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    Spinal Stenosis

    What is Spinal Stenosis?

    Spinal stenosis is a degenerative back disorder resulting from the normal wear and tear on the spine that usually occurs with age. One of the most common back conditions, spinal stenosis affects about five of every 1,000 Americans by the time they are in their mid-fifties. As the discs and ligaments between vertebrae in the spinal column age, they become less flexible, lose fluid, thicken, and harden, causing the discs to bulge into the spinal canal. This causes the lumbar spinal canal and nerve exit sites to narrow. The result is pain, numbness, and weakness in the lower half of the body.

    While some patients have a constant degree of back pain, spinal stenosis mainly results in aching of the buttocks, back of the thighs, calves and shins, and sometimes the feet. Patients usually develop pain or aching first, and eventually experience numbness and weakness in these areas.

    Patients with spinal stenosis are usually uncomfortable when standing and walking and more comfortable sitting down or lying in the fetal position.

    Normal Spine

    Spine with Spinal Stenosis

    Evaluation and Diagnostic Testing

    Before medical treatment or surgery, you are thoroughly evaluated to make sure that you receive the best care and outcome possible. Your doctor will review your symptom history and do a full physical exam.
    A diagnosis of spinal stenosis is confirmed using advanced imaging techniques. Computed tomography (CT) and magnetic resonance imaging (MRI) provide detailed photos of spinal structures. Using these imaging tools, doctors can quickly and easily diagnose spinal conditions, and confirm and locate the injured area with pinpoint precision.

    • MRI - is a test that uses a powerful magnet, computer, and radio waves to take pictures of your bones, discs, nerves, fat and muscles. MRI is painless, and you do not receive any radiation.

    • CT - scan, also known as a CAT scan, is a test that uses X-rays and a computer to take pictures inside your body (for example, muscles, organs, and bones). This helps your doctor find the cause of your illness. CT uses X-rays to precisely identify bone and soft tissue.

    • Radiograph/X-ray - provide one-dimensional snapshots of the spine. Images taken from your front and sides, and in both standing and bending positions, help your doctor evaluate the alignment of your spine.
    The spine is like a chain with many links. Each link, called a ‘motion segment,’ is made of two vertebrae and the disc between them. The narrowing of the spine may involve one or more motion segments. MRIs, CTs and X-rays help your doctor identify which segments are damaged and/or unstable. This information helps determine a course of treatment.

    Treatment Options

    Non-surgical Options

    A variety of non-surgical treatment options are often tried and may prove helpful before considering surgery. It is important to note that these options do not cure spinal stenosis. For persons whose pain is not relieved through non-surgical treatments, surgical decompression for symptomatic lumbar spinal stenosis is usually effective.

    Non-surgical treatment options include:

    • Physical therapy

    • Water-based exercise

    • Back stabilization brace

    • Oral medications - non-steroidal anti-inflammatory medication (ibuprofen or prescription medications of the same variety)

    • Spinal epidural steroid injections (a steroidal medication is injected onto the spinal nerves where they are compressed and may result in temporary reduction of symptoms).

    Surgical Options

    For persons whose pain is not relieved through non-surgical treatments, surgery usually can eliminate pain. Surgical treatment options vary depending upon the number of motion segments involved in the stenosis, whether there is poor alignment of the spine as seen on X-rays, the degree of back pain, and other factors.

    Surgical options include:

    Laminectomy and Laminotomy – involve a more thorough removal of spinal cord and nerve root(s) compression sources, such as herniated discs, bone spurs (arthritis), overlying bone, joint structures, ligament build-up, or tumors. This relieves pressure on the spinal cord or nerve root(s). The term laminectomy comes from the Latin words lamina (bony roof of the spinal canal) and ectomy (removal). Laminectomy removes all of the lamina on selected vertebrae. Laminotomy removes just part of the lamina, and may also remove arthritic overgrowth of ligament and bone. Both surgeries widen the space of the spinal cord or nerve root(s) and therefore relieve symptoms related to compression and irritation of the spinal cord or nerve root(s). These symptoms may include pain and/or numbness, tingling, burning, and weakness. Choosing laminectomy or laminotomy depends on the location and severity of the disease.

    Microdiscectomy and Discectomy – involve trimming or removing part of a disc when it comes in contact with the spinal nerve(s). The goal of this surgery is to relieve symptoms such as leg and/or back pain, weakness, and numbness in your legs and feet. This procedure requires a small incision (cut) of 1 – 2 inches on the back and is done using a microscope and microsurgical techniques. Microdiscectomy is particularly effective in relieving leg pain associated with lumbar disc herniation (rupture, tear).

    Spinal Fusion - involves stabilizing the motion segments using bone and sometimes metallic hardware. Spinal fusion is a surgical procedure done to stop the motion of two or more back bones (vertebrae). Sometimes, abnormal or too much motion of back bones puts pressure on spinal nerves and causes pain. Spinal fusion locks two or more back bones together using a bone graft that comes from your own body (pelvic bone) or from a bone bank. Over time, the bone graft and your back bones grow together and limit the motion at that segment. Pain is lessened, and there may be some restriction when you bend your back forward or backward.

    Indications for spinal fusion include the abnormal curvature of spine (for example, scoliosis or kyphosis), back pain, traumatic injury to the spine, and instability of the spine caused by infections, tumors, or surgical decompression of the nerve.

    X STOP® - a recent, yet unconfirmed, treatment is the use of the X STOP device. The U.S. Food and Drug Administration (FDA) approved X STOP for general use in October, 2006. This metallic (titanium) or plastic implant is placed between the spinous processes – the bony ridges at the back of the vertebrae – just underneath the skin. The implant opens the spinal canal and nerve exit sites to a degree but may not give the best symptom relief. Also, the device can dislodge or break off the bone that it is wedged against, or the bone can soften and the opening effect can be lost.

    Which Treatment is Right for Me?

    Your surgeon reviews the treatment options that are best suited for your medical situation. After a thorough overview and detailed discussion of these treatment and surgical options, you, along with your surgeon, choose the course of treatment that will give the best possible outcome.

    Questions to ask your surgeon

    • What type of spine surgery are you recommending?

    • How long will I be in the operating room?

    • Will I experience post-surgical pain?

    • Will I need to stay in the hospital overnight? How long?

    • Are there alternatives to surgery?

    • What is the natural course of my condition if it is not surgically addressed?

    • What are the benefits of having the operation?

    • What are the risks of having the operation?

    • Will I have physical limitations after surgery? What type?

    • How long do I need to wait before I resume driving after surgery?

    • Will I need physical therapy after surgery?

    • Where can I get a second opinion?

    • How many spinal stenosis surgeries have you performed?

    Preparing for Surgery

    Please call 855-398-1637 (toll free), Monday – Friday from 8:00am – 5:00pm, to speak with an admitting representative. Call us as soon as your procedure is scheduled by your doctor. The admitting staff will help you complete all necessary forms.
    Be sure to have your insurance information readily available when you call.

    When You Go Home

    You will receive instructions for your home care before leaving the hospital. Be sure that you understand these instructions and follow them carefully. Speak with your doctor if you have questions or concerns.

    To plan for your care at home, ask your doctor about:

    • New medicines you will be taking

    • Warning signs for when to call your doctor

    • Your follow-up care

    • Safe activities you can do (climb stairs, exercise, lifting weight, etc.)
      and any special equipment needs.

    Preparing Your Home

    In order to make your recovery as easy and safe as possible, it is important that you prepare your home for your arrival after surgery.

    • Fill any prescriptions or medication before your surgery so they will be ready when you arrive home.

    • Move any items, such as your toiletries, a drinking glass, or pet food, you will need after surgery to waist level to avoid lifting from a low surface or bending excessively.

    • Arrange for transportation since you may not be able to drive for a few days to a few weeks after spine surgery.

    • Ask for help from friends and family for household chores, laundry, and food preparation.

    • Buy slip-on shoes with closed backs that are easy to put on without bending.

    • Prepare to wear a button-up shirt and slip-on pants during recovery.

    Caring for Yourself at Home

    Caring for Your Incision and Dressing

    After surgery, your incision is covered with a shower-proof dressing. Keep the dressing dry and clean for seven days after your surgery to prevent infection. You may take a sponge bath or shower, but the incision must be kept dry. Covering the incision with plastic wrap is a good way to keep it dry. The Steri-Strips® (incision tape) may be removed seven to 10 days after surgery. The staples or sutures will be removed seven to 14 days after surgery during your first post-operative doctor visit.

    Your doctor or surgical nurse will speak with you about proper care for your incision and dressing. It is important to note that this care can vary from patient to patient, so make sure you understand your instructions clearly before leaving the hospital.

    Call Your Doctor Immediately if You Experience Any of the Following Symptoms:

    • If you have a temperature of 101° F or 38.5° C or above.

    • If you have increasing redness and swelling at the incision site.

    • If you notice changes in the amount, look or smell of drainage from your incision.

    • New or increased changes in sensation or numbness in your hands or feet.

    • Severe pain that is not relieved by medication and rest.

    • If you have any questions about spinal stenosis and your surgery.

    Pain Control

    Pain control after surgery includes ice packs, and anti-inflammatory and pain-relieving oral medications. Your doctor gives you medication options and a prescription before surgery or when you leave the hospital. Fill your prescriptions before surgery so they are available when you get home. You can use heat/ice packs to ease the discomfort of mild muscle spasms in the back and legs if you experience them. Remember, your pain level may change from day to day and even throughout the day. Plan to pace your activities according to your comfort level and schedule plenty of time to rest.

    If your pain becomes uncontrollable, call your doctor immediately to talk about pain control options.

    Activity and Body Mechanics

    Ask for help from friends and family for household chores, laundry, gardening, and food preparation for the first month after your surgery. Before you try to resume household activities or exercise, you need to know and understand proper body mechanics and activity restrictions to maintain your spine health.

    General Body Mechanics Following Spinal Surgery:

    • The first week after your surgery, activities should only include light walking, sitting, and riding in a car.

    • No bending at the waist, twisting of the back or stooping. When reaching for an item from a low shelf, squat at the knees or kneel down on one knee.

    • No sitting in soft chairs or sofas that allow your back to curve. Be sure to stand straight and sit straight using a straight-back chair. Sitting may be uncomfortable, so limit your time sitting in a chair.

    • No jogging. Frequent short walks wearing sturdy walking shoes are better than long walks.

    • No lifting, no housework, and no gardening during the first month or until allowed by your doctor. Think before you lift – if it feels too heavy, do not pick it up. When lifting even the smallest items, always hold them close to your body.

    • When getting out of bed or rolling over, use the logrolling technique. While lying on your back, bend the knees up, keeping feet flat on the bed. Roll over on your side in one movement. To sit up, use your elbow and hand to push your torso up into a sitting position, keeping your back straight.

    Guidelines for Physical Activity after Surgery:
    • Most importantly, increase your activity level slowly. Gradually increase your activity level by alternating activity with rest.

    • Plan short walks with rest periods.

    • Increase your walking distance every day.

    • Start your exercises ONLY when you have been instructed by your doctor.

    • Begin your physical therapy program as ordered by your doctor.

    • Discuss returning to work or school with your doctor during your first follow-up appointment.

    Physical Therapy

    Physical therapy (PT) usually begins after the first post-operative office visit or during your hospital stay. Your doctor provides a prescription for PT and discusses timing, frequency, and facility options.