If your symptoms are mild you can treatment spinal stenosis with pain relievers such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs). Weight loss and core stabilization exercises are also effective. Some success has been reported with the use of epidural blocks—injections of pain relievers and a steroid directly into the spine. If those measures fail to control symptoms, surgery may be considered. If severe neurological deficits or impaired bowel or bladder function develop, surgery will be necessary.
Decompression surgery and spinal fusion
The two types of surgery typically performed are decompression surgery (also called laminectomy) and spinal fusion. A new minimally invasive option, interspinous implantation, is also an alternative for some patients.
In decompression surgery, the surgeon removes bone from the back of the spinal canal to enlarge the spinal canal. Bone spurs or protruding disks that are pressing on nerves also will be removed.
If the vertebrae have slipped and are unstable, spinal fusion may also be required. In this procedure, two or more disks are fused together with a bone graft from the hip, a bone substitute and rods and screws.
Both decompression surgery and spinal fusion can be performed during traditional open surgery, in which large incisions are made in the back, or during a minimally invasive laparoscopic procedure in which several smaller incisions are made and the surgeon uses a thin lighted tube (laparoscope) to visualize the affected area of the spine.
Implantation of an interspinous device is a newer minimally invasive option that was approved by the U.S. Food and Drug Administration for people who are at least 50 years old. In this procedure, a small metal implant is placed between the spinous processes of the vertebrae at the site where the nerve is compressed. The goal is to alter the position of vertebrae and increase the dimensions of the spinal canal, thereby reducing pressure on the nerves.
Risks of spinal stenosis surgery
Spine surgery entails the risks common to all surgery (bleeding, infection, blood clots, and reactions to anesthesia). Other potential risks include a bone fusion that doesn’t heal, inadequate or short-lived symptom relief, damage to nerves or the need for further surgery.
The hospital stay for decompression surgery typically ranges from two to five days for a person in good overall health. Results tend to be excellent if the disease is limited to one or two vertebrae.
Patients who undergo open fusion surgery will spend several days in the hospital, will undergo intensive physical therapy for a few months, and will usually achieve full recovery in two to three months. Full recovery can take as long as six to nine months for elderly individuals or those who have chronic health problems.
The recovery time for laparoscopic surgery is shorter than that needed for open surgery. However, not everyone is a candidate for a laparoscopic procedure, and not all surgeons perform them. Your surgeon can tell you if a minimally invasive procedure is an option. If it is an alternative, he or she can discuss the pros and cons of both types of surgery as they pertain to your situation.