Evidence-Based: Physical Therapy Pelvic Floor

Is Spinal Stenosis Surgery Right For Me?

Spinal stenosis surgery should be considered as a last resort, only after all other conservative, non-surgical treatment options have failed. Surgery is reserved for individuals whose spinal stenosis symptoms have become chronic (lasting longer than three months) and debilitating – or for those individuals with an emergency condition like cauda equina syndrome. If your doctor is suggesting surgery, inquire about why he or she is recommending that course of treatment and if there are truly no other alternatives available. Before deciding to undergo any surgical procedure, you may want to consider getting a second or third opinion.

Conducting Your Own Research about Spinal Stenosis Surgery

Since symptomatic spinal stenosis involves an abnormally narrow spinal canal that is exerting pressure on one or more spinal nerves, surgery will be aimed at widening the canal and decompressing those nerves. The underlying cause of the stenosis, such as a herniated disc, bulging disc, bone spurs, or spondylolisthesis, likely will need to be addressed. If you are considering surgery, it would behoove you to do your own research about all the possible surgical procedures that are available for spinal stenosis. The most common procedures are:

• Discectomy – Performed if a herniated disc or bulging disc has protruded into the spinal canal, causing the canal to become narrower and press on a spinal nerve. During this procedure, the disc is removed and spinal fusion is performed, which involves the insertion of a bone graft into the space formerly occupied by the disc. The graft and the adjacent vertebrae are secured with stabilizing hardware and a solid segment of bone eventually forms, with the goal of minimizing range of motion in that area of the spine and consequently, minimizing pain.

• Foraminectomy – Performed if bone, disc material, an ossified ligament, or any other anatomical abnormality is extruding into the foramina, which are the open spaces on either side of each vertebra that function as “canals” through which the spinal nerves pass as they leave the spinal cord and travel to other parts of the body. The material clogging the foramen is removed and a spinal fusion may be performed.

• Laminectomy – This procedure removes the lamina, which is the flat, bony plate that comprises part of the vertebral arch, or the “roof” of the spinal column. The aim of a laminectomy is to create more space in the spinal column so that spinal nerves can pass unimpeded.

The Option of a Minimally Invasive Procedure

The above procedures are generally performed as open spine operations. They will require hospitalization, general anesthesia, and a lengthy, painful rehabilitation. Other surgical options are available, however. Make sure to research minimally invasive spinal procedures that are performed using endoscopic technology. During this type of procedure, a small incision is made and a series of tubes is inserted. An endoscope and surgical tools are funneled through the tubes to the site of neural compression. The bone or tissue directly pressing on the spinal nerve or nerves is removed, without dissecting surrounding muscles or ligaments. Due to its minimally invasive nature, this type of procedure typically does not require hospitalization or general anesthesia, and offers patients a much faster recovery period and fewer risks than an open spine operation.

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