Spinal Stenosis Surgery: Overview

Spinal stenosis surgery is a procedure to create more space in the vertebrae of the spine to reduce compression of the spinal cord and nerve roots. Spinal stenosis occurs when openings in the vertebrae of the spine narrow due to degenerative changes.

This can cause pinching of the spinal cord itself, or of the spinal nerve roots that exit from the spinal cord. It often occurs in the lumbar spine, or low back, but can also occur in the cervical spine of the neck.

Symptoms of spinal stenosis commonly include low back pain, especially with extending the lumbar spine, standing, and walking, as well as tingling, numbness, weakness, and radiating pain into the legs. Spinal stenosis typically has a gradual onset with symptoms that worsen over time.

Back problems.
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What Is Spinal Stenosis Surgery?

Spinal stenosis surgery is a scheduled procedure decided upon by you and your doctor. It is recommended for cases of spinal stenosis where there is severe or progressive nerve or spinal cord compression. Conservative measures, including medications, cortisone injections, and physical therapy, are attempted first.

If symptoms do not improve and continue to significantly impact your quality of life and make everyday tasks very challenging, surgery may be recommended to help decrease the pain, numbness, weakness, and tingling that you are experiencing.

To confirm a diagnosis of spinal stenosis and examine the severity of the present condition, your doctor will prescribe diagnostic imaging tests to be able to see the anatomy of your spine and pinpoint where the issue is located. These tests include:

  •  X-rays
  • Computerized tomography (CT) scans
  •  Magnetic resonance imaging (MRI)

Various Surgery Techniques

The goal of spinal stenosis surgery is to relieve the pressure from the spinal cord or nerve roots by creating more space in the openings of the vertebrae of the spine. This can be accomplished by the following procedures:

  • Discectomy: A procedure to remove a damaged disc between vertebrae of the spine
  • Laminectomy: A procedure to remove a portion of the vertebrae, especially if there is a bone spur
  • Foraminotomy: A procedure to widen the foramina, the openings in the vertebrae where the nerve roots exit from the spinal cord
  • Spinal fusion: A procedure where two or more vertebrae are fused together

Potential Risks

Spinal stenosis surgery often helps relieve chronic pain that has been nonresponsive to other forms of treatment. In some cases, symptoms may stay the same or worsen after surgery. Associated risks with spinal stenosis surgery include:

  • Possible infection
  • Bleeding and blood clots
  • Nerve damage
  • Damage to the membrane that surrounds the spinal cord
  • Need for additional surgery
  • Remaining or returning symptoms

Always make sure to consult with your doctor about the possible risks of spinal stenosis surgery to determine if it is an appropriate option for you given your age, current health status, and medical history.

Purpose of Spinal Stenosis Surgery

Spinal stenosis surgery is usually performed on adults after conservative measures fail to produce lasting changes in symptoms like pain, numbness, weakness, and tingling that interfere with everyday life. Conservative measures used to treat spinal stenosis include:

  • Medications
  • Spinal injections
  • Physical therapy

If no improvement is seen after several weeks of trying these methods and your symptoms significantly impact your daily functioning, your doctor may want to set up a surgical consult to discuss your options and prepare you for surgery.

Always make sure to call your doctor or 911 if you are experiencing a medical emergency.

How to Prepare

Spinal stenosis surgery will be scheduled by your doctor beforehand. You may have to wait several weeks or months to schedule your surgery based on the availability of the surgeon and the operating room.

The surgical team will provide you with more detailed instructions on what you will need to do in the days and hours before surgery. It is recommended that you stay active, eat a healthy diet, and stop smoking prior to any operation to promote optimal healing and make recovery as smooth as possible.

You may need to stop taking certain medications in the days leading up to the surgery to prevent excess bleeding or interaction with anesthesia during the operation. Always consult with your doctor about all prescriptions, over-the-counter medications, and supplements that you are taking for your safety.

Spinal stenosis surgery will occur in the hospital and you should expect to stay overnight for at least a day. Your length of stay will vary based on the procedure that you have performed but will involve at least another day in the hospital, and up to a five-day stay.

You will not be allowed to drive to or from the hospital before or after your surgery, so make sure to make arrangements for a friend or family member to provide transportation for you.

What to Expect

On the day of your surgery, be sure to arrive early to allow for extra time to find your way around the hospital, check in, and fill out all necessary paperwork. Once all documentation is completed, you will change into a hospital gown and be given a brief physical examination to clear you for surgery.

You will receive an IV in your arm or hand to administer fluids and medication and will be wheeled into the operating room on a hospital bed. The surgical team will assist you onto the operating table in the operating room and administer anesthesia to put you to sleep for the surgery.

Most surgical procedures for spinal stenosis will involve you laying on your stomach so that the surgical team can access your back. An incision is made vertically along the spine of the low back to access the vertebrae.

For discectomies, laminectomies, and foraminotomies, tissue including disc portions, vertebrae portions, or bone spurs will be surgically removed to decrease compression of the nerve roots or spinal cord and create more space.

Spinal fusion surgery may be required if there is the presence of fractures and slippage of the vertebrae, significantly herniated discs, or if laminectomies to multiple vertebrae were performed as the spine will become unstable.

Spinal fusion will help stabilize the affected segments of the spine by removing the disc between the vertebrae and surgically fusing two or more vertebrae together. A bone graft is used to fill in the space where the disc was removed to help the vertebrae heal and fuse together.

Occasionally an anterior approach is used during spinal fusion surgery where the spine is accessed through the front of the body. For this type of procedure, an incision is made alongside the side of the abdomen to access the spine from the front.

Recovery

After your surgery, you will be brought to a recovery room for several hours until you fully wake up from the anesthesia. Once you are determined to be stable, you will be transported to a hospital room until the time of discharge.

You will be encouraged to get up and walk within 24 hours after the surgery. Your doctor will schedule follow-up appointments after your surgery once you are discharged home.

For a discectomy, laminectomy, or foraminotomy, you can expect to stay one to two days before being discharged home. Spinal fusion surgeries are more involved and require a longer stay of three to five days to make sure you are stable before being sent home.

Long-Term Care

Once discharged home, you can generally go back to work within a few days to a few weeks after returning from the hospital after a discectomy, laminectomy, or foraminotomy procedure. You can expect to return to normal activities after three months of recovery.

For spinal fusion surgery, it will take several weeks before you can go back to work safely. It can take between six months to a year to recover from spinal fusion surgery.

A Word From Verywell

Spinal stenosis surgery is often the last option utilized to treat spinal stenosis. Conservative measures should be used first to manage symptoms. If you do not experience any improvement, make sure to thoroughly discuss the risks and benefits of undergoing surgery with your doctor and find out if it is an appropriate option for you. After surgery, be prepared to take several months to fully recover and resume everyday activities. 

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Article Sources
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  1. American College of Rheumatology Spinal stenosis. Updated March 2019. 

  2. American Academy of Orthopedic Surgeons. Lumbar spinal stenosis. Updated December 2013.

  3. Cleveland Clinic. Spinal stenosis: Management and treatment. Updated August 17, 2020. 

  4. NYU Langone Health. Surgery for spinal stenosis.