Surgical Management of Spinal Stenosis
Edited By: Richard J. Bransford, M.D.
Last updated Friday, December 23, 2005
Considering surgeryTypes of surgery recommended The type of surgery recommended depends on the cause of the
stenosis. Usually no surgery is required. In the case of stenosis of the canal due to
arthritis and aging, usually a laminectomy is all that is required. For foraminal stenosis due to a disc
herniation, a discectomy may be all that is needed. If the stenosis is caused by a more severe
condition, a fusion or more intricate spine reconstruction may be needed.
Who should consider laminectomy, decompression, fusion? Surgery should be considered for individuals who have failed
conservative treatment with medications and injections, or those with symptoms that
are so severe that they are starting to lose significant function and are at
risk for permanent nerve damage.What happens without surgery? Most people do not have surgery to correct spinal stenosis
and their symptoms either resolve or they learn to live with them. However,
without surgery, there is a risk of permanent nerve damage and possible
paralysis.Surgical options The surgical options for spinal stenosis are based on the
cause of the stenosis.
For stenosis of the canal due to arthritis and aging, or due
to a small spinal canal from birth, usually a laminectomy is all that is
required.
For foraminal stenosis due to a disc herniation, a
discectomy may be all that is needed.
If the stenosis is
caused by a more severe condition, such as spondylolisthesis, fracture, tumor
or scoliosis, then a fusion or a more intricate spine reconstruction may be needed. Effectiveness In the hands of an experienced surgeon, the outcomes of laminectomy,
decompression, and fusion surgery are usually effective in relieving leg and
arm pain caused by the stenosis. Usually
it takes many months for the strength and sensation to return to normal and this
may never occur, but the pain usually decreases rapidly.
Urgency Surgery for spinal stenosis is almost always elective,
except in some very unusual cases in which permanent spinal cord damage may
occur. Usually these cases are not treated surgically until time and other more
conservative options have proven to be ineffective.
Risks The most frequent risks associated with spinal stenosis
surgery, include:
- Infection.
- Stiffness.
- Tear of the lining of the sac surrounding the
spinal cord (dural tear).
- Nerve root or spinal cord injury.
- Anesthetic complications.
These risks can be
minimized by optimizing the medical status of the patient before surgery. For
example, the use of tobacco products increases the risk of adverse events
occurring, therefore, patients are encouraged to stop smoking or using other
tobacco products. Managing risk Most of the risks can be managed with medications, or on
occasion (such as with infection), with a repeat surgery. The most important thing is to identify the
problem and address it.
Surgery for at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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