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Recovering from Lumbar Spinal Stenosis

Lumbar Spinal Stenosis

 

Lumbar spinal stenosis, a common medical problem, denotes an unnatural narrowing of the spinal canal, the center of the spinal column housing the spinal nerves that relay sensorial information to the brain and control the movements of our muscles. The term stenosis comes from Latin, and means a narrowing. When a portion of the spinal canal narrows unnaturally, it can put pressure on the spinal nerves, and these pinched nerves in turn can cause pain and limit mobility.

The good news is that a variety of treatment options are available that have been proven effective in helping individuals recover from or ameliorate the symptoms of spinal stenosis. Conservative, non-invasive therapies include simple lifestyle changes, medications, physical therapy, and injections of anti-inflammatory agents. For patients with spinal stenosis, there’s no way of knowing which of these approaches will be most successful, so physicians may simply prescribe one of these treatments as a first step, and monitor the results to see how the patient responds. If the first method selected doesn’t achieve the results of helping the patient recover from spinal stenosis, the next option may be tried, and so on.

For patients with moderate to severe spinal stenosis who do not respond to conservative treatments, surgery may be recommended. In this form of spinal decompression surgery, the surgeon trims away excess bone in the narrowed center of the affected vertebra, relieving pressure on the compressed nerve or nerves. Historically, a spinal fusion back surgery operation has been performed in conjunction with surgery to relieve spinal stenosis, in order to stabilize the region of the spine where the operation was performed. Today there’s an important, and better alternative to spinal fusion. The TOPS (Total Posterior Spine) System procedure provides better clinical outcomes than spinal fusion surgery. The TOPS solution has the added benefit of preserving the spine’s full range of motion, unlike spinal fusion, which permanently fuses adjacent vertebrae. TOPS also offers a much quicker recovery from surgical treatment for spinal stenosis than spinal fusion. If you’re a candidate for spinal stenosis surgery, make sure you understand all the advanced surgical solutions available today, and what impact each will have on your recovery from this condition.

 

What is a Lumbar Laminectomy?

Lumbar Laminectomy

Medical terminology doesn’t go out of its way to be complicated or hard to understand. It’s simply that the language has to be very precise, and that much of it comes from Latin. Hence, it can be difficult to decipher some med-speak without a little help. Take the term “lumbar laminectomy,” a fairly common surgical procedure that can help alleviate the pain, mobility limitations and other symptoms that often accompany medical conditions of the lower spine. Indeed, the word “lumbar” refers to the lower spine. The lumber portion of the spine comprises the lowest five vertebrae of the spinal column, which bear the designation L1 through L5 – “L” standing for lumbar.

 

Every vertebra in the spinal column is covered in a bony sheath called the lamina, which helps protect

the nerves that run through the spinal column. But sometimes, due to injury, disease, degenerative changes, or other causes, the lamina can put pressure on nerves emanating from the spinal column, a condition referred to as a pinched nerve. Problems within the vertebrae, such as an unnatural narrowing of the spinal canal, a condition called spinal stenosis, can also result in pinched nerves.

When surgery is performed to relieve pressure on a pinched spinal nerve, a procedure called spinal decompression, it requires cutting away the portion of the lamina that is impinging on a nerve, or to gain access to the interior of the vertebrae t

o address a condition such as spinal stenosis. In medicine, the suffix “ectomy” refers to excision or removal. Thus, cutting away a portion of the lamina is a procedure called a laminectomy. So a lumbar laminectomy is an operation in which a portion of the lamina on one of the first five vertebrae is trimmed away. A lumbar laminectomy can achieve dramatic results in alleviating the symptoms of pinched nerves. Traditionally, spinal fusion back surgery was performed in concert with a laminectomy to stabilize the spine at the point of the operation. Now lumbar laminectomy patients have an alternative that provides better outcomes than spinal fusion surgery, while preserving the full range of the spine’s motion: The TOPS (Total Posterior Spine) System procedure. If you’re a candidate for a lumbar laminectomy or other spinal decompression procedure, make sure you understand all your treatment options.

 

Back Pain and Steroid Injections

Back Pain and Steroid Injections

Epidural injections of steroids have often been the treatment of choice for patients with a pinched nerve in the back whose symptoms did not respond to simple exercise, physical therapy, or other more conservative approaches. Steroid injections have also been offered to patients with spinal stenosis whose back pain was unrelieved by less invasive therapy. But the results of a new research study hint that injections of steroids for back pain may be less beneficial than believed. The study is small, but it still bears consideration, as the findings are statistically valid and underscore why healing is as much an art as a science.

The study of the efficacy of steroid injections for back pain examined more than 270 patients, aged 53 to 75 years old, culled from the ranks of a larger study of individuals with spinal health problems. The research subjects were followed for four years. Sixty-nine of these patients had epidural injections and 207 did not, but otherwise the patients’ symptoms were primarily the same in terms of severity, as measured by well-established scales used to measure pain in the leg and lower back. Using these scales, researchers found less improvement among those who had epidural injections than among patients who did not have injections.

Several caveats must be offered when considering the results of this research. First, as the authors readily acknowledge, factors that the researchers didn’t account for and couldn’t control may have affected or skewed the results. Nonetheless, we are seeing fresh thinking and new techniques improving outcomes for many spinal patients. For example, patients who elected to have spinal decompression surgery to relieve symptoms of pinched nerves typically opted for a spinal fusion back surgery in tandem, in order to stabilize the spine. Today, a growing number are opting for TOPSTM – the Total Posterior Solution – System, instead of spinal fusion. The TOPS system, unlike spinal fusion, preserves complete independent motion of the individual vertebrae. This is one more way that fresh thinking, and new technologies and procedures are transforming the care and treatment of back problems.

How to Prepare for Spinal Fusion Back Surgery

 

Doctors Performing Surgery

Spinal fusion back surgery is often performed in conjunction with spinal decompression treatment. The decompression procedure relieves pressure on pinched nerves emanating from the spine, reducing pain and restricted mobility in limbs caused by the compressed nerve. But the spinal decompression surgery involves removing portions of vertebrae, making the spine weaker at these points. Thus, spinal fusion surgery is performed to strengthen the spine after decompression, and involves fusing two adjacent vertebrae with the use of an implant.

Preparing for spinal fusion surgery – whether performed on the lumbar, thoracic or cervical spine – is similar to preparations for any spinal operation, but there are a few specifics to be aware of. First, be prepared to be thoroughly examined before the surgery is performed, so your physicians can plan all aspects of your operation. Radiograph assessments of spinal instability, EMG to test nerve function, and an MRI, CAT, or other scan is often performed to identify nerve compression.

Your overall physical condition will also be assessed to ensure you are in sufficient health to undergo the rigors of the surgery. You will need to discuss any and all pre-existing medical conditions with your physicians, and further evaluation of such conditions may be necessary before proceeding with spine fusion surgery. In fact, one of the most important ways to prepare for spinal fusion is to get into the best physical condition possible. Being in good physical condition translates into fewer complications during surgery and faster recoveries after, among other benefits.

Spinal surgery of any kind should be considered a last resort, undertaken only if more conservative treatments have proven ineffective. But many patients undergoing spinal decompression now have an alternative procedure to spinal fusion, shown in clinical tests around the world to have better outcomes than spinal fusion. The TOPSTM (Total Posterior Solution) System stabilizes the spine without eliminating the independent motion of the individual vertebrae, as spinal fusion does. So one of the best ways to prepare for spinal fusion is to find out if an alternative solution like TOPS makes more sense than spinal fusion surgery for you or a loved one.

Preparing for Spinal Fusion Surgery, Part II

Doctors Completing Surgery

In our last blog we began addressing the topic of preparing for spinal fusion back surgery.  We touched upon tests that may be performed, and the need to prepare physically through a conditioning regimen so your body is ready for the rigors of surgery. Here are additional points anyone considering spinal fusion should remember:

One potential complication of spinal fusion surgery is excessive bleeding. Several commonly used medications can increase bleeding, including aspirin, ibuprofen and other NSAIDs, as can anticoagulants such as warfarin. You will need to discontinue use of any such medications. Should your physician or surgeon be concerned about the risk of excessive blood loss during your spinal fusion operation, you may bank your own blood, called an autologous blood donation, before the surgery.

Be sure to discuss all the medications you are taking with your physicians, and they will advise you when (and if) you should stop taking them. Some medications could cause adverse affects in combination with the anesthetics or other medications used during the operation, and anti-inflammatory medication such as cortisone and chemotherapy can compromise the body’s ability to heal.

Failure of the bone graft to heal, called pseudarthrosis, is one of spinal fusion’s most problematic post-surgical complications. Smoking is associated with this complication, and nicotine has been shown to compromise the ability of bone cells to grow. It is imperative that smokers stop smoking prior to the surgery, and not smoke before their recovery is complete.

Before resigning yourself to spinal fusion surgery, remember that spinal problems often respond to more conservative treatments, such as physical therapy and healthy lifestyle changes. Alternative surgical procedures may also be available. For example, many candidates for spinal fusion can choose the TOPSTM(Total Posterior Solution) System instead. The TOPS System not only preserves all the natural flexion of individual vertebrae, unlike spinal fusion, but it has also been shown to have better outcomes in clinical trials around the world. Indeed, investigating alternative options is another productive way to prepare for a spinal fusion operation.