Spinal stenosis is the narrowing of spaces in the spine (backbone) which causes pressure on the spinal cord and/or nerves. About 75% of cases of spinal stenosis occur in the low back (lumbar spine). In most cases, the narrowing of the spine associated with stenosis compresses the nerve root, which can cause pain along the back of the leg.Most patients with spinal stenosis respond well to non-surgical treatments (such as medication), so you may not have to have surgery. However, there are situations when you may want to go ahead with spine surgery.
One main goal of spinal stenosis surgery is to free up area for your spinal cord and/or the nerve roots. That’s called decompression. By giving your spinal cord and nerve roots more space to pass through, your spine surgeon hopes to decrease your pain from nerve inflammation.
Another goal of spinal stenosis surgery is to increase your motor strength in your arms or legs. If you’ve lost sensation in your arms or legs, your surgeon also hopes to restore that.
Typically, surgeons use 2 surgical techniques for spinal stenosis surgery.
- Decompression: The surgeon will remove tissue pressing against a nerve structure, which makes more room in the spinal canal (for the spinal cord) or in the foramen (for the nerve roots).
- Stabilization: The surgeon works to limit motion between vertebrae.
To remove the tissue that’s pressing on a nerve, your spine surgeon may perform one of the following types of surgery.
- Foraminotomy: If part of the disc or a bone spur (osteophyte) is pressing on a nerve as it leaves the vertebra (through an exit called the foramen), a foraminotomy may be done. Otomy means “to make an opening.” So a foraminotomy is making the opening of the foramen larger, so the nerve can exit without being compressed.
- Laminotomy: Similar to the foraminotomy, a laminotomy makes a larger opening, this time in your bony plate protecting your spinal canal and spinal cord (the lamina). The lamina may be pressing on your nerve, so the surgeon may make more room for the nerves using a laminotomy.
- Laminectomy: Sometimes, a laminotomy is not sufficient. The surgeon may need to remove all or part of the lamina, and this procedure is called a laminectomy. This can often be done at many levels without any harmful effects.
Stabilization Surgery for Spinal Stenosis
Not everyone who has surgery for spinal stenosis will need stabilization, which is also known as spinal fusion. It’s especially helpful in cases where one or more vertebrae has slipped out of the correct position, which makes your spine unstable (and painful). In these cases, the bones slipping can pinch nerves. The need for stabilization also depends on how many vertebrae your surgeon needs to work on. For example, if he or she needs to remove the lamina (using a laminectomy) in multiple vertebrae, your spine may be unstable without those structures. You’ll need to have spinal fusion to help stabilize your spine.
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