Treatments

Spinal Stenosis Surgery Options

Source: Mayo Clinic
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Spinal stenosis

The term spinal stenosis means the narrowing of the spinal canal. It is the abnormal narrowing of the spine in any part or region of it. It causes a restriction in the spinal nerves which results in neurological deficit such as weakness, movement disorders, sensory symptoms, and blackouts. The location of the stenosis tells which area of the body is affected.


Due to this condition, the spinal canal is narrowed at the vertebral canal. This canal is the vertebral column which is formed by the vertebrae through which the spinal cord passes. On the basis of the areas affected, spinal stenosis has a few types which have been discussed below along with their treatment.


Cervical spinal stenosis


It is recorded as the most common form of spinal stenosis. This occurs at a person's neck level. Also, cervical spinal stenosis can grow dangerous by compressing the spinal cord too. Cervical canal stenosis may also lead to myelopathy. This is defined as a serious condition that causes symptoms like body weakness and paralysis.


Lumbar spinal stenosis


In the condition known as lumbar spinal stenosis, the spinal nerve roots in a person's lower back are compressed. Such a compression can lead to symptoms of sciatica which is defined as tingling accompanied with a sense of weakness or numbness that radiates from the lower back and flows into the buttocks and legs.


Thoracic spinal stenosis


This is the least common spinal stenosis. It is focused on the mid-back level.

Diagnoses

The physical checkup of a patient with spinal stenosis will determine the information about the exact location of nerve compression. There are also some other factors as well that should be investigated such as any area of sensory abnormalities, irregular reflexes, numbness, and any muscular etching.


MRI and CT scan are one of the most useful ways to diagnose and determine spinal stenosis. You should know that an MRI uses electromagnetic signals to produce images of the spine. 

Surgery options for spinal stenosis

Anterior cervical discectomy and fusion


Anterior cervical discectomy and fusion is a surgical procedure to treat spinal compression. It involves the decompressing of the spinal cord and nerve roots of the cervical spine with a discectomy (surgical removal of herniated disc material that presses the spinal cord or nerve ). This helps to stabilize the corresponding vertebrae.


This treatment is used when all non-surgical treatments have failed. Posterior approaches seek to generate space around the spinal cord by removing parts of the posterior elements of the spine. The techniques include laminectomy, fusion, and laminoplasty.


Lumbar decompressive laminectomy


This involves removing the roof of the bone overlying the spinal canal and thickened ligaments. The soft tissues such as the hypertrophic ligamentum flavum are peeled off the thecal sac and out of the neuroforamen in order to decompress the nerves. 


People who prefer surgery for lumbar spinal stenosis should know that laminectomy is the most common surgery for lumbar spinal stenosis. It has the highest success rate that is 70-90%. In most cases, just because of decompressive laminectomy patients return to their previous actual active condition and are able to do more with a pain-free lifestyle. 


But still, if a patient is reasonably well to perform his or her duties then they shouldn't go for such surgery unless it is their last option. Also, take note that an interlaminar implant is a non-fusion U-shaped device which is placed between two bones in the lower back that helps to maintain the motion of your spine. It also keeps the spine stable after lumbar decompressive surgery.


Laminoplasty 


Laminoplasty is an orthopedic or neurosurgical surgical procedure for treating spinal stenosis by relieving pressure that is being felt on a person's spinal cord. This procedure involves cutting the lamina (on both sides of the affected vertebrae) and then moving on to swinging the freed flap of bone open thus relieving the pressure on the spinal cord. 


The success rate of laminoplasty is generally favorable. The best prediction of a patient’s post-operative outcome is their pre-operative baseline function level. Some patients may experience some improvements in functions after surgery. However, the goal of this surgery is to prevent the worsening of neurologic functions or paralysis. It isn't for improving function.


It may have some risks as well such as pain, numbness due to nerve manipulation, weakness, paralysis due to spinal root damage, infections.


Spinal Cord Stimulation (Minimally Invasive)


A spinal cord stimulator (SCS) is a small implanted device that sends electrical pulses to the brain to mask pain signal from reaching the brain, and has been used for almost 30 years to help patients reduce chronic pain and opioid usage. Spinal cord stimulation is commonly referred to as nerve stimulation and has recently received more support in the medical community to help avoid over-prescription of opioids for pain management. Spinal cord nerve stimulation is a reversible procedure – recent technologies are far more advanced in personalizing the therapy and controlling pain over extended periods of time. Where many other solutions provide short to mid-term relief, nerve stimulation is a longer term pain relief solution for patients.