Introduction
Spinal stenosis is a common condition that results from the narrowing of the spaces within the spine, which can put pressure on the nerves and cause pain, numbness, or weakness in the back and legs. While many people manage their symptoms through non-surgical methods such as exercise, medication, and physiotherapy, there are cases where surgery may become necessary. This blog will discuss when surgery might be the right option, the types of surgeries available, what to expect from the procedure, and potential risks.
When to Consider Surgery for Spinal Stenosis
Most people with spinal stenosis can manage their condition with conservative treatment options, but surgery may be recommended in the following cases:
- Severe Pain: If your pain is persistent and significantly impacting your quality of life.
- Neurological Symptoms: Symptoms such as numbness, altered sensation or weakness, may indicate nerve damage.
- Reduced Mobility: Difficulty walking or performing daily activities despite using walking aids and supportive devices.
- Lack of Improvement: If you have tried physical therapy, medications, and other treatments without experiencing relief.
It’s important to discuss these factors with your healthcare team, including a specialist or spinal surgeon, to determine the best course of action for your specific situation.
Surgery is not for everyone however in my experience people dismiss it too early. It’s easy for me as I see first-hand most shifts I work at the hospital the great benefits people get from spinal surgery. Be open-minded and speak to people who regularly work with people following surgery.
YOU MUST SEEK URGENT MEDICAL ATTENTION IF YOU HAVE ANY OF THE FOLLOWING!
Red Flags for Cauda Equina Syndrome:
- Bilateral Sciatica: Pain radiating down both legs.
- Reduced Perineal Sensation: Decreased or altered sensation around the “saddle area” (the area that would come into contact with a saddle when sitting).
- Bladder Dysfunction: This typically manifests as painless urinary retention or difficulty initiating urination.
- Loss of Anal Tone: Inability to control bowel movements or loss of sensation.
- Loss of Sexual Function: This could include erectile dysfunction in men or altered sexual sensation in both men and women.
Cauda equina syndrome (CES) is a serious condition that occurs when the nerves at the lower end of the spinal cord are compressed. It requires urgent medical intervention, as delays can lead to permanent damage, including bladder and bowel dysfunction, and loss of sensation or motor control. For more information take a look at this blog.
Types of Surgeries for Spinal Stenosis
1. Decompression Surgery (Laminectomy)
The most common surgical treatment for spinal stenosis is a laminectomy. This procedure involves removing part of the bone (the lamina) or thickened ligaments that are pressing on the spinal cord or nerves, creating more space and relieving pressure.
- Procedure: The surgeon makes an incision in your back to access the affected vertebrae. They then remove the bone, spurs, or ligaments causing compression.
- Benefits: Reduces nerve pain, improves leg strength, and can restore mobility.
- Risks: There is a risk of infection, blood clots, and nerve damage, although serious complications are rare.
2. Spinal Fusion
In cases where spinal instability is present, your surgeon may recommend a spinal fusion. This procedure involves permanently connecting two or more vertebrae to stabilise the spine.
- Procedure: Bone grafts, metal plates, or screws are used to fuse the affected vertebrae.
- Benefits: Stabilises the spine, prevents further narrowing, and can alleviate severe pain.
- Risks: Longer recovery time, potential for limited spinal movement, and a risk of adjacent segment disease (wear and tear in the areas surrounding the fused section).
3. Minimally Invasive Decompression Surgery
For patients who may not need a full laminectomy, minimally invasive options such as microdecompression can be performed. These procedures use smaller incisions, specialised instruments, and sometimes endoscopes to remove only the necessary portions of bone or ligament.
- Procedure: Often performed using a small incision and less muscle disruption, leading to faster recovery times.
- Benefits: Shorter hospital stay, less postoperative pain, and reduced scar tissue formation.
- Risks: Not suitable for severe cases; potential for incomplete decompression.
What to Expect from Spinal Stenosis Surgery
Understanding the preoperative and postoperative phases can help set realistic expectations for recovery:
- Before Surgery: You may undergo imaging tests (such as MRI or CT scans) and a physical examination to evaluate the severity of your stenosis. It’s also common to attend prehabilitation (pre-surgery physical therapy) to strengthen muscles and improve outcomes.
- During Surgery: Depending on the type of surgery, the procedure may last anywhere from 1 to 4 hours. Most surgeries are performed under general anaesthesia.
- After Surgery: You’ll need to take precautions to protect your back and follow a physiotherapy program to regain strength and mobility. Most people experience relief from pain and neurological symptoms within a few weeks, but full recovery can take several months.
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UK Guidelines on Spinal Stenosis Surgery
According to the National Institute for Health and Care Excellence (NICE), surgery for spinal stenosis is recommended when conservative treatments have failed to provide relief, and the patient’s quality of life is significantly impacted. The decision should be made collaboratively between the patient, GP, and specialist team, taking into account the individual’s preferences and overall health status.
Potential Risks and Complications
As with any surgery, there are risks involved, although these are rare. Complications can include:
- Infection: Postoperative infections are a concern but can usually be managed with antibiotics.
- Blood Clots: There is a risk of developing deep vein thrombosis (DVT) after spinal surgery, particularly in the legs.
- Nerve Damage: Although rare, nerve damage can occur, leading to numbness, tingling, or paralysis.
Discussing these risks with your surgeon will help you make an informed decision.
Alternatives to Surgery
Surgery is not the only option for managing spinal stenosis pain. Other interventions may be worth exploring before deciding on surgical treatment:
- Epidural Steroid Injections: Reduce inflammation around the compressed nerves, offering temporary relief.
- Radiofrequency Ablation: Uses heat to disrupt nerve function and reduce pain.
- Physical Therapy: Strengthens the muscles around your spine and improves flexibility.
- Lifestyle Modifications: Maintaining a healthy weight, using supportive footwear, and modifying daily activities can reduce strain on your back.
For more information, see our this blog Managing your Pain with Spinal Stenosis.
Conclusion
Surgery for spinal stenosis can be a life-changing decision, offering relief from chronic pain and improved mobility. However, it’s important to weigh the potential benefits and risks with your healthcare team. By considering all your options—both surgical and non-surgical—you can make the best choice for your long-term health and well-being.
For additional resources, check out our related blogs on managing spinal stenosis pain, best exercises for spinal stenosis, How Walking Aids Can Help Spinal Stenosis Patients: Improve Mobility and Reduce Pain and choosing the right shoes for spinal stenosis.
Take care, Helen
Helen Manders BSc (Hons) MCSP HCPC
Chartered Physiotherapist Since 2001
