Surgery for Spinal Stenosis

If nonsurgical treatment and therapeutic injections have not eased the pain caused by spinal stenosis, doctors at NYU Langone may recommend surgery to relieve pressure on nerves or the spinal cord.

Usually, our spine specialists consider surgery only if symptoms such as weakness, numbness, or pain in the arms or legs indicate severe or progressive nerve or spinal cord compression.

In addition, if instability in the spine has contributed to spinal stenosis—for example, a vertebra or disc that has slipped out of place is constricting nerves or the spinal cord—surgery may be required to stabilize the spine and prevent further damage.

Spinal neurosurgeons and spinal orthopedic surgeons at NYU Langone may perform one or more of the following procedures in either the lumbar or cervical spine. All types of spinal surgery require general anesthesia.

Decompression

Decompression is a term that describes surgical techniques designed to relieve pressure from nerves or the spinal cord. Your surgeon determines the appropriate procedure based on the location of the compression.

NYU Langone specialists may perform multilevel decompression surgery if stenosis occurs in more than one location in the spine.

Laminotomy and Foraminotomy

If stenosis primarily affects the foramen—an opening in the vertebra through which nerves travel outward from the spinal canal—doctors can surgically widen the foramen and relieve pressure on the nerves. Often, doctors first remove part of the bony “roof” of the vertebra—called the lamina—to better access the spinal canal during surgery. These procedures are called laminotomy and foraminotomy.

At NYU Langone, laminotomy and foraminotomy may be performed using a less invasive technique that allows surgeons to access the spine through a small tubular device. The surgeon makes a small incision in the back or neck and then places the tube near the affected vertebra.

Using live X-ray images displayed on a monitor, the surgeon guides small surgical tools through the tube and removes any bone spurs, ligaments, or cartilage constricting the nerves as they pass through the foramen. The doctor then removes the tube and closes the incision with staples or stitches.

Laminectomy

Laminectomy involves removing the lamina, the part of each vertebra that forms the “roof” of the spinal canal. Removing the lamina from the affected vertebrae creates more space in the spinal canal and reduces pressure on the nerve roots and spinal cord.

During laminectomy, a surgeon may also remove any bone spurs that have accumulated due to osteoarthritis.

The surgeon may trim parts of the facet joint—located just above the lamina—if it has become inflamed due to arthritis and is compressing nearby nerves.

Removing a large part of one or more facet joints may destabilize the spine. If this happens, surgeons may elect to perform a spinal fusion in addition to a laminectomy to ensure that the spine heals correctly and to reduce the risk of further problems.

Discectomy

Discectomy involves removal of the injured part of a bulging or herniated disc, relieving pressure on the nerves or spinal cord. This may be an open procedure, allowing direct access to the disc through an incision, or a minimally invasive procedure called microdiscectomy, allowing access to the disc through smaller incisions and use of tiny surgical instruments. Either technique may be used to remove a disc fragment in the lower spine or neck.

Spinal Fusion

If a person has spinal stenosis as well as instability in the spine, such as when a vertebra slips out of place and contributes to nerve or spinal cord compression, this is called spondylolisthesis. Surgeons may perform a spinal fusion to correct the misalignment.

Factors considered in determining the appropriate technique include your age, how much of the spine is affected, and whether you’ve had previous spine surgery.

In spinal fusion, a surgeon permanently joins unstable vertebrae using metal screws and rods. These remain in your spine and act like an internal brace to keep the bones in the correct position.

The surgeon can also insert a small piece of living bone material, called a bone graft, between the joined vertebrae. This bone graft may be taken from your own body, typically from the hip, or from a donor through a bone bank. The graft may be placed directly between the fused vertebrae or inside a small metal cage before placement in the spine, which provides additional stability.

Over time, the joined vertebrae heal, fusing into one bone mass. This gives the spine the stability and flexibility needed to support the body and also eliminates pain caused by the slipped vertebra pushing against nerve roots or the spinal cord.

During spinal fusion, the surgeon may also widen the foramen, trim the facet joints, remove some or all of a herniated disc, or remove bone spurs. These procedures create more space in the spinal canal and decompress the nerve roots or spinal cord, eliminating the source of pain.

What to Expect After Spine Surgery

After surgery, you spend several hours in the recovery room. NYU Langone’s pain management specialists are available 24 hours a day to make sure you’re comfortable during the initial stages of recovery.

Depending on the type of surgery performed, you may spend one or more days in the hospital for observation.

A physiatrist, a doctor who specializes in rehabilitation medicine, visits you after surgery to help you adjust to moving with the newly fused bones. He or she also shows you simple exercises to rebuild strength in the muscles in and around the affected area of your spine. If surgery was performed on the lumbar spine, you may receive a walker or a cane to help you get around.

Some people need to wear a back or neck brace after surgery to keep the spine stabilized while it heals. Your surgeon makes this decision. Typically, a brace is required if surgery was performed in the cervical spine or if a spinal fusion was performed to correct multiple vertebrae. An orthotics specialist can custom fit a brace for you.

Your doctor provides you with pain medication that is taken by mouth in the weeks after surgery. How long medication is required and how quickly your back heals depend on many factors, including your age, what type of procedure was performed, and whether spinal stenosis caused major nerve damage before treatment.

Your doctor schedules a follow-up appointment 10 days after surgery, then every 6 weeks until your bones have healed. During these appointments, imaging tests such as X-rays or CT scans may be used to monitor your healing.

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