Surgery For Spinal Stenosis - When Surgery Is An Option: Back Pain
Content provided by the Faculty of the Harvard Medical School
Surgery for spinal stenosis
Spinal stenosis is a lot less likely than a herniated disk problem to clear up on its own. People with spinal stenosis tend to be older and often have other conditions that can exacerbate their back problem. That helps to explain why only about 20% of people with spinal stenosis improve substantially over time without treatment.
A surgeon treats the condition by removing all structures that press on the nerve and contribute to the stenosis. Between 65% and 75% of people treated in this way eventually obtain good to excellent results — meaning that if their pain persists at all, it can be controlled by non-narcotic or over-the-counter medications, and they can engage in physical activity with few or no restrictions.
In this procedure, the surgeon makes an incision in the back and removes the lamina, the spinous processes, and (if necessary) portions of the paired facet joints, along with any osteophytes or disk herniation. Sometimes a spinal fusion (see below) is performed to fix the position of the vertebrae permanently and prevent future displacement. Rehabilitation variously includes walking, riding a stationary bicycle, or swimming for gradually increasing periods
Spinal fusion surgery and artificial disksPeople with spondylolisthesis, as well as other types of back problems, may benefit from spinal fusion surgery or implantation of an artificial disk. Spinal fusion. In this procedure, a surgeon fuses adjacent misaligned vertebrae. The success rate for such operations varies according to the underlying problem. Cervical spine fusion for a disk problem is highly effective (greater than 85%), whereas lumbar fusion for back pain has a much lower rate of success. Surgeons can use several different methods of fusion to join two or more adjacent vertebrae. The space between the vertebrae can be bridged with a graft of bone from elsewhere in the body or from a bone bank. The graft also stimulates bone growth in the area of the fusion. In addition, metal implants may be secured to the vertebrae, where they serve as internal splints to hold the vertebrae until new bone has consolidated the grafts into a strong bony strut. Finally, small cylindrical metal cages may be inserted into the vertebrae to work as internal splints that hold the vertebrae together while the fusion takes place. These are typically made of titanium and are about an inch long. Following spinal fusion surgery, you may wear a brace, a cast, or neither — depending on the specifics of your operation and the opinion of your surgeon. It usually takes about six months for a spine to fuse. Successful surgery results in a stable union between the fused vertebrae. Within four to nine months, your body replaces most of the grafted bone at the surgical site with new bone. By reducing motion in the affected area of the spine, a bone fusion relieves the pain caused by abnormal movement. After fusion, your range of spinal motion will be approximately 20%–30% less than it was originally. However, compared with your condition before surgery, when pain most likely limited your motion, you are likely to have a greater effective range of movement, as well as freedom from chronic pain. Artificial disk. An alternative to spinal fusion is the implantation of an artificial disk. The FDA approved the first artificial disk for the spine in 2004, and others are in development. Compared with the rigidity of spinal fusion, an artificial disk is designed to mimic a natural disk and provide normal movement between the vertebrae and maintain the disk height between them. In 1997, a French study reviewed 105 artificial disk placement operations over more than four years and found that 79% of the patients had excellent results, with 87% of them returning to work. A subsequent 10-year follow-up study of 100 of the original 107 patients published in 2005 by the same researchers, found excellent results, with 92% returning to work during the follow-up decade. |
| Last updated: | January 23, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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