Surgery Overview
Decompressive laminectomy is the most common
type of surgery done to treat
spinal stenosis. This surgery is done to relieve
pressure on the
spinal cord or spinal nerve roots caused by age-related changes in the spine. It also is done to treat other conditions, such as injuries to the spine,
herniated discs, or tumors. In many cases, reducing
pressure on the
nerve roots can relieve pain and allow you to resume
normal daily activities.
Laminectomy removes bone (parts of the
vertebrae) and/or thickened tissue that is narrowing the spinal canal and
squeezing the spinal cord and nerve roots. This procedure is done by surgically
cutting into the back.
In some cases, spinal fusion (arthrodesis) may be done at the same time to help
stabilize sections of the
spine treated with decompressive laminectomy. Spinal
fusion is major surgery, usually lasting several hours. There are different
methods of spinal fusion:
- In the most common method, bone is taken from
elsewhere in your body or obtained from a bone bank. This bone is used to make
a "bridge" between adjacent spinal bones (vertebrae). This "living" bone graft
stimulates the growth of new bone.
- In some cases an additional
fusion method (called instrumented fusion) is performed, in which metal
implants (such as rods, hooks, wires, plates, or screws) are secured to the
vertebrae to hold them together until new bone grows between them.
There are a variety of specialized techniques that can be
used in spinal fusion, although the basic procedure is the same. Techniques
vary from what type of bone or metal implants are used to whether the surgery
is done from the front (anterior) or back (posterior) of the body. The method
chosen depends on a number of factors, including your age and health
condition, the location (lower back or neck [cervical]) of
stenosis, the severity of nerve root pressure and associated symptoms, and the
surgeon's experience. Spinal fusion increases the possibility of complications
and the recovery time after surgery.
What To Expect After Surgery
Depending on your health and the
extent of the surgery, it may take several months or more before you are able
to return to your normal daily activities.
Why It Is Done
Surgery for spinal stenosis is
considered when:
- Severe symptoms restrict normal daily
activities and become more severe than you can manage.
- Nonsurgical
treatment does not relieve pain, and severe nerve compression symptoms of
spinal stenosis (such as numbness or weakness) are getting
worse.
- You are less able to control your bladder or bowels than
usual.
- You notice sudden changes in your ability to walk in a
steady way, or your movement becomes clumsy.
Most spinal stenosis occurs in the lower (lumbar) back. If
you have stenosis in the neck (cervical) area, your doctor may recommend surgery because this condition can cause spinal cord
and nerve damage and paralysis.
The decision to have surgery is
not based on imaging test results alone. Even if the results of imaging tests
show increased pressure on the spinal cord and spinal nerve roots, the decision
to have surgery also depends on the severity of symptoms and your ability to
perform normal daily activities.
In some cases
spinal fusion will be done at the same time to
stabilize the spine. Spinal fusion might make it easier for you to move around
(improve function) and relieve your pain. It can also help keep the bones from
moving into positions that squeeze the spinal canal and put pressure on the
spinal cord.
How Well It Works
Surgery for spinal stenosis usually
is elective but may be recommended if symptoms cannot be relieved with
nonsurgical treatment. In general, experts feel that surgery has good results
and relieves pain in the lower extremities for people who have severe symptoms
of spinal stenosis and who have few other serious health problems.
Research shows
that:
- Out of 100 people who had this surgery,
up to 80 were satisfied with the results. This means that about 20 out of 100
were not satisfied.1
- Out of 100 people who
have this surgery, 10 to 20 need to have surgery again after several years
because their symptoms come back. This means that 80 to 90 out of 100 don't
need a second surgery.1
- Surgery may work better than nonsurgical treatments to relieve pain and help you move better. If nonsurgical treatments have not worked well enough, surgery might be able to help you.2
- By 3 months, people who had surgery notice more improvement in their symptoms and can be more active than people who did not have surgery.2 This difference continues for at least 4 years after surgery.3
- The benefits of surgery appear to last for many years. After 8 to 10
years:
- People treated with surgery were as
satisfied as those treated without surgery.
- People who had surgery
were generally able to be more active and had less leg pain than those who had
nonsurgical treatment.4
But
symptoms may return after several years. A second surgery
may be needed if:
- Spinal stenosis develops in another area of the
spine.
- An earlier surgical procedure was not effective in
controlling symptoms.
- Instability develops, or fusion does not
occur.
- Regrowth of tissue (lamina) presses on the spinal cord or
spinal nerve roots.
Spinal fusion may be done at the same time as decompressive
laminectomy. Spinal fusion may help to stabilize sections of the spine that
have been treated with decompressive laminectomy. In general, fusion is only
done if an area of the spine is unstable, which means the small bones can move
too much. This extra movement causes wear and tear on the soft tissues, leading
to irritation and pain. The goal of fusion is to keep the damaged bones in the
spine from moving so that the soft tissues are protected.
Risks
Complications from spinal stenosis surgery may
result from the impact of other existing medical problems and the severity of
the spinal problem. Also, all surgery poses risks of complications.
These complications may be more serious in an older adult.
Possible complications include:
- Problems from having
general anesthesia.
- A deep infection in
the surgical wound.
- A skin infection.
- Blood clots in
the deep leg or pelvic veins (deep vein thrombosis), which in rare
cases travel to the lungs (pulmonary embolism).
- An unstable spine
(more common after multiple laminectomies are done without using spinal
fusion).
- Nerve injury, including weakness, numbness, or
paralysis.
- Tears in the fibrous tissue that covers the spinal cord
and the nerve near the spinal cord, sometimes requiring
a second surgery.
- Difficulty passing urine or loss of bladder or bowel
control.
- Death (rare) related to major surgery.
If you have
diabetes or circulation problems or if you are a
smoker, you may be at greater risk for complications.
What To Think About
Most experts recommend that
people with spinal stenosis try nonsurgical treatments before choosing surgery.
Surgery for lumbar spinal stenosis is most
likely to relieve pain, numbness, and weakness that are mostly in your legs.
Surgery may not work as well for relieving pain that is mostly in your
back.
Surgery is usually effective if
you have severe leg pain and numbness and you have not been able to move around
well for a long time. But in some cases, the symptoms return after surgery. It
is also possible that nerve symptoms, including numbness and clumsiness, may
not be relieved or may return.
After a
laminectomy and fusion, spinal stenosis may develop directly above or below the
surgery site. Repeated surgeries for spinal stenosis increase your risk of
complications and instability in the spine.
Age should not be a factor in deciding whether to have decompressive
laminectomy. But if you have other medical conditions
that will make this procedure and follow-up rehabilitation less successful,
surgery may not be recommended.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
References
Citations
- Isaac Z, et al. (2005). Lumbar spinal stenosis. In WJ
Koopman, ed., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 2087–2092. Philadelphia: Lippincott
Williams and Wilkins.
- Weinstein JN, et al. (2008). Surgical versus nonsurgical therapy for lumbar spinal stenosis. New England Journal of Medicine, 358(8): 794–810.
- Weinstein JN, et al. (2010). Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine, 35(14): 1329–1338.
- Atlas SJ, et al. (2005). Long-term outcomes of
surgical and nonsurgical management of lumbar spinal stenosis: 8- to 10-year
results from the Maine Lumbar Spine Study. Spine, 30(8):
936–943.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | William M. Green, MD - Emergency Medicine |
|---|
| Specialist Medical Reviewer | Robert B. Keller, MD - Orthopedics |
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| Last Revised | March 1, 2011 |
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Isaac Z, et al. (2005). Lumbar spinal stenosis. In WJ
Koopman, ed., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 2087–2092. Philadelphia: Lippincott
Williams and Wilkins.
Weinstein JN, et al. (2008). Surgical versus nonsurgical therapy for lumbar spinal stenosis. New England Journal of Medicine, 358(8): 794–810.
Weinstein JN, et al. (2010). Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine, 35(14): 1329–1338.
Atlas SJ, et al. (2005). Long-term outcomes of
surgical and nonsurgical management of lumbar spinal stenosis: 8- to 10-year
results from the Maine Lumbar Spine Study. Spine, 30(8):
936–943.
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