minimal pain, complications and scarring, as well as faster recoveries.

The surgeons at Laser Spine Institute perform four main types of minimally invasive decompression surgery, including:

  • Laminotomy — This procedure can relieve symptoms caused by spinal cord or nerve root compression by increasing the space available within the spinal canal to release entrapped nerves. To do so, a surgeon uses specialized surgical instruments to remove of a portion of the lamina through small incisions.
  • Foraminotomy — This technique may be utilized if bone spurs, displaced disc material or enlarged ligaments are blocking an intervertebral foramen. The intervertebral foramina are open passageways situated on either side of each vertebra. Nerve roots pass through these narrow channels to exit the spinal cord and reach other areas of the body. By removing tissue that is encroaching this area, a surgeon can create more space to allow nerve roots to pass unencumbered.
  • Discectomy — This approach involves the removal of herniated or bulging disc material that is exerting pressure on the spinal cord or a nerve root. Using a specialized laser and other surgical tools, a surgeon can vaporize and remove displaced disc material to create more space for impinged neural tissue.
  • Facet thermal ablation — This procedure is performed to remove damaged tissue from a spinal facet joint and desensitize the associated nerve inside the joint to relieve symptoms.

Spinal fusion surgery for spinal stenosis

Spinal fusion is sometimes recommended for patients with severe spinal stenosis. The goal of fusion surgery is to enhance the stability of the spine following the surgical removal of bony matter, intervertebral disc material and other tissue. Traditionally, spinal fusion has been performed through an open spine approach that requires large incisions and carries a high risk of failed back surgery syndrome (FBSS), which may result from infection, hardware failure, bone graft rejection or nerve damage. Laser Spine Institute offers alternatives for some patients in the form of minimally invasive stabilization (MIS) surgery, which involves small incisions and is performed on an outpatient basis.

Some of the minimally invasive stabilization (MIS) techniques perfected by the surgeons and other medical experts at Laser Spine Institute include:

  • Decompression with Interlaminar Stabilization™ device — After removing the source of the pressure, a surgeon inserts a coflex® device to help maintain the decompression and stabilize the spine with minimal restriction on the patient’s range of motion.
  • Anterior cervical discectomy fusion (ACDF) — Guided by detailed images created with a fluoroscope (a special type of X-ray), a surgeon removes an unhealthy intervertebral disc, then inserts an artificial replacement disc or a bone graft and small titanium plate.
  • Cervical disc replacement — A surgeon removes a damaged intervertebral disc and inserts an artificial disc in its place.
  • Transforaminal lumbar interbody fusion (TLIF) — To minimize the movement of sensitive nerve roots, a surgeon accesses the spine slightly from the side and inserts a bone graft and spacer into an unstable disc space to encourage the formation of a solid bond between two or more vertebrae.
  • Lateral lumbar interbody fusion (LLIF) — Accessing the spine from the side, a surgeon removes a portion of a degenerated intervertebral disc, then inserts a spacer to restore the proper disc height, along with bone grafts to encourage the adjacent vertebrae to heal together for enhanced stability.
  • Posterior cervical fusion — Accessing the spine through the back of the neck, a surgeon inserts bone grafts or implants to create spinal stability and help two or more vertebrae to grow together into a single, stronger unit.
  • SI joint fusion — With the guidance of images created with a fluoroscope, a surgeon accesses the SI joint at the point where the sacral bone joins the pelvis bone and inserts a special implant designed to provide stability.

To learn more about minimally invasive spinal stenosis surgery or request a review of your recent MRI, contact Laser Spine Institute today.

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