Surgical Management of Spinal Stenosis
Edited By: Richard J. Bransford, M.D.
Last updated Friday, December 23, 2005
About the procedureTechnical details There are various approaches to treat stenosis, depending on
the cause.
Most stenosis in the cervical spine is operated on through
the front of the neck with very little muscle damage. The major structures are pushed and pulled to
the side, without having to cut much tissue and allowing access to the bones on
the front of the neck. The bones and discs can then be accessed to remove any
compression on the nerve roots and spinal cord. Usually a fusion or disc
replacement is then performed to maintain the stability of the neck.
Depending on how many vertebral segments are involved, occasionally a back side (posterior) approach needs
to be used on the cervical spine. This tact is much less common and is a more
invasive procedure, causing more pain due to all the muscles on the back of the
neck having to be peeled away from the bones to obtain accesss.
Most lumbar surgery is done through the back. The patient is face down on the operating
table. If a disc is all that needs to be removed, this can be done through an
incision measuring about 2 centimeters. A pathway is made down to the lamina (roof
of the bone over the back of the spinal cord) and a small window is made in the
bone allowing the surgeon to see the spinal cord. The spinal cord is gently
pulled to the side and an instrument is used to reach down the side of the cord
and remove the disc that is out of place. Most patients have significant relief
of leg pain following this type of procedure.
If the cause of stenosis is due to arthritis and a
generalized tightening of the cord, then a larger incision is required. The
whole lamina is exposed on both sides and then typically the whole lamina and
the overlying spinous process (see figure)
is removed. Sometimes only one segment needs
to be decompressed and sometimes multiple levels need to be addressed.
If there is spinal instability, such as a spondylolisthesis
or scoliosis associated with the stenosis, then sometimes screws and rods need
to be placed to provide stability so the pain and nerve compression does not
recur or persist.
Anesthetic Patients undergoing spine surgery will usually be
administered a general anesthetic causing them to be completely asleep during
the procedure. A tube is inserted in their throats and into their lungs to
assist with breathing.Length of laminectomy, decompression, fusion Spinal surgery can take anywhere from one hour to about eight
hours depending on what is being done. A
discectomy or laminectomy can usually be done in one to three hours depending
on the complexity. If a fusion is
required, this will usually take three to eight hours, depending on how many segments
need to be addressed and whether the procedure is a revision of a previous
surgery.
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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