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Spinal Stenosis: Non-Operative Treatment and Spine SurgeryStewart G. Eidelson, M.D.
This is Part Two of a two-part article designed to answer typical questions patients have about spinal stenosis including the causes, symptoms, and diagnostic process. Part One answers questions about treatment and recovery.
Can Spinal Stenosis be treated without surgery?
Yes - in fact, less than 5% of patients with a spinal disorder ever require spine surgery!
What types of non-surgical treatments are available?
There are several non-surgical options your doctor may recommend to treat your spinal stenosis. Often, treatment combines more than one type of therapy. For example, medication may be combined with physical therapy. Let's review a few of the non-surgical therapies one by one.
Medication: There is a wide variety of medications available to relieve inflammation, pain, and muscle spasm. Although some drugs are available over-the-counter (OTC), it is wise not to combine these with prescription drugs your doctor provides unless it is under his direction. Just like prescription medications, OTC drugs can cause serious side effects.
Injections: The most common type of injection used to help alleviate the symptoms of spinal stenosis is an epidural injection. This type of injection places medication (usually a steroid) into the space that surrounds specific nerve roots (the epidural space). The medication helps to reduce inflammation and acute pain that radiates into the arms or legs. Usually a course of three injections are given over a period of several weeks.
Physical Therapy (PT): PT usually combines inactive therapy and therapeutic exercise. Inactive therapy includes heat or ice packs, ultrasound, electrical stimulation, and massage. These treatments help to ready the patient for active therapy by relaxing tight muscles and easing pain or discomfort. Therapeutic exercise includes stretching and prescribed exercises to help stabilize the spine, build strength and endurance, and increase flexibility.
What happens if I'm one of the 5% that needs surgery?
Surgery, any kind of surgery is a serious decision. Your doctor will take sufficient time to thoroughly explain your surgical options with you. You might consider bringing a family member or friend along for an added set of 'ears'.
A few patients do require spine surgery to treat the symptoms caused by spinal stenosis. The goal of surgery is to relieve the pressure on the spinal cord and/or nerve roots. This is accomplished by enlarging the spinal canal and/or neuroforamen. The type of surgical procedure performed depends on the type, location, and cause of the spinal stenosis.
What is the name of the surgical procedure?
There are several different surgical procedures used to treat spinal stenosis. Listed below are the names and a brief description of each procedure. Once again, your doctor will explain which procedure or procedures will be performed during your operation.
Laminotomy: The lamina is a small, thin bony spinal structure located at the back of the spine (posterior) that covers access to the spinal canal and spinal cord. A small portion of the lamina may be removed to relieve pressure on the nerve roots.
Decompressive Laminectomy: This is the most common surgical procedure performed in the lumbar spine. The lamina is removed to decompress or relieve pressure on the nerves.
Foraminotomy: During this procedure, the neuroforamen are enlarged. Sometimes this procedure is combined with a laminotomy.
Medial Facetectomy: One of the causes of spinal stenosis is one or more enlarged joints. The spinal joints are named facet joints. During this procedure part of the facet joint is removed to increase space.
Anterior Cervical Discectomy and Fusion (ACDF): This procedure removes a diseased disc (discectomy) through the front (anterior) of the neck (cervical). After the disc is removed, the spine must be stabilized. This is accomplished using a cervical plate and screws (instrumentation) and fusion (bone graft). Fusion is similar to glue that hardens over time to create a solid construct, which stabilizes the spine.
Lumbar Discectomy and Fusion: This is similar to ACDF, except entry into the spine may be gained through the front (anterior), back (posterior), or side (transforaminal).
Cervical Corpectomy: During this procedure, part of the vertebra and adjacent disc are removed to decompress the cervical spinal cord and nerve roots. Instrumentation and fusion are performed to permanently stabilize the spine.
Will the surgical procedure take away my pain?
This is a good question. Your doctor will provide you with statistics that help to predict your surgical outcome. These statistics are important and will help you to determine if surgery is the best choice.
If your nerves were badly damaged before surgery, you may experience some pain or numbness afterward. Sometimes there is no improvement at all. Unfortunately, as you age your spine will continue to change or degenerate. Sometimes symptoms reappear several years after surgery.
How long will it take me to recover and get back to my life?
This depends on the type of surgical procedure and your condition before surgery. Some spine procedures can be performed on an outpatient basis that allows you to go home the same day. A more comprehensive procedure, such as one involving fusion requires hospitalization.
At an appropriate time after surgery, your doctor will prescribe a course of physical therapy. This gives patients a good step forward in their recovery and return to everyday activities.