How to fix stenosis of the spine

Most patients with cervical or lumbar spinal stenosis respond well to non-surgical treatments (such as medication), so you may not need spine surgery. However, there are situations when you may want to go ahead with spine surgery.

Table of Contents Show

Decompression Surgery for Spinal Stenosis
Stabilization Surgery for Spinal Stenosis
Open Spine Surgery or Minimally Invasive Spine Surgery ?
Be Aware of These Surgical Risks
Recovery From Spinal Stenosis Surgery
What causes lumbar spinal stenosis?
What are the symptoms of lumbar spinal stenosis?
How is lumbar spinal stenosis diagnosed?
How is lumbar spinal stenosis treated?
What can I do to prevent lumbar spinal stenosis?
Living with lumbar spinal stenosis
When should I call my healthcare provider?
Key points about lumbar spinal stenosis

You've tried non-surgical treatments and they haven't been successful.
You've been in severe pain for a lengthy period of time.
You're experiencing radiculopathy, which is a medical term used to describe pain, numbness, and tingling in the arms or legs.
You've lost sensation in your arms or legs.
You have decreased motor strength in your arms or legs.
You've lost bowel or bladder control (eg, cauda equina syndrome).

One main goal of spinal stenosis surgery in your neck or low back is to free up area for your spinal cord and/or the nerve roots. That's called decompression. By giving your spinal cord and nerve roots more space to pass through, your spine surgeon hopes to decrease your pain from nerve inflammation.

Another goal of spinal stenosis surgery is to increase your motor strength in your arms or legs. If you've lost sensation in your arms or legs, your surgeon also hopes to restore that.

By giving your spinal cord and nerve roots more space to pass through, your spine surgeon hopes to decrease your pain from nerve inflammation.

Typically, surgeons use 2 surgical techniques for spinal stenosis surgery.

Decompression: The surgeon will remove tissue pressing against a nerve structure, which makes more room in the spinal canal (for the spinal cord) or in the foramen (for the nerve roots).
Stabilization: The surgeon works to limit motion between vertebrae.

Decompression Surgery for Spinal Stenosis

To remove the tissue that's pressing on a nerve, your spine surgeon may perform one of the following types of surgery.

Foraminotomy: If part of the disc or a bone spur (osteophyte) is pressing on a nerve as it leaves the vertebra (through an exit called the foramen), a foraminotomy may be done. Otomy means "to make an opening." So a foraminotomy is making the opening of the foramen larger, so the nerve can exit without being compressed.
Laminotomy: Similar to the foraminotomy, a laminotomy makes a larger opening, this time in your bony plate protecting your spinal canal and spinal cord (the lamina). The lamina may be pressing on your nerve, so the surgeon may make more room for the nerves using a laminotomy.
Laminectomy: Sometimes, a laminotomy is not sufficient. The surgeon may need to remove all or part of the lamina, and this procedure is called a laminectomy. This can often be done at many levels without any harmful effects.

Indirect decompression is a variation of decompression surgery where pressure is relieved by spreading the bones apart instead of removing bone. This can be done with instrumentation, such as interspinous process devices or interbody cages. Even artificial discs can accomplish some indirect decompression by restoring the height between adjacent vertebrae.

Stabilization Surgery for Spinal Stenosis

Not everyone who has surgery for spinal stenosis will need stabilization, which is also known as spinal fusion. It's especially helpful in cases where one or more vertebrae has slipped out of the correct position, which makes your spine unstable (and painful). In these cases, the bones slipping can pinch nerves. The need for stabilization also depends on how many vertebrae your surgeon needs to work on. For example, if he or she needs to remove the lamina (using a laminectomy) in multiple vertebrae, your spine may be unstable without those structures. You'll need to have spinal fusion to help stabilize your spine.

Spine stabilization surgery has been common for many years. It can be done alone or at the same time as a decompression surgery. In spine stabilization, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from your own body) or a biological substance (which will stimulate bone growth). Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability and help fuse the bones. The fusion will stop movement between the vertebrae, providing long-term stability.

Open Spine Surgery or Minimally Invasive Spine Surgery ?

If your surgery is performed through a relatively large incision in your back, that's called open surgery. Another option is minimally invasive surgery, which is done through several small incisions. The surgeon may use a microscope, endoscope, or tiny camera and very small surgical instruments.

However, minimally invasive surgery is not for everyone. If your surgeon needs to work on many vertebrae, you'll probably need to have open surgery.

Be Aware of These Surgical Risks

As with any operation, there are risks involved with surgery for spinal stenosis. Your doctor will discuss potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:

general risks of anesthesia
injury to your spinal cord or nerves
non-healing of the bony fusion (pseudoarthrosis)
failure to improve
instrumentation breakage/failure
infection and/or bone graft site pain

Recovery From Spinal Stenosis Surgery

After your surgery, you aren't going to be instantly better. You will most likely be out of bed within 24 hours, and you'll be on pain medications for 2 to 4 weeks. After the surgery, you'll receive instructions on how to carefully sit, rise, and stand. It's important to give your body time to heal, so your doctor will probably recommend that you restrict your activities: In general, don't do anything that moves your spine too much. You should avoid contact sports, twisting, or heavy lifting while you recover.

After surgery, be vigilant. Report any problems—such as fever, increased pain, or infection-to your doctor right away.

You should always take good care of your body and practice healthy habits, but you should be especially healthy following surgery. You should:

follow your doctor's treatment plan
sit and stand properly
learn to lift correctly
exercise regularly (low-impact aerobic exercise is especially good, but check with your doctor first)
use proper sports equipment
attain and maintain a healthy body weight
eat healthy foods (a well-balanced, low-fat diet rich in fruits and vegetables) and get enough calcium
stop smoking
avoid excessive use of alcohol

And take heart: The results with surgery to correct spinal stenosis are usually good. Generally, 80% to 90% of patients have relief from their pain after surgery.

Notes: This article was originally published January 14, 2008 and most recently updated April 12, 2018.

Your spinal cord is a bundle of nerves that runs through a tunnel formed by your vertebrae. The tunnel is called the spinal canal. Lumbar spinal stenosis is a narrowing of the spinal canal in the lower part of your back. Stenosis, which means narrowing, can cause pressure on your spinal cord or the nerves that go from your spinal cord to your muscles.

Spinal stenosis can happen in any part of your spine but is most common in the lower back. This part of your spine is called your lumbar area. Five lumbar vertebrae connect your upper spine to your pelvis.

If you have lumbar spinal stenosis, you may have trouble walking distances or find that you need to lean forward to relieve pressure on your lower back. You may also have pain or numbness in your legs. In more severe cases, you may have difficulty controlling your bowel and bladder. There is no cure for lumbar spinal stenosis, but you have many treatment choices.

What causes lumbar spinal stenosis?

The most common cause of spinal stenosis is osteoarthritis, the gradual wear and tear that happens to your joints over time. Spinal stenosis is common because osteoarthritis begins to cause changes in most people’s spines by age 50. That's why most people who develop symptoms of spinal stenosis are 50 or older. Women have a higher risk of developing spinal stenosis than men.

Besides osteoarthritis, other conditions or circumstances can cause spinal stenosis:

Narrow spinal canal
Injury to the spine
Spinal tumor
Certain bone diseases
Past surgery of the spine
Rheumatoid arthritis

What are the symptoms of lumbar spinal stenosis?

Early lumbar spinal stenosis may have no symptoms. In most people, symptoms develop gradually over time. Symptoms may include:

Pain in the back
Burning pain going into the buttocks and down into the legs (sciatica)
Numbness, tingling, cramping, or weakness in the legs
Loss of sensation in the feet
A weakness in a foot that causes the foot to slap down when walking ("foot drop")
Loss of sexual ability

Pressure on nerves in the lumbar region can also cause more serious symptoms known as cauda equine syndrome. If you have any of these symptoms, you need to get medical attention right away:

Loss of bowel or bladder control
Severe or increasing numbness between your legs, inner thighs, and back of the legs
Severe pain and weakness that spreads into one or both legs. This makes it hard to walk or get out of a chair

How is lumbar spinal stenosis diagnosed?

To diagnose lumbar spinal stenosis, your healthcare provider will ask you questions about your symptoms and do a complete physical exam. During the physical exam your healthcare provider will look for signs of spinal stenosis, such as loss of sensation, weakness, and abnormal reflexes.

These tests help make a diagnosis:

X-rays of your lumbar spine. These may show bone growths called spurs that push on spinal nerves and/or narrowing of the spinal canal.
Imaging tests. A CT scan or MRI scan can give a more detailed look at the spinal canal and nerve structures.
Other studies. Your healthcare provider might order a bone scan, myelogram (a CT taken after injecting dye), and EMG (an electrical test of muscle activity).

How is lumbar spinal stenosis treated?

If you have lumbar spinal stenosis, many types of healthcare professionals can help you, such as arthritis specialists, nerve specialists, surgeons, and physical therapists. Treatment can include physical therapy, medicine, and sometimes surgery. Except in emergencies, such as cauda equina syndrome, surgery is usually the last resort.

Physical therapy may include exercises to strengthen your back, stomach, and leg muscles. Learning how to do activities safely, using braces to support your back, stretching, and massage may also be helpful.
Medicines may include nonsteroidal, anti-inflammatory medicines that relieve pain and swelling, and steroid injections that reduce swelling.
Surgical treatments include removing bone spurs and widening the space between vertebrae. The lower back may also be stabilized by fusing together some of the vertebrae.
Acupuncture and chiropractic care may also be helpful for some people.

What can I do to prevent lumbar spinal stenosis?

Because almost everyone has some osteoarthritis of the spine by age 50, you can’t really prevent lumbar spinal stenosis. But you may be able to lower your risk. Here are some ways to keep your spine healthy:

Get regular exercise. Exercise strengthens the muscles that support your lower back and helps keep your spine flexible. Aerobic exercises like walking, swimming, cycling, and weight training are all good for your back.
Maintain good posture. Learn how to safely lift heavy objects. Also, sleep on a firm mattress and sit in a chair that supports the natural curves of your back.
Maintain a healthy weight. Excess weight puts more stress on your back and can contribute to developing symptoms of lumbar spinal stenosis.

Living with lumbar spinal stenosis

The best way to manage lumbar spinal stenosis is to learn as much as you can about your disease, work closely with your medical team, and take an active role in your treatment.

Keep your lower back as healthy as possible by maintaining a healthy weight, practicing good body mechanics, and getting regular exercise.

Simple home remedies like an ice bag, heating pad, massage, or a long, hot shower can help. The nutritional supplements glucosamine and chondroitin have been recommended as nutritional supplements for osteoarthritis, but recent studies have been disappointing. Ask your healthcare provider if you should try any nutritional supplements and discuss any alternative treatments or medicines you’re thinking about trying.

When should I call my healthcare provider?

Lumbar spinal stenosis can cause cauda equine syndrome, which needs medical attention right away. Call your healthcare provider if you have:

Loss of bowel or bladder control
Severe or increasing numbness between your legs, inner thighs, or back of your legs
Severe pain and weakness that spreads into one or both legs, making it hard to walk or get out of a chair

Key points about lumbar spinal stenosis

Lumbar spinal stenosis is the narrowing of the spine that happens gradually over time.
There is no cure for lumbar spinal stenosis but your healthcare provider can help you manage the condition.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.