Surgical Treatment for Spinal Stenosis

Treatment for spinal stenosis can be surgical or nonsurgical. Nonsurgical options you can discuss with your health-care provider include:

  • Exercise, such as walking or biking

  • Over-the-counter medications to help control swelling and pain, such as nonsteroidal anti-inflammatory drugs or analgesics

  • Epidural steroid injections given by your health-care provider

  • Reduced physical activity

  • Use of a back brace or corset, depending upon the location of the discomfort

If the pain continues to be a problem, your health-care provider may recommend possible surgical procedures, including decompressive laminectomy and fusion.

Decompressive laminectomy allows a surgeon to reduce the pressure on the spinal cord by removing the lamina, the bony shingles that cover the spinal nerves. The surgeon may also choose to remove the spinous process, bones that project from the spinal column.

Painful bony growths, or spurs, can also be removed during this procedure. A fusion procedure might be performed to help stabilize the spinal column after some of the bone has been removed.

The fusion procedure helps stabilize the spine after portions of the bone in the spinal column have been removed. A fusion procedure involves attaching metal screws, plates or other devices to spine bones to help keep them properly aligned.

Fusion is usually performed when two or more of the spinal bones, also called vertebrae, have been injured. Small pieces of bone may also be attached to the injured bones to help them fuse into one solid piece.

The bone used for this procedure is usually taken from another bone in the body, most often from the hip. This does not damage the hip and makes the fusion more stable. If needed, a small surgery on the hip will be performed at the same time as the spine surgery.

 

Medications

As with any surgery, patients will feel some pain during recovery. Expert medical staff will help you be as pain-free as possible. Although the staff may frequently ask if you are feeling pain, it is best not to wait until it hurts a lot to ask for pain relief. Pain is easier to treat when it is still mild.

Some patients may be observed overnight in the intensive care unit depending upon the type of surgery and their health status. Anyone who needs support for breathing from a ventilator or special intravenous (IV) medications for blood pressure will need to spend time in an intensive care unit after spine surgery. Talk with your health-care provider about what you can expect for post-surgical recovery.

 

Considerations

Many patients with spinal stenosis may be treated without surgery. The purpose of surgery is to relieve pressure on the spine, but surgery may be required if a person has:

  • Persistent pain that cannot be treated by nonsurgical methods

  • Numbness or weakness that interferes with walking

  • Impaired bowel or bladder function

  • Other types of nerve problems that may involve the spinal cord

The laminectomy or removal of bone may be performed without spinal fusion in a young person who has achondroplasia, a genetic disease affecting spinal cord formation.

 

Effectiveness

The American Association of Orthopaedic Surgeons reports that about 80 percent of patients experience good to excellent results from surgery. Here are some other advantages of surgery, according to the association:

  • Fusion surgery reduces the cause of more back and leg pain

  • Using screws and rods helps the healing process for the spinal column

  • Fusion surgery may allow the patient to get out of the post-operative brace quicker

Your health-care provider will discuss the results you or your loved one can expect following surgery for spinal stenosis.

 

Risks

As with any surgical procedure, there are risks involved. For spinal stenosis surgery, the risks include:

  • Infection

  • Bleeding or blood clots

  • A reaction to anesthesia during surgery

  • A tearing of the covering of the spinal cord during the surgical procedure, called a dural tear

  • Injury to the spinal cord

  • A failure or breakage of the implanted fusion device, such as rods or screws

  • A return of pain or other symptoms after surgery

Patients face greater risks from surgery if they are elderly, overweight, smoke or have diabetes.

 

Talk with your health-care provider about any concerns you may have about surgery. UW Medicine experts are leaders in their fields and have many years of experience in treating your type of spinal condition.

 

Urgency

Surgery may be recommended without delay if a person has cauda equina syndrome, symptoms of which include numbness or weakness that interferes with walking or impaired bowel or bladder function.