Do I Need Spinal Stenosis Surgery?

Is spinal stenosis surgery in your future? Consider this:

The spine is a highly mechanical part of the human body. Not only does it serve as a major neural thoroughfare, but it also supports a fair amount of body weight. And, of course, this doesn’t even consider the fact that the spine bends and twists as we all go about our day. Basically, your spine does a lot of work—much more than we are often aware of on a day to day basis.

But, because of these very facts—because the spine is such a busy place—it also can succumb to a slew of potential problems. After all, anything that moves will eventually wear down. It’s just a natural part of physics and the aging process. Some people are fortunate enough to go their entire lives without experiencing any major problems.

But, even these people are subject to wear and tear degeneration—symptoms or no. Of course, there are some people who experience much more trouble than others with their backbones. These people may develop osteoarthritis, spinal stenosis, slipped or herniated discs, and much more. Where you fall in all of this will depend on a large variety of both observable and unknowable factors.

But today, we are here to talk about one condition in particular: spinal stenosis. First of all, what does “stenosis” even mean? Well, that’s an excellent question. Basically, spinal stenosis causes the spaces in and around your spine to narrow. That may not sound like a major deal, but this can actually put a great deal of pressure on nearby nerves and adjacent structures. When your nerves are being compressed, you’re definitely going to feel that in the form of pain and other neurological symptoms.

Symptoms of Spinal Stenosis

First and foremost, spinal stenosis can occur at different levels of the spine. Generally speaking, the two main types are cervical and lumbar stenosis. Naturally, cervical stenosis refers to the neck as the site of the condition, while lumbar stenosis involves the lower back. Additionally, it is possible for spinal stenosis to occur at multiple levels of the spine at the same time. Unfortunately, that means a patient could potentially have both cervical and lumbar stenosis.

But that’s just location, right? How do I know if I even have this condition? Here a general list of symptoms to keep an eye out for:

• Numbness or tingling in the extremities
• Noticeable weakness in the limbs
• Difficulty walking and keeping balance
• Neck and/or back pain
• Cramping in the legs after standing for long periods of time

If you are experiencing any of these symptoms and they are not abating within a period of two weeks, then it may be time to see a doctor. Of course, that isn’t to say that you absolutely have to wait two weeks before seeing your physician. If you feel like your symptoms are severe enough and conservative methods aren’t helping, contact your doctor right away. After all, the less time you have to spend in discomfort the better.

Usually, your doctor will exhaust all conservative options before opting for surgery. However, in some cases when the condition is severe enough, your doctor may opt for a surgical procedure right away. Don’t let this scare you. Great strides have been made in the realms of minimally invasive back surgery. Procedures for spinal stenosis are both incredibly safe and highly successful.

Spinal Stenosis Causes & Risk Factors

Unfortunately, some people are simply born with a smaller than average spinal canal. Obviously, these people are more susceptible to spinal stenosis. However, in most cases, the condition occurs in patients who are above the age of 50. While the cause of spinal stenosis is typically degenerative, that doesn’t mean that young people are immune to narrowed spinal canals. The condition may also occur in those who have had an injury or in those who have a congenital deformity such as scoliosis. In other words, being 25 doesn’t rule spinal stenosis out.

As far as underlying causes are concerned, here are some conditions that could be causing your stenosis:

• Disc Herniation: Cracks in the outer shell of a disc may result in its softer, internal material leaking out. This ruptured disc material may then apply pressure to nearby nerves or the spinal cord itself.
• Trauma: Fractures in the vertebrae may lead to displaced bone that can damage nearby structures. Additionally, any swelling around the spine will narrow the surrounding spaces.
• Bone Overgrowth: Degenerative conditions such as osteoarthritis may lead to the formation of bone spurs. These ossified protrusions usually lead to pain as they cause damage to nearby structures.
• Thickened Ligaments: Ligaments are responsible for holding the bones of the spine together. Over time, these structures may stiffen and become thicker. When this happens, the ligaments may apply pressure to the adjacent spaces in the spinal canal.

Of course, these are just a few of the most common examples. Spinal stenosis may also be the result of abnormal growths or tumors. It all depends on the specifics of your individual case. For more information, make sure to ask your doctor plenty of questions.

Fig. 1: Spinal stenosis from herniated disc

Spinal Stenosis Treatment

As with most medical conditions, spinal stenosis treatment is categorized as either conservative or surgical. In the vast majority of cases, your doctor will attempt to exhaust all non-intrusive methods before considering surgery. The exception to this rule, however, is if they deem your case severe enough to warrant immediate surgery.

Conservative Methods of Treating Spinal Stenosis

First of all, there are many different prescription medications available to those who suffer from spinal stenosis. As you might expect, pain may be reduced with NSAIDs such as Advil or acetaminophen (Tylenol). But did you also know that antidepressants and anti-seizure drugs can help ease chronic pain as well? There is also the option of temporary, guided use of opioids. But, due to their addictive nature, your doctor will try to avoid this form of treatment when possible.

Physical therapy is another great conservative treatment for spinal stenosis. A lot of people who have spinal stenosis tend to become less active as a result of their discomfort. This is only natural. After all, wouldn’t you become less active if you were in constant pain? The objective of PT is to remedy this problem, injecting a little activity into the patient’s sedentary lifestyle. Doing so has the added benefit of strengthening muscles, enhancing flexibility, and reducing pain.

Lastly, there is always the option of steroid injections. With spinal stenosis, your nerve roots will become agitated and swollen at the points where they are being pinched. While steroid injections can’t fix the condition, they do work wonders for reducing inflammation.

Spinal Stenosis Surgery Options

If none of the above methods seem to work for you, then consider taking the spine surgery route. With spinal stenosis surgery, the goal is to relieve pressure on the spinal cord or affected nerve roots by increasing the space within the spinal canal. There are a number of ways to accomplish this task, but the most common methods include:

• Laminotomy: With this procedure, your doctor will remove a portion of your lamina—typically just large enough to relieve pressure.
• Laminectomy: During a laminectomy, the performing surgeon will remove the posterior portion of the lamina on the affected vertebrae. In some instances, the affected vertebrae may need to be fused to an adjacent bone via metal hardware in order to maintain spinal stability.
• Laminoplasty: This procedure is only performed for cervical stenosis. This surgery generates space within the spinal canal by creating a hinge on the affected vertebra’s lamina. Metal hardware may also be used in this procedure in order to bridge the gap in the opened section of the spine.

Back in the day, these surgeries were only available as traditional open back procedures. Today, many traditional surgeries of the spine have minimally invasive variants that make them much safer and more effective. Minimally invasive procedures typically use smaller incisions to accomplish the same goal. Moreover, they involve pushing tissues (including muscle) to the side rather than cutting through them. In many cases, they can be done on an outpatient basis allowing for same-day discharge from the surgical center.

Contact Us

Have you been experiencing back pain for a period of two weeks or more? Have you tried over-the-counter or conservative options to no avail? If so, then you may want to contact our practice at (855) 210-0899. At New York City Spine, you’ll find a team of spine specialists who are extremely passionate about back pain relief. We offer the latest and greatest in minimally invasive surgery options at our treatment centers in New York and New Jersey. For more information, contact us today!