Your Lower Back Pain: What Is Lumbar Stenosis?
Conditions
Lumbar stenosis is a condition resulting from the narrowing of the spine. This narrowing is often due to bone spur formation, arthritis, thickening of the ligaments in the spine and possible bulging of discs. It is most common in older adult. However, occasionally this does occur in young patients too.
Symptoms
Symptoms can include back pain and sciatica. This can then result in leg pain with possible weakness, numbness and tingling. Sciatica is also, at times, referred to as radiculopathy, which is caused by pinching of a nerve in the back.
Lumbar spinal stenosis can also be caused by what is known as neurogenic claudication. This is an impingement or inflammation of the nerves emanating from the spinal cord and originating at a nerve. Claudication is an indication of a painful cramping or weakness in the legs. The condition causes pain, weakness and/or numbness when standing or walking. However, often sitting, lying down or flexing the back will relieve the sensation.
Additionally, standing up straight is often difficult, so many patients tend to stand slightly bent over. An MRI is required to make an accurate diagnosis and recommendation for treatment. Unfortunately, not all patients are candidates for minimally invasive a lumbar decompression versus a traditional laminectomy.
Decompressive Laminectomy Surgery
Patients are positioned face-down. The precise location of the incision will be confirmed by an intraoperative X-ray, using fluoroscopy. A skin incision, about 1 inch in length, is made to one side of the mid- back, at the surgical level. Dilators are sequentially placed to split the muscle down to the lamina, the back part of the spine, as illustrated in this image.
A retractor is then placed to hold the muscle tissue out of the area of focus, allowing surgical access to the spine. Using a microscope, overlying soft tissue is removed, to expose bone. Using a microscope improves surgical lighting and vision, making surgery more accurate. Specially designed surgical instruments are used to remove bone spurs and the lamina. This is what is referred to as a lumbar laminectomy or a lumbar decompression.
Then the surgical table is tilted, to allow for a better perspective, and the spinous process is undercut. Using a special biting instrument, the anterior part of the lamina, on the opposite side, can then be removed. The ligament under the bone is also opened and removed, and the disc can be checked for further issues.
Advantages of Minimally Invasive Surgery
Both sides of the impingement may be decompressed from a single-entry incision, made from only one side. Doing so preserves the midline spinous process and ligaments. The contralateral (opposite side) facet joint is also then preserved, making a minimally invasive surgery much less destabilizing than the traditional, open laminectomy surgery. This approach can also be used in patients with shifting, or destabilization, of the spine. In a traditional open surgery, a laminectomy is usually combined with fusion as an open laminectomy, when a patient has a condition such as lumbar stenosis, destabilizes the spine too much.
In employing a minimally invasive approach to a laminectomy, a lumbar decompression, we have even successfully treated patients with spondylolisthesis, as well as stenosis, with the decompression alone. Clinical outcomes are generally excellent. And, avoiding fusion allows a much faster recovery, reducing complications.
Since a minimally invasive lumbar decompression (laminectomy) involves smaller incisions, the instance of postoperative pain is far less. Additionally, less blood loss occurs than in an open laminectomy. In addition, the MIS approach to this procedure is less destabilizing to the spine, resulting in faster recovery time periods. And, since many patients with spinal stenosis are elderly, it means they can experience much needed relief through a refined surgery, with far less risk. Minimally invasive lumbar decompression (laminectomy) is more easily tolerated in than open back surgery. Therefore, advanced age alone may not be an absolute contraindication to spine surgery. In fact, we have successfully performed minimally invasive lumbar surgeries in many patients well into their 80s!
Recovery
Patients typically begin walking immediately after minimally invasive surgery and generally go home the day after their surgery, even when more than one level in the back requires surgery.
By two weeks post-op, most patients see a significant reduction in pain medication usage. And, many are already noting an improved ability to walk, are standing straighter than prior to back surgery and do not have the pain they experienced prior to the procedure.
Caution
There are cases where a minimally invasive lumbar laminectomy may not be the best option for treatment. Patients with scar tissue from previous surgery, spinal deformities, or excess obesity may only benefit from a traditional open back surgery. Your surgeon should thoroughly discuss all your options, as well as the pros and cons of each, with you.