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How is spinal stenosis surgery prevented? How effective is spinal stenosis surgery? How dangerous is spinal stenosis surgery? How long does recovery take after spinal stenosis surgery? What activities should be avoided with spinal stenosis? Is walking bad for spinal stenosis? Let's go deeper.
What is spinal stenosis?
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When you hear a doctor say "spinal stenosis," they often mean spinal stenosis. There is a hole through the bones of the spine (vertebrae) through which the spinal cord and nerves pass. This hole can become smaller with arthritis, bone spurs, inflamed ligaments, and/or bulging intervertebral discs (5). When this happens it is called spinal stenosis. To better understand this, check out my video on the neck (which is similar to the back):
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How is spinal stenosis treated?
For patients who have difficulty standing without symptoms and for whom physical therapy fails, spinal stenosis is often treated with surgery to decompress the area (6). This often means removing the bone, disc, and ligaments around the tight spot in the central canal. A fusion is often added, where material is inserted to screw the bones of the spine together.
How effective is spinal stenosis surgery?
To decide if you want to avoid spinal stenosis surgery, we must first make sure that the procedure will work. The SPORT study looked at patients who underwent spinal stenosis surgery versus those who did not (1). Interestingly, there was no difference between patients when they reached four years or more after the procedure. Another high-profile study randomized patients to stricture surgery versus physiotherapy, but surgical patients fared no better than those who had PT alone (2). Finally, another review that analyzed many studies on this topic also found that surgery was no better than PT (4).
Therefore, the answer is that the results of spinal stenosis are not impressive. In fact, it is no better in the long run than no surgery or physical therapy. So why are we redoing these procedures on patients?
How dangerous is spinal stenosis surgery?
One of the reasons why patients would want to avoid spinal stenosis surgery is complications. To get into that, we first need to understand that some of what spine surgeons in research studies report on complications is often different from what patients report as a complication, which means that surgeons may underestimate complications (3 ). In an analysis of five main studies, the rate of surgical complications reported by surgeons for spinal stenosis surgery is 10-24% (4). That's 1 in 10 to 1 in 4 patients who have had surgery! These include infection, nerve damage, increased pain, the need for more surgery, and other problems.
Learn more about Regenexx procedures for stricture disorders.How long does recovery take after spinal stenosis surgery?
Expect to be "down" for several days after the procedure. Most patients use sedatives for one to several weeks. However, if a fusion is added to the surgery, most patients will be on medication for approximately two months after the procedure (7). Short walks with braces can occur after the first week or two for most people. However, do not expect to return to full activities for 6 months. For patients with surgical success, most patients feel like they are back to 100% after one year.
Can spinal stenosis surgery be avoided?
There are a few ways to avoid spinal stenosis surgery, some more invasive than others. toThe option is called the Coflex device,that is, a metal spacer implanted between the spinous processes (8). This often happens after surgical decompression. The main idea behind the device is that it retains some movement, but its implantation can damage the normal fascia, muscles and ligaments in the area.
There are other treatments that are performed or implanted using only X-ray guidance without surgery.One type is SLIGHTa procedure that involves cutting the ligamentum flavum (the inflamed ligament that often puts pressure on the spinal cord or nerves), which is then pulled back like a cut rubber band (9). This opens up the area, but also reduces stability in the spine, as this ligament helps keep things stable. There are also newer implant-based solutions, such asspacers that can be inserted using fluoroscopy, such as the Superion device(10). The problem with this implanted device is that even though it is placed without surgery, the implant still forms the original ligament architecture and then puts more pressure on the intervertebral discs.
Is there a way to avoid spinal surgery without destroying the stuff I was born with?
The Regenexx-DDD procedure is the only one that can maintain normal anatomy, does not implant metal parts, and yet patients report feeling much better. How do you do this? We use precision orthobiological injections, in this case primarily your own platelets, and many things we can make from that source, including advanced effluents and plasma. If necessary, we can also use your own stem cells. Watch my video below to learn more about how it works:
How well does it work? Take, for example, a 66-year-old nurse whom I reassessed yesterday. She has severe central tube stenosis at her waist and she was only able to stand for about 15 minutes before we started. Now, after three treatments with injections guided by ultrasound and fluoroscopy, which caused her pain for only a few days while she went about her normal activities, she has been awake for over an hour and is planning a trip to England. next month, where she plans to run miles.
What activities should be avoided with spinal stenosis?
Keep in mind that the main problem with spinal stenosis is extension. This causes the inflamed ligament at the back of the spinal canal (ligamentum flavum) to press on the nerves or spinal cord and is what causes the symptoms. This is the reason why bending activities usually work better. This means that before we get to the bottom of it, bicycling is a better activity than running because it keeps you in that slouched position.
Is walking bad for spinal stenosis?
It's not that there's anything wrong with walking, but standing up while walking can cause symptoms by forcing the inflamed ligament onto nerves, which can reduce leg strength in most patients. So until the problem is fixed (hopefully without surgery), if you want to exercise by walking, use a rolling walker so you can stay in a slight curve.
The result; Surgery is not the only treatment for spinal stenosis. In fact, it is loaded with side effects and is no better than physical therapy. So do yourself a favor and try to avoid it!
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Bibliographic references:
(1) Lurie JD, Tosteson TD, Tosteson A, et al.Long-term outcomes of lumbar spinal stenosis: eight-year results from the Spine Patient Research Trial (SPORT). Vertebral column (Phila Pa 1976). 2015? 40(2): 63-76. do:10.1097/BRS.00000000000000731
(2) Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, et al Surgical versus non-surgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015? 162:465-473. do:10.7326/M14-1420
(3) Ratliff JK, Lebude B, Albert T, Anene-Maidoh T, Anderson G, Dagostino P, Maltenfort M, Hilibrand A, Sharan A, Vaccaro AR. Spinal surgery complications: a comparison of spinal surgeons and patients undergoing spinal surgery. J Neurosurgery of the Vertebral Column. June 2009; 10(6): 578-84. do:10.3171/2009.2.SPINE0935.
(4) Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment of lumbar spinal stenosis. Cochrane Database System Rev. 2016;2016(1):CD010264. Posted on January 29, 2016. doi:10.1002/14651858.CD010264.pub2
(5) Epstein NE, Hollingsworth RD. Nursing Review Deel International Surgical Neurology Section 2: Lumbal Spinal Stenosis. Surg Neurol Int. 2017? 8:139. Posted on July 7, 2017. doi:10.4103/sni.sni_150_17
(6) Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 4 Jan 2016 352:h6234. do:10.1136/bmj.h6234.
(7) Vail D, Azad TD, O'Connell C, Han SS, Veeravagu A, Ratliff JK. Postoperative use of opioids, complications and costs in the surgical treatment of lumbar spondylolisthesis. Vertebral column (Phila Pa 1976). 2018;43(15):1080-1088. do:10.1097/BRS.0000000000002509
(8) Li D, Hai Y, Meng X, Yang J, Yin P. Topping surgery versus posterior lumbar interbody fusion for degenerative lumbar disease: a comparative study of clinical efficacy and adjacent segment degeneration. J Orthop Surg Res. 2019? 14(1): 197. Published June 28, 2019. doi:10.1186/s13018-019-1245-3
(9) Chen H, Kelling J. Mild lumbar decompression procedure: a review. Pain exercise. February 2013; 13(2): 146-53. do:10.1111/j.1533-2500.2012.00574.x.
(10) Nunley PD, Deer TR, Benjamin RM, Staats PS, Block JE. Decompression of the spinal process is associated with decreased opioid analgesia in patients with lumbar spinal stenosis. Res. of pain J. 2018, 11:2943–2948. Posted on November 20, 2018. doi:10.2147/JPR.S182322
Dr. A.S. Chris Ryeis an expert in regenerative medicine and the emerging field of interventional orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for much of the published research on the use of stem cells for orthopedic applications.show profile
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NOTE: This blog post contains general information to help the reader better understand regenerative medicine, musculoskeletal health, and related topics. Any content on this blog, website or linked material, including text, graphics, images, patient profiles, results and information, is not intended and should not be considered or used as a substitute for medical advice, diagnosis or treatment. Always consult a professional, certified health care provider to discuss whether a treatment is right for you.
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FAQs
Avoid spinal stenosis surgery? ›
Although spinal stenosis patients often don't require surgery, prompt treatment is essential to recovering from this condition. Patients generally need a combination of conservative therapies, such as physical therapy, anti-inflammatory medications, lifestyle changes, and steroid shots, to recover.
What happens if you don't have spinal stenosis surgery? ›Risks of Untreated Spinal Stenosis
Constant Pain and Discomfort: Even if your condition begins with only mild or intermittent pain, it will likely become worse over time, occurring more often and at worse levels.
There is little or no risk in not having surgery unless you have serious symptoms. These symptoms include having trouble controlling your bladder or bowels, numbness or weakness, and sudden changes in the way you walk or move. These symptoms aren't likely to get better on their own, and they could get worse.
Is it worth having surgery for spinal stenosis? ›You may want to have surgery if you have tried other treatments for a few months and your pain or other symptoms are still so bad that you can't do your normal activities. Back surgery has some risks, including infection, nerve damage, and the chance that the surgery won't relieve your symptoms.
How do you stop spinal stenosis from progressing? ›"Unfortunately, nothing can stop the progression of spinal stenosis, since it is due to daily wear and tear," said Dr. Hennenhoefer. "The symptoms of spinal stenosis typically respond to conservative treatments, including physical therapy and injections."
Can you live with spinal stenosis without surgery? ›Rest assured, most spinal stenosis patients recover without the need for surgery. But, if you're suffering from a severe form of this spinal condition, know that there are many innovative treatment options at your fingertips.
What is the newest treatment for spinal stenosis? ›Weill Cornell Medicine Pain Management offers a new technology to treat spinal stenosis and minimize the painful symptoms. Vertiflex superion is a device that is implanted into the area of the spine causing pain and relieves pressure on the affected nerves.
What is the safest surgery for spinal stenosis? ›Decompressive laminectomy is the most common and successful surgery done for treatment of symptoms associated with lumbar spinal stenosis.
What percentage of spinal stenosis surgeries are successful? ›The results of our study showed that the outcomes were excellent to good in 72% of patients, similar to the results of a meta-analysis of the literature on the outcome of surgery for spinal stenosis [25].
What is the least invasive surgery for spinal stenosis? ›Endoscopic Decompression: The least invasive option available, this advanced technique requires only the tiniest of incisions (7 mm, or less than a quarter of an inch).
How do I know if my spinal stenosis is severe? ›
Numbness in your genital region and/or loss of bladder or bowel control is another indication that you suffer from severe spinal stenosis. It's a rare but very serious complication that requires immediate attention. “For severe stenosis, surgery is generally recommended,” Dr.
What is considered severe spinal stenosis? ›Stenosis is considered severe when it causes loss of certain functions or disabilities, or when other treatment options have failed to relieve symptoms. You should consult an expert neurosurgeon to assess your symptoms.
What is the best way to live with spinal stenosis? ›While anti-inflammatory medications may ease symptoms, in the long run, you may be better off changing your posture and the way you move. Surgery is a good option for some people with lumbar spinal stenosis. But, for some people, physical therapy can often achieve good results with fewer risks.
Can sitting make spinal stenosis worse? ›In spinal stenosis, people typically experience less pain with leaning forward, and especially with sitting. Studies of the lumbar spine show that leaning forward can increase the space available for the nerves. Pain is usually made worse by standing up straight and walking.
Can a chiropractor fix spinal stenosis? ›Chiropractic care can help reduce the pressure on the nerves while restoring your range of motion and reducing pain levels due to spinal stenosis. Chiropractic care is a proven, safe and effective treatment option for those who are searching for an alternative and natural method to treat spinal stenosis.
What are the 4 stages of spinal stenosis? ›These four stages are the Dysfunction Stage, the Dehydration Stage, the Stabilization Stage, and the Collapsing Stage.
Can stenosis get better without surgery? ›There are several nonsurgical options available to treat spinal stenosis. In fact, most cases of spinal stenosis improve without the need for surgery. Often, finding an effective solution for spinal stenosis requires a combination of therapies, such as medication combined with physical therapy.
When is spinal stenosis serious? ›Most people with spinal stenosis cannot walk for a long period without having significant pain. More serious symptoms include: Difficulty or poor balance when walking. Problems controlling urine or bowel movements.
How quickly does spinal stenosis progress? ›Typically, spinal stenosis progresses at a slow pace if it's not treated properly. As the condition advances, the open space in the spinal canal continues to decrease. Eventually, spinal stenosis can lead to nerve impingement as the spinal canal presses on nearby nerves.
Can spinal stenosis cause permanent damage? ›When to get professional help. Rarely spinal stenosis can cause a condition called Cauda Equina Syndrome to develop. This is a rare but serious back condition which can lead to permanent damage or disability. If you develop this condition you'll need to be seen by an emergency specialist spinal team.