Purpose of Spinal Stenosis Surgery

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Spinal stenosis is characterized by spinal cord or nerve root compression due to narrowing of the openings in the vertebrae of the spine. Spinal stenosis surgery involves removing structures of the spine, including discs, portions of vertebral bone, or bone spurs, in order to create more space and relieve pressure from the spinal cord and nerve roots. This helps to reduce pain, weakness, numbness, and tingling associated with spinal stenosis.

Senior man discussing X-ray with doctor.
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Diagnosis Related to Spinal Stenosis Surgery

Spinal stenosis surgery is performed for patients who have been diagnosed with spinal stenosis. Spinal stenosis occurs when narrowing of the openings in the vertebrae of the spine results in compression of the spinal cord or the nerve roots that exit from the spinal cord.

Spinal stenosis occurs most commonly in the lumbar spine, or low back, but can also occur in the cervical spine of the neck.

The vertebrae of the spine have one large opening in the middle of each vertebra called the vertebral foramen. With the vertebrae of the spine stacked on top of one another, the vertebral foramen of one vertebra segment lines up with the vertebral foramen of both the vertebra above and below it. This forms the spinal canal where the spinal cord is located.

When vertebrae articulate, or stack upon one another, to form the intervertebral joints of the spine, openings called the intervertebral foramina are created. These openings exist between every pair of vertebrae in the spine and are where the spinal nerve roots exit from the spinal cord.

The spinal nerve roots branch out to the rest of the body to form the peripheral nervous system. Nerves exiting from the cervical spine branch out to the arms while nerves exiting from the lumbar spine branch out to the legs.

Spinal stenosis can fall under two classifications. Central stenosis occurs when narrowing of the vertebral foramina forming the spinal canal in the center of the spine places pressure on the spinal cord. Foraminal stenosis occurs when narrowing of the intervertebral foramina on the sides of the vertebrae places pressure on the exiting nerve roots.

Spinal stenosis is most common among adults over the age of 50 years old and can be due to a variety of different causes that create narrowing of the openings of the vertebrae of the spine. These commonly include:

Bone spurs due to arthritis: As the spine ages, it can develop arthritis in which the cartilage between the joints of the spine begins to break down. Cartilage is a protective cushioning between joints, and when it starts to break down, the bones are subjected to increased friction as they rub against each other.

When this occurs, the body creates new bone in response to the increased friction. This can often create an overgrowth of bone, or bone spurs called osteophytes, which can grow into and encroach upon the space in the spinal canal.

Bulging or herniated discs: In addition to the cartilage that lines each joint and provides cushioning, a vertebral disc exists between each vertebra of the spine that helps to provide extra cushioning and shock absorption. As the spine ages, the discs begin to flatten and lose height. This flattening can cause the disc to bulge slightly outside of the spinal column.

Injury or excessive loading to the spine can cause the inner jelly-like substance of the disc to break through the outer fibrous layer and result in a herniated disc. Both bulging and herniated discs cause disc material to expand and compress nerve roots.

Injuries to the spine: Broken or dislocated bone fragments from the vertebrae of the spine, as well as inflammation from injury, can cause narrowing of the openings of the spine.

Spinal cord tumors or cysts: Excessive growths, such as tumors or cysts, within the spinal cord take up space and narrow the opening for the spinal cord to run, resulting in spinal cord compression.

Thickened ligaments: Ligaments are a form of thick connective tissue that holds bones together. Arthritis can cause ligaments to thicken over time and encroach upon the spinal canal.

Paget’s disease: Paget’s disease is a condition characterized by overgrowth of bone, which can occur in the vertebrae of the spine and cause compression of the spinal cord and nerve roots.

Congenital abnormalities: Some people are born with a narrowed spinal canal which increases the risk of developing spinal stenosis. Scoliosis, a condition that causes an abnormal curvature of the spine, can also narrow the spinal canal or intervertebral foramen and result in spinal cord or nerve root compression.

Criteria

To be an eligible candidate for spinal stenosis surgery, adults usually must try conservative measures to treat spinal stenosis first. These methods include:

  • Medications: Anti-inflammatory and analgesic (pain-relieving) medications are often prescribed to help manage symptoms.
  • Injections: A doctor may inject cortisone into the spine to create a local anti-inflammatory response to decrease pain and nerve root compression.
  • Physical therapy: Several weeks of physical therapy can be prescribed to help improve spine mobility, strengthen core and hip muscles, increase flexibility and range of motion, correct poor posture, and administer modalities and manual treatment to help with pain relief.

Flexion-based exercises, which require bending the spine forward rather than backward, are most effective for treating symptoms of spinal stenosis.

If you do not experience any improvement in symptoms such as back or leg pain, tingling, numbness, or weakness after several weeks of trying conservative measures, you should follow up with your doctor to discuss your treatment options.

If your symptoms continue to significantly impact your daily activities and quality of life, spinal stenosis surgery may be an option for you to help treat your symptoms.

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

Tests and Labs

Your doctor will ask about your symptoms and medical history and perform a physical examination to assess you for spinal stenosis. This will include asking you to move your spine in varying directions to see which movements make your symptoms worse.

You will often find that extension of the lumbar spine, or bending backward, will increase your symptoms, as well as positions like standing and walking.

You will also have imaging tests performed in order to confirm the exact location and severity of the narrowing of the spine and spinal cord or nerve root compression. These include:

  • X-rays: An X-ray of the spine can be used to get an image of the vertebrae to see if there is the presence of arthritis, injury, malalignment, or the possibility of a spinal tumor.
  • Computed tomography (CT) scans: A CT scan is a special type of radiological imaging that provides a three-dimensional picture to view the spine in more detail to determine the cause of your spinal stenosis symptoms. It provides cross-sections of the spine to more precisely locate problematic areas.
  • Magnetic resonance imaging (MRI): An MRI uses magnetic waves to produce an image of the spine. While it can examine the bones and joints of the spine, it is also good for examining the discs, spinal ligaments, the spinal cord, and nerve roots. There is no radiation involved with an MRI.

A Word From Verywell

Spinal stenosis surgery may or may not be an appropriate option for you given your age, medical history, and current health status. Always make sure to consult with your doctor about the possible risks and benefits of undergoing spinal stenosis surgery. Your doctor will be able to guide you in the right direction if surgery may be necessary or if conservative measures can effectively manage your symptoms.

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Article Sources
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  2. MedlinePlus. Foraminotomy. Updated November 5, 2018.

  3. Cleveland Clinic. Spinal stenosis: Overview. Updated August 17, 2020. 

  4. Lurie J, Tomkins-lane C. Management of lumbar spinal stenosis. BMJ. 2016;352:h6234. doi:10.1136/bmj.h623

  5. Cleveland Clinic. Spinal stenosis: Overview. Updated August 17, 2020.