Lumbar spinal stenosis surgery is a very common invasive approach to care for many patients who are affected by the ravages of symptomatic vertebral canal impingement in the lower regions of the spinal anatomy. Surgery can be a dangerous and frightening endeavor. There are known risks inherent to all forms of spinal surgery and positive procedural outcomes are never guaranteed. In fact, most forms of back surgery demonstrate truly awful curative results. That being said, stenosis surgery represents some of the best uses of operative intervention within the entire back and neck pain treatment industry.
This essay concentrates on providing guidance for patients who are seeking surgical cures to the most common of all stenotic conditions in the spine; the lumbar variety. We will examine the types of procedures utilized and detail the statistical expectations for treatment outcomes.
Lumbar Spinal Stenosis Surgery Procedures
Lumbar stenosis can come from many different types of pathological spinal conditions, as well as a variety of completely normal components of the aging process. Finding the right surgical procedure to resolve the canal impingement depends wholly on the accuracy of the diagnostic conclusion. In many circumstances, surgical procedures will need to be combined and revised, since each patient may have unique and multiple contributors to their lumbar stenosis. Therefore, this section provides an overview of some of the most common procedural options that can be successfully utilized to clear the central spinal canal and restore neurological functionality.
Disc-related canal narrowing does not usually qualify as true spinal stenosis, since it is often a transitory condition. The exception is when the intervertebral material calcifies, forming an osteochondral bar that can have serious stenotic implications. For all other cases where intervertebral herniations cause or contribute to stenosis, a variety of procedures can help reduce the size of the bulging nucleus. The most common of these procedures include nucleoplasty, IDET and discectomy.
Traditional degenerative stenosis, many forms of congenital stenosis and some varieties of developed stenosis due to trauma occur from the build-up of ossified material within the central canal. These types of stenosis are usually treated surgically using laminectomy, foraminotomy and corpectomy.
Stenosis caused by atypical spinal curvatures and spondylolisthesis usually entail hardware-assisted vertebral fusion techniques.
Lumbar Spinal Surgery Techniques
Each type of stenosis procedure can be accomplished using a variety of surgical techniques. While there are far too many specific practices to detail in a single article, we can provide helpful guidance for patients who are looking to accomplish their surgical goals, without causing undue trauma to health spinal tissues.
Traditional spinal operations involve dorsal incisions, muscular dissection and full open spinal visualization. This means that the surgical cut is made in the lower back, the muscles are dissected away from the backbone and the spine itself will be visible to the surgeon directly. While still used in some specific scenarios, most fully open dorsal approaches to surgery are a thing of the past, which is a very good thing. These are barbaric operations that are terribly painful to recover from. Most of these techniques will necessitate long periods of postoperative rehabilitation and ongoing physical therapy.
Endoscopic procedures and fiber-optic surgical tools can facilitate spinal surgery from the back, side or front of the body. Often, multiple small incisions are used for advanced surgeries, eliminating the need for muscular dissection. Anterior approaches to care are usually the least invasive and most successful.
Laser surgery has revolutionized the efficacy of many types of spinal operations. Lasers demonstrate pinpoint accuracy, create minimal blood loss and can reduce the chances for some types of post-surgical complications.
Lumbar Spinal Stenosis Surgery Outcomes
We have spent years cautioning patients about the hazards of spinal surgery, as well as the general misuse of surgical endeavors in the back and neck pain treatment sectors. We are admittedly very anti-surgery. However, we also understand that sometimes, spinal procedures are definitely needed and in cases of problematic spinal stenosis, these circumstances are commonplace.
Going one step further than understanding the necessity for surgical intervention, we often actually recommend it for the worst cases of stenosis. This carefully thought-out suggestion is due to 2 primary reasons:
First, virtually no variety of stenosis will not respond well to conservative care. Symptom-based treatments allow stenosis to progress, often creating the ideal circumstances for enduring spinal nerve injury to transpire.
Second, of all spinal operations, stenosis techniques that are targeting bone-related canal impingement, such as those caused by age-related arthritic changes, are some of the most successful. However, disc-related stenosis operations demonstrate some of the worst curative results in the dorsalgia therapy arena.
All in all, for patients who require an operation, the outcome can be positive, as long as several factors are thoroughly considered. To this end, we provide the following guidance for anyone considering or seeking surgical lumbar stenosis care:
Be sure to consult with several surgeons and get multiple opinions on the best type of procedure and surgical approach.
Choose the very best surgeon available to you and make them stand behind their prognosis for recovery.
Select the least invasive surgery that will accomplish the primary treatment goal.