Everything You Need to Know About Spinal Stenosis Surgery

It is perfectly normal to feel nervous before a major surgical operation. In fact, it would be unusual to find a patient awaiting surgery who is not worried at all. The best way to alleviate some of the concerns is to let them know exactly what to expect beforehand by addressing some of the burning questions.

How is the procedure performed?

There are two main ways in which spinal stenosis surgery can be performed. Both methods are designed to address the same problem. Spinal stenosis arises when the layer of cartilage in between the spinal vertebrae wears off and the vertebrae come closer together. Since spinal nerves leave the spinal cord through this cartilage called the inter vertebral disc, the two vertebrae which come closer together compress the nerve leading to the symptoms experienced. The surgery is performed to decompress these spinal nerves. This can be done in two ways:

Open surgery

An incision is made along the mid line of your back which goes deep inside to expose the spine. Once the vertebrae compressing the nerves are identified, the issue can be addressed by:

• fusing the vertebrae together thereby limiting their movement against the nerve
• removing a part of one or both vertebrae which is closest to the nerve thus leaving the nerve free from compression
• replacing the vertebrae with an artificial facet joint
• inserting a device known as an x-stop between the 2 vertebrae

Minimally invasive surgery

The same procedures performed during an open surgery as listed above can also be done during a minimally invasive procedure. The only difference here is in the method. Instead of making a long incision along the back, only a small incision of about 1 inch is made. Then an instrument known as a retractor is inserted. The retractor is a hollow tube through which the surgeon inserts any necessary instruments needed to perform the procedure. The surgeon will make use of a small camera attached at the end of an endoscope to have a better view of what they are doing.

Which procedure is better?

• The extent of damage to your spinal vertebrae will determine the form of surgery performed and the fact is, there isn’t just one procedure which is more effective than the other. However, the minimally invasive procedure has fewer complications when compared to open spine surgery and will allow you to recover faster.

Will I feel any pain?

The entire procedure is done while you are under general anesthesia, so you will be unconscious and unaware of any pain.

How long does it take?

A typical spinal stenosis surgery does not have a standard time and can last anywhere between 1 to 10 hours or more. A number of factors affect the duration of the surgery. They are mentioned below.

• The extent of the damage to the spinal vertebrae – there are 33 vertebrae and 32 intervertebral discs between them. Hence it is possible for more than one of these discs to be damaged, requiring multiple points on which surgery must be performed. Obviously, the more damage there is, the more time it will take before leaving the operating room.
• The surgeon’s experience – a surgeon with years of experience performing a particular type of surgery will always do it faster than the one who is inexperienced.
• The mode of operation – the surgery could be open or minimally invasive. Open surgery will definitely take longer because there is a lot more work, but a minimally invasive procedure can be done faster.

Are there any complications?

Modern medical technology and increased knowledge of the doctors about human body has drastically reduced the risk of complications. Some common complications to expect include:

• infection of the surgical site and surrounding tissue
• pain after surgery
• weakness after the procedure
• bleeding from the surgical site

These risks should not worry you as they can be managed effectively using medication and proper care. However, you should select your doctor carefully to minimize the risk, and go for a specialist in spinal stenosis surgery if possible. There are other measures your doctor might ask you to take such as staying away from blood-thinning medications like Aspirin a few days before the surgery as these might lead to excessive bleeding.

Are there alternatives?

If the idea of a surgery seems scary to you, then you should know that there are other non-invasive measures to manage spinal stenosis. For example:

• Pain medication – spinal stenosis can cause a lot of pain either in the upper or lower body. Various pain medications can help alleviate this discomfort.
• Anti-inflammatory medication – the degeneration of the intervertebral disc can also cause inflammation which increases the pain by pressing against the nerve. Various medications are also available to take care of this issue. 
• Physical therapy – after recognizing the early symptoms, you could join a physical therapy program to strengthen your back muscles and the spinal vertebrae. It is possible to stay away from the operating room if you do it soon before severe degeneration of the intervertebral discs occur.
• Resting – damage to the spine could be due to overuse. For example, by carrying heavy weights or due to trauma. Resting could give your body enough time to heal.

It should be noted that these measures are usually the first recommendation by any doctor, and by the time they start talking about surgery, perhaps they might have noticed that there is severe damage. To find out for sure, you can perform various tests as indicated below:

• X-rays to determine the extent of damage to the spinal vertebrae. When used together with myelogram, a dye which can be seen on an X-ray scan, it shows the particular areas of the spinal vertebrae that have the most damage by analyzing how pressure is spread along the spine.
• MRI which provides a detailed 3D image of your spine helping your doctor identify any other possible causes of your signs and symptoms.
• Bone scans which are provided by a radioactive material which is injected into the spine and attached to the bone. This is used to detect any fractures, tumors or infections in the spinal vertebrae.

The decision about whether or not to undergo spinal stenosis surgery is almost always up to the patient. However, your surgeon should be able to give you enough information about the pros and cons of this surgical procedure to help you decide what is best for you.