The narrowing of spaces between the spines which compresses spinal cord and nerve roots is known as spinal stenosis. It is characterised by neck or back pain, numbness and weakness in arms and legs and treated with self care remedies, medicines, injections, physical therapy and surgery.
When spinal stenosis causes paraplegia, bowel and bladder incontinence it is termed as cauda equina syndrome and is considered as a surgical emergency. Spinal canal is reopened through surgery which is narrowed due to arthritis, bone spurs and other problems which causes the nerves to be pinched or squeezed.
Though progression of spinal stenosis cannot be controlled and the disorder cannot be cured, surgery can improve mobility and enhance quality of life. Spinal stenosis is a complex disorder caused by degenerative, neoplastic, infectious or congenital causes where treatment varies based on the cause. After prolonged spinal stenosis where injections do not work, surgical intervention is suggested.
Spinal stenosis in lumbar spine may cause pain, numbness, pins and needles feeling in the leg which is worse while walking and better while sitting with which low back pain is experienced.
In cases of progressive weakness in legs, surgery should not be delayed lest it leads to intensive and long term nerve damage. When surgery provides good result in minimizing leg pain, it is not equally effective treatment for activity related lower back pain.
Lumbar laminectomy is performed in central spinal stenosis where a part of posterior part of vertebrae is removed to provide more space of compressed spinal cord or nerve roots. It is performed only when 8 to 12 weeks treatments like physical therapy, medications and epidural injections do not produce results.
Lumbar laminectomy surgery aims to relieve neural tissue compression and improve leg function. While one or more spinal motion levels may be treated, the focus is to treat leg symptoms and not lower back pain.
Lumbar laminectomy for spinal stenosis can be bilateral or unilateral. In bilateral laminectomy both sides of the lamina of the affected vertebra are removed. The intervertebral foramina may or may not be widened and adjacent tissue and bone may be removed. In unilateral laminectomy a part of lamina in one side of vertebrae is removed.
Anterior cervical discectomy and fusion is considered as standard and successful surgery method for spinal stenosis and is done when arthritis is more severe and involves facet joints or deformity.
When spinal stenosis is due to herniated disc or bone spur in the area where nerve roots leave spinal canal, posterior foraminotomy is performed and this surgical intervention has 90 per cent success rate.
Posterior laminoplasty is performed for multilevel spinal stenosis and this procedure has several indications and contraindications. When done with skilled surgical technique, results are good.
Posterior laminectomy and fusion is performed when spinal stenosis is severe and is accompanied with deformity, trauma or tumours. These procedures can be paired with anterior procedures and recovery time is longer.
Before opting for spinal stenosis surgery, one experiences fear, seeks second opinion and considers recovery challenges besides being alert about the pain and quality of life.