Non surgical management :

Oral medications:

Nonsteroidal anti-inflammatory medications (NSAIDs) can help relieve inflammation and provide pain relief from spinal stenosis.

Physical therapy:

Physical therapists will work with you to develop a back-healthy exercise program to help you gain strength and improve your balance, flexibility and spine stability. Strengthening your back and abdominal muscles — your core — will make your spine more resilient. Physical therapists can teach you how to walk in a way that opens up the spinal canal, which can help ease pressure on your nerves.

Steroid injections:

Injecting corticosteroids near the space in the spine where nerve roots are being pinched or where worn areas of bone rub together can help reduce inflammation, pain and irritation. However, only a limited number of injections are usually given (typically three or four injections per year) because corticosteroids can weaken bones and nearby tissue over time.

Decompression procedure:

This outpatient procedure, also known as percutaneous image-guided lumbar decompression (PILD), specifically treats lumbar spinal stenosis caused by a thickening of a specific ligament (ligamentum flavum) in the back of the spinal column. It is performed through a tiny incision and requires no general anesthesia and no stitches. The procedure is guided by an X-ray and a contrast agent that is injected during the procedure. The surgeon uses special tools to remove a section of the thickened ligament, which frees up space within the spinal canal, reducing compression on nerve roots. Some of the advantages of this procedure are that the bony architecture of the spine is left intact and there is little disruption in the mechanics of the spine so people recovery quickly. People usually go home a couple hours after the procedure and begin walking and/or physical therapy soon thereafter. Compared with before the procedure, you will be able to walk and stand for longer periods of time and experience less numbness, tingling and muscle weakness.

When is the Surgery is required ?

Because of the complexity of spinal stenosis and the delicate nature of the spine, surgery is usually considered when all other treatment options have failed. Fortunately, most people who have spinal stenosis don’t need surgery. However, talk with your healthcare provider about surgical options when:

i) Your symptoms are intolerable, you no longer have the quality of life you desire and you can’t do or enjoy everyday life activities.

ii) Your pain is caused by pressure on the spinal cord.

iii) Walking and maintaining your balance has become difficult.

iv) You have lost bowel or bladder control or have sexual function problems.

What the surgical options for spinal stenosis?

Surgery options involve removing portions of bone, bony growths on facet joints or disks that are crowding the spinal canal and pinching spinal nerves.

Types of spine surgery include:

Laminectomy (decompression surgery):

The most common type of surgery for this condition, laminectomy involves removing the lamina, which is a portion of the vertebra. Some ligaments and bone spurs may also be removed. The procedure makes room for the spinal cord and nerves, relieving your symptoms. In a laminectomy, the lamina portion of the vertebral bone is removed.

Laminotomy: This is a partial laminectomy. In this procedure, only a small part of the lamina is removed – the area causing the most pressure on the nerve.

Laminoplasty: In this procedure, performed in the neck (cervical) area only, part of the lamina is removed to provide more canal space and metal plates and screws create a hinged bridge across the area where bone was removed.

Foraminotomy: The foramen is the area in the vertebrae where the nerve roots exit. The procedure involves removing bone or tissue this area to provide more space for the nerve roots.

Interspinous process spaces: This is a minimally invasive surgery for some people with lumbar spinal stenosis. Spacers are inserted between the bones that extends off the back of each vertebrae called the spinous processes. The spacers help keep the vertebrae apart creating more space for nerves. The procedure is performed under local anesthesia and involves removing part of the lamina.

Spinal fusion: This procedure is considered if you have radiating nerve pain from spinal stenosis, your spine is not stable and you have not been helped with other methods. Spinal fusion surgery permanently joins (fuses) two vertebrae together. A laminectomy is usually performed first and bone removed during this procedure is used to create a bridge between two vertebrae, which stimulates new bone growth. The vertebrae are held together with screws, rods, hooks or wires until the vertebrae heal and grow together. The healing process takes six months to one year.

Is spinal surgery safe? What are the risks of surgery for spinal stenosis?

All surgeries have the risks of infection, bleeding, blood clots and reaction to anesthesia. Additional risks from surgery for spinal stenosis include:

i) Nerve injury.

ii) Tear in the membrane that covers the nerve or spinal cord.

iii) Failure of the bone to heal after surgery.

iv) Failure of the metal plates, screws and other fasteners.

v) Need for additional surgery.

vi) No relief of symptoms/return of symptoms.

Cervical Myelopathy :

Cervical myelopathy results from compression of the spinal cord in the neck (cervical area of the spine). Symptoms of cervical myelopathy may include problems with fine motor skills, pain or stiffness in the neck, loss of balance, and trouble walking.

What is Cervical Spine Surgery?

Your spine surgeon may recommend cervical spine surgery to relieve neck pain, numbness, tingling and weakness, restore nerve function and stop or prevent abnormal motion in your neck.

Your surgeon does this by removing a disc or a bone and fusing the vertebrae together with a bone graft either in front of or behind the spine.

What are the Reasons for Cervical Spine Surgery?

Cervical spine surgery may be indicated for a variety of spinal neck problems.

Generally, surgery may be performed for degenerative disorders, trauma or instability.

These conditions may produce pressure on the spinal cord or on the nerves coming from the spine.

What Conditions are Treated with Cervical Spine Surgery?

i) Degenerative Disc Disease

ii) Cervical Deformity

iii) Craniovertebral junction abnormalitiesv

iv) Prolapse intervertebral disc

v) Cervical Compressive Myelopathy

What are the surgeries for cervical myelopathy ?

Cervical spinal fusion :

Cervical spinal fusion joins two of your vertebrae into a single, stable piece of bone. It’s used in situations where an area of the neck is unstable, or when motion at the affected area causes pain.

Anterior cervical discectomy and fusion (ACDF) :

ACDF is a type of surgery that’s done to treat a pinched nerve or spinal cord compression.
The surgeon will make the surgical incision at the front of your neck. After making the incision, the disk that’s causing the pressure and any surrounding bone spurs will be removed. Doing this may help relieve the pressure on the nerve or spinal cord.

A spinal fusion is then performed to give stability to the area.

Laminectomy :

The purpose of a laminectomy is to relieve pressure on your spinal cord or nerves. In this procedure, the surgeon makes the incision at the back of your neck.
Once the incision is made, the bony, ridged area at the back of the vertebra (known as the lamina) is removed. Any disks, bone spurs, or ligaments that are causing compression are also removed.

Laminoplasty :

A laminoplasty is an alternative to laminectomy to relieve pressure on the spinal cord and associated nerves. It also involves an incision on the back of your neck.

Instead of removing the lamina, the surgeon creates a door-like hinge instead. They can then use this hinge to open up the lamina, reducing compression on the spinal cord. Metal implants are inserted to help keep this hinge in place.
The advantage of a laminoplasty is that it preserves some range of motion and also allows the surgeon to address multiple areas of compression.

This kind of surgery can treat a pinched nerve in your neck. The surgeon will make the incision at the front of your neck.

Artificial disk replacement (ADR) :

During ADR, the surgeon will remove the disk that’s applying pressure to the nerve. They’ll then insert an artificial implant into the space where the disk was previously located. The implant may be all metal or a combination of metal and plastic.

Unlike ACDF, having an ADR surgery allows you to retain some of the flexibility and range of motion of your neck.

What does the recovery period typically involve?

you can expect to spend a day or two in the hospital following your surgery. Exactly how long you’ll need to stay in the hospital will depend on the type of surgery you’ve had.

Often, neck surgeries require only night, whereas lower back surgeries typically require longer stays.

It’s normal to feel pain or discomfort while recovering. Your doctor will likely prescribe medication to help relieve your pain.

Most people can typically walk and eat the day after their surgery.

The bottom line

Neck surgery isn’t the first option for treating neck pain. It’s typically only recommended when less invasive treatments aren’t effective.

There are some types of neck conditions that are more often associated with neck surgery. These include issues like pinched nerves, compression of the spinal cord, and severe neck fractures.

There are several different types of neck surgery, each with a specific purpose. If surgery is recommended for the treatment of your neck condition, be sure to discuss all your options with your doctor.