Degeneration in the spine is an inevitable consequence of the aging process. The symptoms that we each experience related to degeneration does vary considerably. As we pass our youthful 20’s and early 30’s into midlife, the discs in our spine begin losing their water content and elasticity. The discs begin to develop fissures and degeneration begins. Bone spurring around the joints of the lower back forms and narrows the spaces where the nerves exit from the spine. Eventually, the central space occupying the nerves also begins to narrow in later life. This process leads to spinal stenosis in which back pain with radiations to the leg(s) becomes apparent. For some, this comes earlier in life than for others. Some are born with smaller diameter spinal canals which pre-dispose them to this.
Treatment for spinal stenosis of the lumbar spine consists of activity modification, physical therapy, medications, and injections. Some will fail to improve with non-surgical treatment and have unremitting symptoms that requires surgery. Surgery to remove or correct spinal stenosis is commonly known as a lumbar laminectomy.
This type of procedure involves making one or more incisions to the lower back and dissecting the soft tissues and muscles away from the underlying bones. The arch of the back of the spine is made up by the lamina. A laminectomy literally means removing this area of the spine to create more room for the nerves. In spinal stenosis, the lamina and ligaments that sit underneath, become thickened resulting in compression of the nerves.
This type of surgery requires a skilled surgeon to carefully remove sections of bone and ligament to free pressure on the affected nerves. Care must be taken not to remove too much bone as this may lead to instability. In some cases, a limited laminectomy can be performed to create more room for the nerves exiting the spine.
This procedure is normally performed in a hospital setting under general anesthesia. In some cases, a single level laminectomy can be performed as an outpatient. Multiple levels and the presence of medical co-morbidities usually require at least an overnight stay in the hospital.
The goal is to remove pressure off of the affected nerves to try and alleviate the symptoms of nerve compression. Results of this type of surgery vary considerably based on the technique utilized, presence of other abnormalities encountered, chronicity of nerve compression, and several other factors. Depending on the age of the patient, a full recovery can 6 to 12 months.
The surgery may not alleviate all complaints of back pain as it does not stop the degenerative process from occurring. Many patients report improved ability to walk and enjoy activity following recovery from this surgery. Outcomes are improved with proper patient selection, meticulous surgical technique, and patient’s understanding of pre-defined expectations.
The general risks of this procedure include infection (superficial or deep), nerve injury, bleeding, development of spinal instability, incomplete relief of symptoms and risks associated with anesthesia.