Can Spinal Stenosis Surgery Be Minimally-Invasive?
Especially in people over the age of 50, spinal stenosis is a prominent cause of chronic back pain and neurological symptoms. When this condition isn’t improved with several months of non-invasive treatment, your doctor may recommend spine surgery.
Patients who are concerned about the complications associated with traditional spine procedures may be interested in minimally-invasive spinal surgery. Also called MIS, minimally-invasive surgery can reduce your risk of complications, shorten your recovery, and cause less pain after the procedure.
With the benefits of MIS in mind, can spinal stenosis surgery be minimally-invasive? Here, we’ll discuss this question and discover spinal fusion alternatives for spinal stenosis patients.
What is Spinal Stenosis?
Spinal stenosis is a common condition that develops when the spaces in the spinal canal become narrower. With less space in the spinal canal, the nerve roots and spinal cord may become compressed. This can result in a variety of symptoms, including:
- Back pain and stiffness
- Sciatica, which is nerve pain that extends from the lower back to the buttocks and down the legs
- Cramping and/or numbness in the legs
- Lost sensation and/or a sensation of weakness in the feet
- In severe cases, lost bladder or bowel control
What Causes Spinal Stenosis?
Most often, spinal stenosis is triggered by osteoarthritis-related spinal degeneration. Osteoarthritis is a condition that occurs when the cartilage that cushions the joints (including the joints in the spine) breaks down over time. This results in pain, stiffness, and inflammation.
Other spinal conditions including herniated discs, spinal fractures, and bone spurs can also lead to spinal stenosis. Less commonly, patients are born with a narrow spinal canal or scoliosis (an irregular curve of the spine), leading to congenital spinal stenosis
Surgery For Spinal Stenosis
Surgery for spinal stenosis typically entails spinal decompression. The goal of spinal decompression surgery is to alleviate pressure on the spinal cord and/or spinal nerves to relieve back pain, stiffness, and neurological symptoms.
There are multiple possible approaches to decompressive spinal stenosis surgery. These include:
Laminectomy is the most frequently performed procedure for spinal stenosis. It involves removing some or all of the lamina, which covers the back of the vertebra. By getting rid of some or all of the bony arch at the back of the affected vertebra, your surgeon creates more room in the spinal canal.
Laminotomy is similar to laminectomy. However, while laminectomy involves the total removal of the lamina, laminotomy involves only partial removal of the lamina. Laminectomy and laminotomy are both performed to alleviate nerve compression.
To determine which procedure you need, your surgeon will consider the specifics of your case. However, both types of spine surgery are conventionally performed with a posterior method.
Foraminotomy is another type of spine procedure. It’s done to expand the path where the spinal nerve roots leave the spinal canal. The name of this procedure is taken from the word “foramen”, which is defined as a passage in medical terminology. The end of the word, “otomy”, is a term meaning “to open”.
While performing a foraminotomy, your surgeon will cut out any bone and soft tissue that’s blocking the passageway. By removing these tissues, your surgeon will effectively relieve pressure on the spinal nerve roots.
The facet joints are small joints that connect the vertebrae from the back of the spine. Each vertebra has two facet joints.
In facetectomy, the surgeon fully or partially removes the facet joints of the affected vertebrae. The goal of this procedure is to assuage nerve compression on the nerve roots that run near the facet joints of the lower spine.
Patients who experience spinal stenosis caused by a herniated (bulging) disc may need a discectomy. In this spinal procedure, the surgeon removes damaged disc tissue to eliminate strain on the spinal nerves.
In a discectomy, your surgeon will aim to leave as much of the intervertebral disc untouched as possible.
The Benefits of Minimally-Invasive Spinal Treatment
Minimally invasive spinal stenosis surgery presents several benefits over conventional spinal surgery. These include:
Less Postoperative Pain
During surgery, the body goes through a degree of trauma. But, minimally-invasive spine surgery limits or entirely avoids cutting through the muscles.
By reducing the trauma to your muscles and soft tissues, MIS leads to less pain after spinal procedures. This can also lessen the need for pain medication after surgery.
Less Time in The Hospital
After undergoing spinal surgery, patients are eager to return home as fast as possible. After all, you’re bound to feel more comfortable in your own home than in a hospital bed. So, one of the most attractive benefits of minimally-invasive surgery is that it can reduce the length of your hospital stay.
After struggling with chronic back pain, a lengthy recovery period from spine surgery can be daunting. Additionally, a lengthy recovery period can require patients to take time away from work and their favorite activities.
Many minimally-invasive procedures can be done with local anesthesia, rather than general anesthesia. This makes MIS safer, as the risk of severe complications is much lower with local anesthesia when compared to general anesthesia.
Though arguably a less crucial benefit than reduced pain and a faster recovery, less scarring is a perk of minimally-invasive surgery. Due to a smaller incision, MIS limits scarring after surgery.
Lower Risk of Complications
Medical complications are a major concern among surgery patients. Minimally-invasive surgery can limit the risk of medical complications, including the risk of infection and an adverse reaction to general anesthesia. Additionally, MIS avoids excess blood loss and the problems that it can cause.
Minimally-Invasive Spinal Stenosis Surgery
Minimally invasive surgery (MIS) is available for spinal stenosis. Methods that can be used to achieve minimally invasive spine surgery include:
- Using small incisions to limit bleeding and scarring
- Using specialized instruments and/or a microscopic camera to guide the surgeon
- Moving the muscles away from the spine with a tubular retractor
- Accessing the spine from the patient’s side, rather than the back, to avoid the large back muscles
- Using a percutaneous placement of rods, screws, and other spinal implants for implant placement without disturbing the spinal muscle
- A percutaneous placement involves using x-ray imaging to position guidewires into the vertebrae on the same path as the screws will take. The screws can then take the route of the guidewires and help guide the rod placement. The rods can be connected to the screws and the screws can be secured into place using screw extenders that reach outside of the skin.
Spinal Fusion and Minimally-Invasive Spinal Stenosis Surgery
Spinal fusion is commonly performed for spinal stenosis surgery. By fusing two or more of the injured vertebrae together, fusion provides stability and pain relief. However, spinal fusion isn’t conventionally a minimally-invasive procedure.
The Downsides of Spinal Fusion Surgery
Along with the risks of a non-MIS procedure, traditional fusion also presents risks of its own. For one, fusion significantly lengthens the amount of time that the patient must remain in the hospital after spine surgery. Additionally, the complete recovery period after spinal fusion can last as long as a year.
One of the most prominent downsides of spinal fusion is the fact that it can limit patients’ mobility. In the area of the fused vertebrae, patients often lose the ability to bend, rotate, and flex the back. This can prevent patients from taking part in their favorite activities after fusion surgery.
Thankfully, minimally-invasive spinal fusion surgery is possible with the help of innovative spinal implant systems.
Spinal Implants For Minimally-Invasive Spinal Stenosis Surgery
Some implant systems can facilitate minimally-invasive spinal stenosis surgery and serve as spinal fusion alternatives. By stabilizing the spine without preventing motion, an implant can help resolve spinal stenosis without the need for fusion.
The TOPS spinal implant is one of the available alternatives to spinal fusion that can allow for a minimally-invasive procedure. It’s a mechanical device that replaces the tissues removed in spinal decompression surgery. The implant works by instituting a controlled range of motion in the spine.
Minimally-Invasive Spinal Fusion Surgery Recovery Time
The minimally-invasive spinal stenosis surgery recovery time is much shorter than that of conventional spine surgery. With the TOPS System, patients can regain a complete range of motion immediately after the procedure. Additionally, in comparison to fusion, TOPS patients are subject to far fewer restrictions during the recovery period.
Non-Surgical Alternatives to Spinal Stenosis Surgery
Patients looking to entirely avoid spinal surgery may achieve symptom improvement from ongoing non-surgical treatment. Treatment options include:
- Physical therapy
- Chiropractic care
- Massage therapy
- Anti-inflammatory medication
- Epidural steroid injections
- Lifestyle and activity modifications
Your doctor can advise you on the best approach for surgical or non-surgical treatment to resolve symptoms of spinal stenosis, including proven and less invasive solutions like the TOPS spinal implant.