laminectomy is the most
common type of surgery done to
treat spinal stenosis. This surgery
is done to relieve pressure on
the spinal cord or spinal nerve
roots caused by age-related changes
in the spine and to treat other
conditions, such as injuries to
the spine, herniated discs, or
tumors. In many cases, reducing
pressure on the nerve roots can
relieve pain and allow you to
resume normal daily activities.
removes bone (parts of the vertebrae)
and/or thickened tissue that is narrowing
the spinal canal and squeezing the spinal
cord and nerve roots. This procedure is
done by surgically cutting into the back.
some cases, spinal fusion (arthrodesis)
may be done at the same time to help stabilize
sections of the spine treated with decompressive
laminectomy. Spinal fusion is major surgery,
usually lasting several hours. There are
different methods of spinal fusion:
the most common method, bone is taken
from elsewhere in your body or obtained
from a bone bank. This bone is used
to make a "bridge" between
adjacent spinal bones (vertebrae). This
"living" bone graft stimulates
the growth of new bone.
In some cases an additional fusion method
(called instrumented fusion) is performed,
in which metal implants (such as rods,
hooks, wires, plates, or screws) are
secured to the vertebrae to hold them
together until new bone grows between
There are a variety of specialized techniques
that can be used in spinal fusion, although
the basic procedure is the same. Techniques
vary from what type of bone or metal
implants are used to whether the surgery
is done from the front (anterior) or
back (posterior) of the body. The method
chosen will depend on a number of factors,
including your age and health condition,
the location (lower back or neck [cervical])
of stenosis, the severity of nerve root
pressure and associated symptoms, and
the surgeon's experience. Spinal fusion
increases the possibility of complications
and the recovery time after surgery.
To Expect After Surgery
Depending on your health and the extent
of the surgery, it may take several months
or more before you are able to return
to your normal daily activities.
It Is Done
Surgery for spinal stenosis is considered
are so severe that you are unable to
perform normal daily activities and
your quality of life is affected.
The symptoms become more severe and
intolerable over time.
Most spinal stenosis occurs in the lower
(lumbar) back. If you have stenosis
in the neck (cervical) area, your health
professional may recommend surgery to
prevent worsening of the condition,
which can cause nerve damage and paralysis.
decision to have surgery is not based
on imaging test results alone. Even if
the results of imaging tests show increased
pressure on the spinal cord and spinal
nerve roots, the decision to have surgery
also depends on the severity of symptoms
and your ability to perform normal daily
some cases spinal fusion will be done
at the same time to stabilize the spine.
Spinal fusion might make it easier for
you to move around (improve function)
and relieve your pain. It can also help
keep the bones from moving into positions
that squeeze the spinal canal and put
pressure on the spinal cord.
Well It Works
Surgery for spinal stenosis usually is
elective but may be recommended if symptoms
cannot be relieved with nonsurgical treatment.
In general, experts feel that surgery
has good results and relieves pain in
the lower extremities for people with
severe symptoms of spinal stenosis who
have few other serious health problems.
In general, up to 80% of people are satisfied
with the results of surgery for spinal
stenosis.2 For people with severe symptoms,
surgery usually reduces leg pain and improves
walking ability.3 However, symptoms may
return after several years. About 10%
to 20% of people who have had surgery
need to have surgery again.
may be necessary if:
stenosis develops in another area of
An earlier surgical procedure was not
effective in controlling symptoms.
Instability develops, or fusion does
Regrowth of tissue (lamina) presses
on the spinal cord or spinal nerve roots.
Spinal fusion may be done at the same
time as decompressive laminectomy. Spinal
fusion may help to stabilize sections
of the spine that have been treated
with decompressive laminectomy. Some
studies suggest it may also improve
function over time and relieve pain.
Complications from spinal stenosis surgery
may result from the impact of other existing
medical problems and the severity of the
spinal problem. In addition, all surgery
poses risks of complications. These complications
may be more serious in an older adult.
from having general anesthesia.
A deep infection in the surgical wound.
A skin infection.
Blood clots in the deep leg or pelvic
veins (deep vein thrombosis), which
rarely travel to the lungs (pulmonary
An unstable spine (more common after
multiple laminectomies are done without
using spinal fusion).
Nerve injury, including weakness, numbness,
Tears in the fibrous tissue that covers
the spinal cord and the nerve near the
spinal cord, sometimes requiring reoperation.
Difficulty passing urine or loss of
bladder or bowel control.
Death (rare) related to major surgery.
If you have diabetes or heart disease
or are a smoker, you may be at greater
risk for complications.
To Think About
Most experts recommend that people with
spinal stenosis try nonsurgical treatments
before opting for surgery. People who
delay their surgeries while using other
treatments still have a reasonable expectation
to have good results from their operations.
Surgery for lumbar spinal stenosis is
most likely to relieve pain if it is mostly
in your legs. Surgery does not usually
work as well for relieving pain that is
mostly in your back.
is usually effective if you have severe
leg pain and numbness and you have not
been able to move around well for a long
time.4 But in some cases, the symptoms
return after surgery. It is also possible
that nerve symptoms, including numbness
and clumsiness, may not be relieved or
may also return.
a laminectomy and fusion, spinal stenosis
may develop directly above or below the
surgery site. Repeated surgeries for spinal
stenosis increase your risk of complications
and instability in the spine. Age should
not be a factor in deciding whether to
have decompressive laminectomy. However,
if you have other medical conditions that
will make this procedure and follow-up
rehabilitation less successful, surgery
may not be recommended.
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