Monday, April 8, 2024

Should I Have Surgery For Spinal Stenosis

Categorization Of Patients With Lumbar Stenosis

Part 2 – Non Surgical Treatments for Lumbar Spinal Stenosis

The leg pain associated with lumbar spinal stenosis can vary greatly in intensity. Once symptoms develop, patients usually fall into one of three categories:

  • 15 to 20% get better
  • 70% live with their symptoms and manage them through nonsurgical treatments
  • 10-15% undergo surgery for lumbar stenosis, specifically a laminectomy1

The Different Types Of Surgeries For Lumbar Spinal Stenosis

Surgeons writing in the medical journal Pain Medicine gave an excellent rundown of surgical procedures that someone with lumbar spinal stenosis can explore. Here is a brief summary of their learning points and some explanatory notes.

Surgical options range from minimally invasive decompression surgery for indirect lateral and central stenosis using interspinous spacers to more conventional invasive decompression surgery, either with or without fusion. Here are brief descriptions.

  • Using interspinous spacers
  • If you have been researching or contemplating this type of surgery, you know that a spacer is inserted into the rear portion of the vertebrae to hold them apart. For instance, a spacer is placed between L3 and L4 if that is where your stenosis is. The spacer will help alleviate pressure.
  • The study authors note that: Stand-alone interspinous spacers are designed for the treatment of symptoms of intermittent neurogenic claudication, that are brought on by moderate lumbar spinal stenosis. The benefit of this type of surgery is that it avoids getting near the spinal canal. You are not getting fused and some degree of flexibility can be maintained. The downside is higher complication rates have been reported. The authors again note: Not all patients are suitable for treatment with an interspinous spacer. Patients with osteoporosis and spondylolisthesis with dynamic instability are not appropriate candidates for interspinous spacers.

Minimally Invasive Lumbar Decompression

Cervical Spinal Stenosis Surgery

The Bonati Spine Institute has a 30+ year record of developing and performing groundbreaking procedures to treat cervical spinal stenosis and relieve chronic neck pain and other symptoms associated with the condition. The Bonati procedures are performed in an outpatient setting using a mild sedative and demonstrate a minimally invasive approach to treating neck stenosis. All procedures are endoscopic laser spine surgeries performed with patented instruments designed to minimize tissue damage, blood loss, and recovery time when compared to traditional open spine surgery.

Cervical spine surgeries performed at the Bonati Spine Institute to treat chronic neck pain are similar to those described for spinal stenosis. The decompression surgeries performed include the decompressive laminectomy, foraminotomy, and laminotomy.

The Bonati Spine Institute encourages patients with spinal stenosis to contact us to request a no-obligation MRI review or discuss your conditions with our medical professionals. Find out why The Bonati Spine Procedures are considered to be among the worldâs best solutions when it comes to advanced spine surgery. Your pain from spinal stenosis can become a thing of the past.

In This Section

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What Is Conservative Care For Back Pain

For new back pain or a recurrence of an existing back pain condition, try these measures before surgery:

  • Wait. The most time-tested cure for back pain is time itself. Many times, back pain gets better on its own. But don’t wait to see a doctor if you have “red flag” symptoms with back pain, such as fever or loss of bowel or bladder control.

  • Apply ice and heat. In the early or “acute” stage of a bout with back pain, ice can numb the pain and ease swelling of the injured tissues. After a few days, heat may provide more comfort, get the blood flowing in the injured area, and reduce stiffness.

  • Take pain relievers as needed. Over-the-counter pain relievers ease discomfort and some also reduce inflammation. Acetaminophen is gentle on the stomach but does not reduce inflammation. The other option is an anti-inflammatory pain reliever like ibuprofen , naproxen , or aspirin.

  • Stay physically active. Short periods of bed rest or sitting may be helpful during the acute phase, but extended bed rest isn’t. Keep moving as much as you can manage. The movement will help to keep you functioning.

  • Stretch and strengthen gently. As the intense pain subsides, introduce gentle stretching and strengthening exercises. Ask your doctor or a physical therapist for detailed guidance.

Images: Thinkstock

Foraminotomy For Spinal Stenosis

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A foraminotomy is a decompression surgery performed in order to increases the space of the foramen and hollow out the passageway where the nerve roots exit the spinal canal. The procedure involves the removal of bone or tissue that obstructs the neuroforamen and compresses the nerve roots leading to inflammation and radiating pain. The removal of part of the lamina is often necessary for the surgeon to gain access to the affected nerve roots in the neuroforamen. For this reason the foraminotomy is often performed in conjunction with a laminectomy or laminotomy.

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Questioning Surgery: No Association Has Been Found Between The Severity Of Pain And The Degree Of Stenosis

  • No association has been found between the severity of pain and the degree of stenosis, although patients who are symptomatic tend to have narrower spine openings than asymptomatic patients.
  • Making a diagnosis of spinal stenosis based on the absolute size of the spinal canal also has its drawbacks since it does not indicate whether or not there is impingement or distortion of either the spinal cord or nerve roots. Impingement or encroachment of the spinal cord by bone is called myelomalacia impingement of the spinal nerve roots is called radiculopathy.

Recovering From Lumbar Decompression Surgery

You’ll usually be well enough to leave hospital about 1 to 4 days after having surgery, depending on the complexity of the surgery and your level of mobility before the operation.

Most people are able to walk unassisted within a day of having the operation, although more strenuous activities will need to be avoided for about 6 weeks.

You may be able to return to work after about 4 to 6 weeks, although you may need more time off if your job involves driving for long periods or lifting heavy objects.

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What Is Cervical Stenosis

Your spinal cord goes through the neck bones. That hole for the spinal cord is called the central canal and it can get smaller making it a tight fit for the cord. That can happen due to disc bulges, bone spurs, arthritic facet joints, or enlarged and swollen ligaments. You can even be born with a tight central canal. See my video below for an explanation of how that works:

This tightness can irritate the spinal cord and lead to all sorts of symptoms. Everything from numbness, tingling, weakness, or aches and pains elsewhere. When this happens, this is called symptomatic spinal stenosis. This is when patients begin to ask the question, Do I need surgery for cervical stenosis?

The Bone Is Closing In All Around The Nerves Understanding What Causes Spinal Stenosis And The Narrowing Of The Spine May Help You Avoid Surgery

Part 3 – Surgical Treatments for Lumbar Spinal Stenosis

Bone spurs form as a result of the microinstability of the spine. Bone spurs are an inner cast that the body forms to help hold the spine in its correct position. Unfortunately, bone overgrowth also causes problems of reduced mobility and eventual nerve compression.

  • Our body has a difficult decision to make:
  • Bone spurs and narrowing of the spine limit the destructive spinal motion that causes pressure on the nerve .
  • Allow the spine to move without restriction and cause possible damage to the spinal cord.
  • The body has to make the choice between the lesser of the two evils. Usually, the body generates bone spurs or the narrowing of the spinal canal.

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Living With Lumbar Spinal Stenosis

The best way to manage lumbar spinal stenosis is to learn as much as you can about your disease, work closely with your medical team, and take an active role in your treatment.

Keep your lower back as healthy as possible by maintaining a healthy weight, practicing good body mechanics, and getting regular exercise.

Simple home remedies like an ice bag, heating pad, massage, or a long, hot shower can help. The nutritional supplements glucosamine and chondroitin have been recommended as nutritional supplements for osteoarthritis, but recent studies have been disappointing. Ask your healthcare provider if you should try any nutritional supplements and discuss any alternative treatments or medicines youre thinking about trying.

Be Aware Of These Surgical Risks

As with any operation, there are risks involved with surgery for spinal stenosis. Your doctor will discuss potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:

  • general risks of anesthesia

  • injury to your spinal cord or nerves

  • non-healing of the bony fusion

  • failure to improve

  • infection and/or bone graft site pain

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How Is Spinal Stenosis Diagnosed

Your healthcare provider will review your medical history, ask about your symptoms and conduct a physical exam. During your physical exam, your healthcare provider may feel your spine, pressing on different area to see if this causes pain. Your provider will likely ask you to bend in different directions to see if different spine positions bring on pain or other symptoms. Your provider will check your balance, watch how you move and walk and check your arm and leg strength.

You will have imaging tests to examine your spine and determine the exact location, type and extent of the problem. Imaging studies may include:

  • X-rays: X-rays use a small amount of radiation and can show changes in bone structure, such as loss of disk height and development of bone spurs that are narrowing the space in the spine.
  • MRI: Magnetic resonance imaging uses radio waves and a powerful magnet to create cross-sectional images of the spine. MRI images provide detailed images of the nerves, disks, spinal cord and presence of any tumors.
  • CT or CT myelogram: A computed tomography scan is a combination of X-rays that creates cross-sectional images of the spine. A CT myelogram adds a contrast dye to more clearly see the spinal cord and nerves.

Can Spinal Stenosis Heal On Its Own

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Generally no because the most common causes of spinal stenosis is normal age-related wear and tear on the bones and structures of the spine. However, if the cause of your spinal stenosis is a herniated disk, it can sometimes get better on its own with a short amount of rest or with treatments such as physical therapy, anti-inflammatory medications or spinal injections.

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Research: Findings Warn Doctors To Stop Doing Certain Spinal Surgeries

Diagnosing stenosis as the cause of a patients pain is very problematic. We are going to the following problems that may lead to failed back surgery due to surgery not addressing the true cause of the patients pain.

  • No association has been found between the severity of pain and the degree of stenosis, although patients who are symptomatic tend to have narrower spines than asymptomatic patients.
  • Studies have found that diagnosing spinal stenosis with 10 mm as the sagittal diameter alone produces false-positive rates approaching 50%.
  • Making a diagnosis of spinal stenosis based on the absolute size of the spinal canal also has its drawbacks since it does not indicate whether or not there is impingement or distortion of either the spinal cord or nerve roots. Impingement or encroachment of the spinal cord by bone is called myelomalacia impingement of the spinal nerve roots is called radiculopathy.

What Matters Most To You

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for lumbar spinal stenosis

Reasons not to have surgery

I want surgery if there is a chance it will help me.

I want to avoid surgery at all costs.

My work and home life are flexible enough that I can take the time I need to recover after surgery.

I can’t afford to take time off.

Nonsurgical treatments have not worked well enough for me.

I want to keep trying nonsurgical treatments and see if they help me feel better and move around easier.

Getting relief from my pain and weakness will be worth it, even if I need to have the surgery again in a few years.

I’m not sure it’s worth it to have surgery that might need to be repeated in a few years.

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Three Years Later Many Patients Who Chose Not To Have Spinal Surgery For Stenosis Are Doing Good

A May 2022 paper published in JAMA, the Journal of the American Medical Association writes about a series of patients with lumbar spinal stenosis followed up for up to three years without operative intervention. In this group of patients:

  • approximately one-third of patients reported improvement,
  • approximately 50% reported no change in symptoms,
  • and approximately 10% to 20% of patients reported that their back pain, leg pain, and walking were worse.

Further,

  • Long-term benefits of epidural steroid injections for lumbar spinal stenosis have not been demonstrated.
  • Surgery appears effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management.

However, surgery needs to be carefully recommended. The researchers note:

For some people the answer appears to be yes: But what kind of people should just move forward with the surgery? Smokers type 2 diabetics and obese people.

This is a March 2019 study from the Departments of Neurosurgery at Rush University Medical Center, the University of Texas South Western Medical Center, and the University of Cincinnati Medical Center. It was published in the medical journal Spine.

Here are the learning points:

  • The study examined 4133 patients who underwent 1, 2, or 3-level posterior lumbar instrumented fusion.
  • 20.8% of patients were smokers
  • 44.5% had type II diabetes,
  • 38.2% were obese
  • The patients had long-term nonoperative therapy that included:
  • 84.4% used opioids,
  • One More Time: Back To Questioning The Mri Research: Spinal Surgery Failure For Spinal Stenosis Patients Is Due Mainly To Surgical Error And Nearly 55% From Misdiagnosis

    Is there a cure for Spinal Stenosis without surgery? | The Clinic: Episode 1

    Above we discussed problems with the MRI and the over-reliance of surgeons on recommending surgery to their patients.

    Published in the medical journal Osteoarthritis and Cartilage researchers at one of Japans leading medical research centers, Wakayama Medical University Hospital, discovered something unsettling for the diagnosed stenosis patient. It seems that many asymptomatic individuals have radiographic lumbar spinal stenosis.

    • There seems then to be confusion if the patient is not complaining of back pain, but the MRI says it is stenosis, does the patient has a problem that needs to be operated on?

    So in 938 patients with an average age of about 66, they found when they did an MRI, Lumbar Spinal Stenosis was very prevalent. But when they asked the patient if they had back pain or other spinal problems, spinal stenosis complaint was uncommon.

    In recent research, surgeons in Mexico publishing in the Spanish language medical journal Cirugía y Cirujanos say that spinal surgery failure for spinal stenosis patients is due mainly to surgical error and nearly 55% from misdiagnosis.

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    When To See A Surgeon For Spinal Stenosis

    See Lumbar Stenosis Surgery

    Usually a result of the wear-and-tear changes in an individuals spine that occur naturally with age, spinal stenosis of the lumbar spine typically produces pain, cramping, numbness, weakness and/or a pins-and-needles feeling in the legs that is worse with walking and better with resting or leaning forward. The patient may also experience low back pain and/or hip pain along with this activity-related leg discomfort .

    See Lumbar Spinal Stenosis Surgery Options

    Who Gets Spinal Stenosis

    Spinal stenosis can develop in anyone but is most common in men and women over the age of 50. Younger people who are born with a narrow spinal canal can also have spinal stenosis. Other conditions that affect the spine, such as scoliosis, or injury to the spine can put you at risk for developing spinal stenosis.

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    Should I Get Back Surgery For My Spinal Stenosis

    A study by the National Institute of Arthritis and Musculoskeletal and Skin Diseases on spinal stenosis surgery success rate data shows that surgical treatment is more effective for relieving the low back and leg pain symptoms of spinal stenosis and for improving function than non-surgical treatments.

    Considering this, you might be wondering why wouldnt you immediately pursue stenosis of the spine surgery? Well, for one, there are major risks associated with both cervical spinal stenosis surgery and lumbar stenosis surgery. And sometimes conservative methods such as modifying your activities, wearing a neck or back brace for spinal stenosis treatment and engaging in targeted exercises are able to resolve the condition at a much better price than the spinal stenosis surgery cost.

    Simply being subject to general anesthesia involves risks. Some of the other more common complications that are linked to spinal canal stenosis surgery include the development of:

  • Tear in the membrane covering the spinal canal in the area of the operation
  • While such issues can be remedied, they can push back spinal stenosis surgery recovery time.

    Other risks associated with cervical or lumbar stenosis surgery include:

    • Failure of the surgery to relieve the pain and other symptoms

    Exercises For Spinal Stenosis

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    You might feel as though youre in too much pain to exercise, but movement is crucial to your overall health. Try to perform some stretching exercises several times a day.

    If you havent exercised in awhile, start slowly, even if its only a few minutes a day. Ideally, you should exercise for 30 minutes at least three times a week.

    If exercise is particularly difficult, try exercising in a pool. The buoyancy of the water makes it easier to move and get full range of motion.

    Regular exercise can help improve flexibility and balance, enabling you to move better. Not only is it good for your physical health, but it can also improve your sense of well-being.

    Your doctor or physical therapist can recommend exercises specifically designed to strengthen your back and abdominal muscles. They can also instruct you on how to do them safely. If your condition is severe, you may need a back brace for extra support.

    If exercise is aggravating your condition, see your doctor.

    Besides regular movement, massage therapy may help loosen up your back muscles and provide overall relaxation. Chiropractic manipulation is another option, but ask your doctor if its a good choice for your particular condition.

    If nothing else helps and your quality of life is at stake, there are a few surgical options.

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