Lumbar Stenosis Surgery
Lumbar stenosis surgery (sometimes referred to as lumbar spinal canal decompression) is a spine surgery that alleviates symptoms caused by pressure on the nerve roots and spinal canal. The lumbar spine can become arthritic in several areas. This can lead to unnatural pressure on the nerves in your back, and pain the joints of the lumbar spine.
Why Lumbar Spinal Stenosis Surgery?
Lumbar stenosis often causes severe pain in the lower back, buttocks, legs, or all of the above. Often, these symptoms are worse when standing or walking, ad sometimes made better with flexing the low back or sitting down. If nonsurgical treatment options have failed to provide relief, lumbar stenosis surgery may be able to improve your quality of life.
- Symptoms have forced you to drastically limit your daily activities
- You are unable to stand or walk upright for any significant length of time without pain
- Your condition has had a profound impact on the quality of your daily life
- Nonsurgical treatments such as medications, lifestyle modifications, and spinal injections have not provided substantial relief
Individuals with lumbar stenosis may need surgery to correct the following symptoms:
- Pain (often severe) in the lower back, buttocks, legs, or all of the above
- Pain that worsens when walking or standing for more than a few seconds
- Pain that diminishes when sitting down, leaning forward, or flexing forward
- Tingling, weakness, or numbness that radiates downward from the lower back into the buttocks and legs
- Lower back pain that is so intense that older patients must lean over a shopping cart or another assistive device to experience relief (“shopping cart sign”)
- Pain that inhibits daily activities, especially in the legs
- Symptoms that fluctuate over time, some periods with flaring pain and other periods with few or no symptoms
- Symptoms may be progressive (but not always) and debilitating
- Symptoms develop slowly over time (usually found in patients over the age 50)
Candidates for lumbar stenosis surgery meet the following criteria:
- Back and leg pain are impairing quality of life and limiting activity
- Progressively worsening symptoms
- Neurological deficits, such as weakness and numbness in the legs
- Loss of normal bladder and/or bowel function
- Difficulty standing or walking
- Nonsurgical treatments have failed to relieve symptoms
Lumbar spinal stenosis is often mistaken for hip arthritis or other related hip problems. Proper diagnosis requires both a physical examination and imaging exams like an MRI, CT, and X-rays in clinic.
The stenosis, or pressure, on your lumbar spine can come from several areas including the discs, ligaments in the spine, or the smaller joints in the back of the spinal column.
Surgery for lumbar stenosis can widen the spinal canal and decompress the spinal cord to allow for healing and proper functionality. There are several options for spinal stenosis surgery:
- Lumbar laminectomy (most common): Surgical removal of excess bone and arthritic debris that is compressing the nerves in the back.
- Laminotomy: Surgical micro-decompression procedure creating an opening within the bone by removing a part of the lamina to relieve pressure. This can be done through a tubular system to allow for minimally invasive surgery.
- Interspinous process spacer: Surgical insertion of a device between the spinous processes to allow for decompression.
- Spinal fusion: Surgical removal of a degenerated disc and fusing the adjacent vertebrae in patients with instability, pathologic motion, and compression of nerves in the spine.
Frequently Asked Questions
“Stenosis” comes from a Greek word meaning “narrowing” or “choking”. Lumbar spinal stenosis is when the tissues of the spine go through an abnormal narrowing, usually due to degeneration associated with aging. The small stabilizing facet joints between and behind the vertebrae of the spine tend to enlarge over time and compress the nerve roots in the spine. Most often, lumbar stenosis is the result of osteoarthritis and/or degenerative spondylolisthesis (slipped disc). Most affected individuals are over age 50, although in rare cases younger patients may develop lumbar stenosis due to a spinal injury or deformities such as a curvature of the spinal canal.
While all surgery poses risks, spinal stenosis surgery is a safe and effective procedure for appropriately selected candidates. While all surgical procedures have risk, modern technology including continuous monitoring of the nerves in the spine and minimally invasive procedures lower the risks for patients. The risks, benefits, and alternatives will be discussed with you in detail with Dr Pehler.
There are several nonsurgical treatment options for lumbar stenosis. Depending on your condition and the type of stenosis you have, any one of these might be recommended before deciding on surgery.
- Lifestyle modifications: Many affected individuals use a cane or walker to alleviate pain while standing and walking. Using a stationary bike for your regular exercise can enable you to stay active while minimizing symptoms due to the more comfortable sitting and flexed-forward position of being on a bike. Various spinal stenosis exercises, under the guidance of a physical therapist, are often recommended to prevent further debilitation.
- Medications: NSAIDs or anti-inflammatory drugs can effectively treat lumbar stenosis by relieving inflammation.
- Spinal Injections: Epidural injections can be administered on an outpatient basis. The epidural steroid solution introduces an anti-inflammatory agent as well as a fast-acting local anesthetic for pain relief.
Nonsurgical treatments are usually preferred by most patients if their day-to-day living is still largely unaffected. However, if your lumbar stenosis has significantly affected the quality of your daily life and nonsurgical treatment options have proven unsuccessful, it may be time to consider a procedure.
Every patient’s symptoms, pathology, and options are unique. Customized treatment plans utilizing all available nonsurgical and surgical treatment options will be given to every patient.