Lumbar Spinal Stenosis

Lumbar Stenosis with Neurogenic Claudication

The spine is one of the most important elements of the human body. When it stops working properly, it can cause tremendous pain. Moreover, it can also affect other parts of the human body, especially the legs. This is why it’s so crucial to address and diagnose all spinal problems in time. 

If you feel pain and stiffness in your leg that eases when you sit down, you might suffer from neurogenic claudication.  

What Is Neurogenic Claudication?

Neurogenic means that the problem appears in the nervous system. Claudication is a word to describe leg pain or heaviness, especially while walking. This problem can appear when there is a compression of the spinal nerves in the lower part of your spine. 

This type of claudication is different from vascular claudication. The second one is caused by reduced blood flow to the leg. 

What Are the Symptoms of Neurogenic Claudication?

Some of the most common neurogenic claudication symptoms appear mostly in the back or one or both legs and include: 

• tingling
• pain
• cramping

Those symptoms can be also noticed in the hips or buttocks. People who suffer from neurogenic claudication can also feel that their legs are weak or heavy. Affected people often notice that those symptoms ease while leaning forward or sitting down. This can increase while standing upright and walking. 

What Connects Neurogenic Claudication and Lumbar Stenosis

Neurogenic claudication is considered one of the main symptoms of lumbar stenosis. The first former is rather an effect of the problem, rather than its core. Lumbar stenosis is a health condition in which the canals that protect the nerve or the spinal cord narrow in the lower back area. When space is narrower, the nerve cannot travel freely down the spine to other parts of the body, for example, the legs. 

There are some factors that can cause this disorder at a young age. However, most people who suffer from lumbar stenosis are 60 years old or higher. Simply put, this disorder affects people as they grow older.

With age, bones and joints thicken. The discs that connect vertebrae can lose their water. Because of that, they no longer play their crucial role which is absorbing shocks between the vertebrae. 

When you sit down or lean, you can feel pain relief. It happens because while sitting you can stretch the spine. By doing so, you force the spaces of your spine to open up and take off the pressure from the nerves.

Causes and Risk Factors

The main cause of neurogenic claudication is spinal stenosis, or put more simply, narrowing of the spinal canal in the lower back (lumbar area). Some of the most common causes of spinal stenosis are arthritic changes and wear and tear in the lower spine. 

Those changes can lead to bulging discs, overgrowth of bone spurs, and thickening of ligaments. Stenosis may press on the nerve roots that are responsible for feeling and movement of the lower body. This compressing can cause prolonged pain, tingling, and cramping. 

The pain intensifies while standing because in this position the spinal canals are naturally narrower. That causes extra pressure on the nerve roots. You can temporarily ease the pain by flexing forward or sitting. Remember that it’s only a temporary solution and is not going to solve your problem. You need professional medical attention. 

Neurogenic Claudication Test and Diagnosis

The best way to know if you suffer from neurogenic claudication is by consulting a specialist. You need to have thorough physical exams, connected with detailed interviews. This way a physician can determine where your pain comes from, and what type of pain it is. 

Some of the symptoms allow a medical expert to recognize if you suffer from vascular claudication or a neurogenic one. One of the main differences between those two is that in the case of vascular claudication, the pain often eases after resting, while in neurogenic claudication, discomfort is relieved for a while when in a particular position. 

To confirm a diagnosis of neurogenic claudication, you might need to participate in a few tests. They can determine the cause of your pain and better prepare you for treatment. 

Some of the most common tests that are run when spinal stenosis is suspected are:

• X-Ray: This test uses electromagnetic energy beams, known as X-rays, to show the image of bones. X-rays can provide an image of the bone anatomy and curvature of the vertebral column. It’s a great tool to check spinal discoloration and slippage. X-rays can be useful in confirming Kyphosis and scoliosis. Other things that are visible on the X-ray are bone abnormalities, for example, a narrowed disc space, bone spurs, erosion, collapse, and fracture of a vertebral body. A doctor can recommend dynamic or extension X-rays. This test can show the spine in motion. Thanks to this more advanced scanning, a medical doctor can verify if there are any abnormalities, such as excessive movement or instability in the spine. Through the X-ray test, it’s impossible to see soft tissues, such as spinal nerves, the disc, spinal cord, or ligaments. A doctor is also not going to see tumors, cysts, or vascular malformation. 

• Magnetic resonance imaging, also known as MR, is a test that uses large magnets and radiofrequencies to show images of bones and soft tissues on a computer. It can help check if the stenosis is caused by a herniated disc or bulging. 

• Computer tomography scan uses X-rays and a computer to show images of soft tissues and bones.

Based on your symptoms and effects of testing, a doctor can identify your problem and decide which method of treatment would be the best for you.

Can Neurogenic Claudication Lead to Disability?

As your spine is a very important part of the body, you have to act fast. Otherwise, you risk severe health problems or even disability. According to statistics, neurogenic claudication caused by lumbar spinal stenosis can lead to disability. It is the problem that causes most spinal surgeries among older people, and it is also considered one of the most common causes of disability among this group.

Treatment 

The most effective way to get rid of neurogenic claudication is by surgery. During the treatment, the nerve roots in the lumbar spine are decompressed. It might happen that if the compression that was affecting the spine caused a herniated disc, a microdiscectomy procedure might be necessary. In other cases, a process of laminectomy is very often necessary, when the part of a bone is removed.

Spinal implants can make the surgery less traumatic. A spinal implant is a very useful device that can reduce back pain. When you suffer from any disorder in your spinal column, you might benefit from it. The device can be surgically placed in between your vertebrae and you can manage it remotely once you feel the pain. You are going to send low-level electrical impulses to the spinal cord. 

Thanks to this, you can stimulate your spine and reduce pain. This solution is ideal for anyone for whom the nonsurgical method of reducing pain doesn’t work. Spinal implants can be a great solution for people who suffer from neurogenic claudication and are looking for a long-lasting solution for their problem and pain. 

What is the X-Stop procedure?

X-Stop is a minimally invasive spinal surgery procedure that may be performed to treat cases of lumbar spinal stenosis that don’t respond to more conservative treatments, such as physical therapy and medication. X-Stop is also the name of the titanium implant used in the procedure, a device in a category termed “Interspinous Process Decompression Systems.” This lumbar spinal surgery procedure was approved as safe and effective by the FDA in 2005.

Lumbar spinal stenosis is an unnatural narrowing of the spinal column in the lower, or lumbar portion of the spine. The constricted spinal canal that characterizes spinal stenosis puts pressure on the spinal cord and the nerves emanating from it at the affected vertebrae, which can cause pain and restrict mobility. In the X-Stop procedure, the titanium implant is inserted into the spine through a small incision made between two spinal “processes” of the vertebra affected by stenosis. Spinous processes are the protrusions of the individual vertebra visible along the back. The X-Stop device distracts two vertebral segments and relieves the pressure on the nerve roots caused by the stenosis, which in turn often relieves leg and back pain. The X-Stop, a recent advance in spinal stenosis surgery, is not an alternative to spinal fusion back surgery, a procedure that eliminates the natural flexion and rotation of the fused vertebrae. The X-Stop is ideal for patients with very mild spinal stenosis. For more advanced disease, the X-Stop is not applicable because the implant cannot be used when decompression surgery is necessary to remove the bony elements pressing on nerve roots. In such situations, where decompression surgery is performed in conjunction with spine stabilization, the TOPS System may be a more relevant solution for maintaining the spine’s native motion.

As developers of treatments for advanced spinal stenosis and associated conditions, we at Premia Spinerecommend that patients learn about all their treatment options. If you have a back condition that’s causing pain or is affecting your mobility, be certain to learn about all the choices available to you.

Why are some spinal surgeons more successful than others?

It’s a fact that some spine surgeonshave higher success rates for the operations they perform than their colleagues. What accounts for these differences in surgical outcomes of spinal procedures? A number of factors influence surgical success rates and should be considered when interpreting what the rates say about a particular spinal surgeon’s abilities.

Spine surgery is a highly complex endeavor requiring years of training and experience to perfect. Surgeons with more experience tend to have more successful outcomes than less experienced surgeons. The success rates of board certified or board eligible spine surgeons are also typically higher than those of non-board certified or eligible surgeons. Another factor to consider: some surgeons specialize in specific areas of the spine – such as lumbar spinal surgery – and some specialize in treating particular conditions – such as slipped disc or spondylolisthesis – while other back surgeons do not specialize in any one type of treatment. Specialists have higher success rates than those of their colleagues who do not focus on the type of surgeries they perform.

Beyond the skill of the surgeon, success rates are also linked to the type of procedure chosen to treat a particular problem. The decision to utilize one procedure – perhaps because the surgeon is more familiar with it – rather than an alternative treatment, can also affect a surgeon’s success rate. For example, there is a choice in surgical stabilization procedures to employ following decompression spinal surgery, which is performed to treat conditions including spinal stenosis, spondylosis, and spinal cord injuries. In the past, spinal fusion back surgery has been virtually the only surgical stabilization option, but today an alternative procedure, the TOPS™ (Total Posterior Solution) System has been proven in clinical trials around the world to provide better success rates that spinal fusion. Thus, a back surgeon might have a better than average success rate performing spinal fusion procedures, but still not reach the success rates achieved with a new procedure. That’s why it’s important to be familiar with the full range of available treatment options when evaluating the success rates of any spine surgeon.

Choosing a Spinal Surgeon

Choosing a spinal surgeon is among the most important medical decisions a patient can make. A spinal surgeon does more than perform an operation. A spinal surgeon consults with you, explains options and answers questions, and plans your treatment and recovery. You need to trust your spine surgeon, and to feel free to discuss all medical matters frankly.

You should choose a spinal surgeon who is board certified or board eligible, and trained in a fellowship program. If possible, choose a surgeon who specializes in the area of the spine that requires treatment– for example, a lumbar spinal surgery specialist if your problem is in the lower back. Alternatively, choose a spine surgeon who specializes in treating the specific condition affecting you, such as spondylolisthesis or spinal cord injuries.

Recent years have witnessed tremendous advances in treatment of spinal conditions, such as minimally invasive procedures that provide better outcomes than traditional open back surgery. It is essential that you choose a back surgeon that has experience with advanced procedures, to ensure you have access to the very latest treatments and the greatest spectrum of surgical options. For example, surgery to treat spinal stenosis, slipped disc and a variety of other conditions that can result in pinched nerves, have often utilized spinal fusion back surgery as a means of stabilizing the spine, following spinal decompression therapy. Today the TOPS ™ (Total Posterior Solution) System provides a clinically proven superior alternative to spinal fusion surgery. Moreover, the TOPS implant preserves the full range of movement of the spine’s individual vertebrae, whereas spinal fusion eliminates the spine’s natural motion between fused vertebral segments. Examples like this illustrate why it’s important to work with a spine surgeon who can offer a complete range of surgical options. Thoroughly investigate all your treatment options as well as the qualifications of the specialists you consider working with, and you’ll be sure to make a wise choice when it comes to selecting a spinal surgeon.

How soon can you return to athletics after spinal surgery?

Near the top of the list of questions from almost every spinal surgery, the patients indicate how long they will have to wait for the following surgery before resuming their everyday activities. When it includes athletics – golf and tennis, bowling and the like, pastimes that put tremendous strain on the back – the answer becomes more complex. The factors influencing the time before patients can get back in the game include their physical condition and health. Just because one engages in strenuous physical activity doesn’t mean they are in good physical condition or health. Recovery times are faster for surgery patients in good physical shape because their bodies heal more quickly. Of course, the operation itself will play a significant role in deciding when you’ll be back on the tennis courts, golf course, taking a job, or engaging in a simple walk. The postoperative physical therapy program also plays a significant role. But the type of back surgery is the primary factor affecting the time required to get back into sports activities.

How to recover from surgery if you are an athlete or cannot live without daily activity – read further in this article.

Table of contents

1. What does it mean to be in recovery?
2. Exercises after surgery
3. Conclusion

What does it mean to be in recovery?

While many people consider back surgery as the end of a promising sports career, Olympic, amateur, or professional athletes have returned to their competition after many common types of operations. General physical condition, professionalism during surgery, and spine rehabilitation affect how quickly you return to the game. Here are some tips for athletes planning to return to sport after a minimally invasive intervention. 

Follow your doctor’s recommendations

In most cases, surgeons consult about postoperative care. They depend not only on the patient’s health and medical history but also on the desire to return to sports. We previously discussed lower back surgery recovery: diet, exercise, physical therapy, massages, proper wound care, and medication support are vital aspects of recovery. Of course, you shouldn’t neglect motivation and grit to achieve success. And if your competition is right around the corner, and you’re still in the hospital ward, this is not a reason to be upset. Your orthopedic surgeon will take this into account when planning your postoperative period. Of course, everyone wants to leave and start an everyday life immediately. Still, following the recommendations, you’ll be able to return to sports faster than causing implicit harm to your body during self-rehabilitation. Returning too early cancels not only the healing but the operation’s effectiveness. 

So, a doctor’s advice may include:

• doing certain exercises
• wearing compression bandages, insoles, and stockings to avoid the risk of complications
• A diet that includes vitamin and mineral complexes
• A set of particular activities after back surgery.

Define your limits

You’d also talk to your coach about your career prospects or options (if you’re an amateur athlete) when getting approval from your PCP to return to athletics. It’s essential to be careful and aware of the limitations.

The postoperative stage depends on the patient, understanding the symptoms of complications, and a quick reaction if something goes wrong. E.g., accurately characterizing the level of pain and discomfort, reporting aches, numbness of the limbs, dizziness, suppuration in the wound area doesn’t mean a step back in the rehabilitation progress, but on the contrary, the ability to accelerate after a slight slowdown. Try to protect the spine, especially in the early stages of recovery. Respect your body and its healing times. 

Don’t forget about the course of drugs

Infections at the site of the surgical incision most often occur 2–4 weeks after the intervention. Most often, the following symptoms appear:

• redness and suppuration at the incision site;
• back pain that gets worse;
• fever and fever;
• change in consistency, odor, and color of drainage.

It’s essential to treat any of these and some other signs as they arise. If ignored, unavoidable consequences may occur. 

For patients with deep infection, a course of intravenous antibiotics is often given for about two months. Chronic contamination leads to the removal of the implant. 

Keep the wound clean: it must be washed with water and soap at least once a day. Remember to keep the wound dry for healing and crusting. It’s undesirable to utilize ointments, lotions, body creams on the operated areas. After two weeks, when the staples or stitches are removed, you may return to bathing or swimming. 

For opioid pain relievers, discontinuation usually occurs within the first few weeks, at most a month. There are other pain management options, such as using acetaminophen or non-steroidal anti-inflammatory drugs. But, as in the first case, they have their pros and cons and depend on the medical history. By combining medicines with physical therapy, you can achieve impressive results. 

It’s no secret that athletes’ dedication to the postoperative rehabilitation program greatly influences their subsequent success. Depending on overall progress in physical therapy, you may get consent to exercise, but return to activity must be gradual and gentle to avoid unnecessary risks.

Exercises after surgery

Patients, who have undergone minimally invasive TOPS™ procedures, can usually regain a full and painless range of motion. They have the greatest likelihood of returning to sport at pre-injury levels. Conversely, most exercises after spinal fusion aren’t available to athletes, and the possibility of injury increases – they’re less likely to return to athletics. Any collisions and falls will negatively affect health.

In any case, physiotherapy is a panacea for healing – movement combined with other aspects of rehabilitation can give you a chance for a better life. Let’s consider the leading practices that are useful for patients in the postoperative period.

Walking

It’s worth moving daily to improve blood circulation and speed up the healing of muscles and spine tissues. E.g., an essential therapy is walking, which can support the normal functioning of the heart and lungs. An upright position of the body is the best activity for the spine after surgery – this way, you can protect the discs from unnecessary stress. So, start with simple walks, and then work with your coach to develop your exercise program.

Bench press

That’s one of the simplest and effective therapies utilized in various types of operations. For instance, laminectomy recovery exercises are invaluable as they help protect discs and strengthen your back muscles.

This exercise is valuable because the discs hold the lower back during flexion and extension of the lumbar spine. So, to perform the training, you need to do the following steps:

1. Lie face down with your arms parallel to your body.
2. The back and hips should be relaxed. Gently lift your upper body while leaning on your stomach. Feel light pressure in your lumbar region.
3. Hold this position for about two seconds and slowly lower yourself to the floor. Do ten hikes.

Straight leg raise (SLR) 

To strengthen the muscles of the lower back, it’s worth doing the SLR exercise. To do this, while lying on your stomach, slowly and alternately lift each leg up. In doing so, try to tighten your abdominal muscles. Do an exercise with a delay of two seconds at the highest point of the limb position. As before, do ten reps per set. Such a physiotherapy approach is appropriate for laminectomy, fusion, microdiscectomy, decompression, and of course, implantation.

Regain your mobility with Premia Spine! Contact us now

In some cases, the surgical treatment chosen for a given spinal condition will affect not only the time needed to get back on the playing field but the degree to which you will ever be able to recover your old form. Take the stabilization procedure following spinal decompression surgery, for example. Spinal decompression is performed to relieve pressure on nerves within or emanating from the spine caused by conditions including spinal stenosis, spondylolisthesis, and other degenerative changes or as a result of spinal cord trauma. Spinal fusion back surgery has been the primary stabilization procedure. But the fused vertebrae lose their independent motion following stabilization. Often, patients are restricted from physical activity for up to 6 months while waiting for the biological fusion process to complete. Today, the TOPS™ (Total Posterior Solution) System provides an alternative to spinal fusion. The TOPS™ System, a surgical implant, stabilizes the spine while preserving each vertebra’s independent motion – and the good news is that there are no restrictions on your physical activity after surgery. That’s going to ensure better performance whenever it’s time to get back in the game.

Conclusion

As you improve your range of motion in your spine, it’s time to start doing more challenging activities that will help you get back to working condition. To do this, discuss a possible change in activity with a PCP and trainer and adjust the training schedule. After implantation, you don’t have to worry that you can’t perform some exercises. The TOPS™ System is an alternative to spinal fusion and allows you to perform any range of movements required for warm-up, training, and cool-down.

Should I stop taking medications before spinal surgery?

You have a pinched nerve, slipped disc, a spinal cord injury, or other back problem that has not responded to conservative treatments, and you have reached the decision to have spinal surgery. You and your back surgeon will discuss many aspects of your pre- and post-operative treatment, and the subject of the medications that you are currently taking – and whether you should continue their use – is high on the list of topics.

Usually patients are advised to continue use of prescription medications such as those for controlling blood pressure, even on the day of surgery – provided the medications are taken with just a small sip of water. However, use of blood thinners, aspirin, anti-inflammatory drugs, and diabetic and herbal medications should be discontinued prior to surgery. Your surgeon and staff will ask for a complete list of all medications you are taking, and it’s important to provide accurate answers.

One of the goals of post-operative care is effective pain management, and that requires patients to be free and weaned from any narcotic pain medications and muscle relaxants before the back surgery is performed. Fortunately, the open back surgery procedures of just a few years ago have in many cases been replaced by less invasive surgical procedures performed to relieve common back problems such as spinal stenosis, or symptoms of sciatica. These minimally invasive procedures cause little damage to collateral tissue, and therefore produce less pain and require less palliative medication, further speeding recovery. Other recent advances provide improved post-operative outcomes. For example, patients can now choose the TOPS™ (Total Posterior Solution) System instead of spinal fusion back surgery after a spinal decompressionprocedure. The TOPS System provides better clinical outcomes than spinal fusion, and preserves the full range of the individual vertebrae. Spinal fusion eliminates the independent motion of fused vertebrae, and has been shown to promote deterioration of adjacent vertebrae.

The procedure selected to treat your back problem is also a critical part of the discussions you will have with your orthopedic surgeon. Be sure to discuss all your surgical options, including advanced, proven procedures that can provide the best outcomes for your spinal condition.

What is Neural Claudication?

Recently, we addressed the topic of claudication. Claudication refers to pain typically felt in the legs as a result of vascular (blood vessel) problems or back problems (such as spinal stenosis) that can cause pinched nerves in the lower back.

Neurogenic claudication is a common symptom of lumbar spinal stenosis, which is the abnormal narrowing of the spinal canal in the lumbar (lower) spine. Neurogenic refers to the condition’s genesis in the nerves, while claudication (Latin for limp) refers to painful weakness or cramping in the legs.

The Basics of Neurogenic Claudication

Also called pseudoclaudication, neurogenic claudication occurs as a result of compression of the nerves in the lumbar spine. Neurogenic claudication is widely considered a syndrome, meaning that it involves a group of symptoms that usually develop collectively. 

Causes

As aforementioned, most cases of neurogenic claudication are triggered by spinal stenosis, which occurs when the space around the spinal cord diminishes.

Understanding Spinal Stenosis

Spinal stenosis is estimated to affect 8% to 11% of adults in the United States, according to the American Academy of Orthopedic Surgeons. It’s the most prevalent in adults over the age of 50.  

Common causes of spinal stenosis include bone spurs, bulging discs, and the thickening of ligaments in the spine.  

• Bone spurs are solid lumps of extra bone that can develop as a result of wear and tear on the spine, such as osteoarthritis. 
• Bulging discs, which may also be called herniated discs or slipped discs, occur when there’s a tear in the firm exterior of a spinal disc. The soft interior of the disc may push out through this crack and place stress on spinal nerves.  
• The ligaments that support the spine and keep the vertebrae connected can stiffen with age. As a result, the ligaments may thicken and begin to take up extra space in the spinal canal. 

These spinal conditions can trigger the impingement of spinal nerves, which leads to the symptoms associated with neurogenic claudication. 

Bilateral vs. Unilateral

This syndrome may be bilateral (in both legs) or unilateral (in one leg). However, most cases of neural claudication are bilateral. 

Symptoms 

Symptoms of neural claudication typically include pain, cramping, weakness, and tingling. These symptoms most often appear in one or both legs, the lumbar spine, and the buttocks. 

Pain from neural claudication may be triggered by walking or prolonged standing and is generally alleviated by changing position or bending the waist. Unlike vascular claudication, neural claudication can’t be alleviated simply by resting.

In severe cases, pain from this syndrome may be persistent. Without treatment, spinal stenosis and neural claudication can become a source of chronic pain. 

Treating Neural Claudication

Diagnosis

First, your physician will need to run tests to provide a diagnosis. An x-ray, MRI, and CT scan are all often used to diagnose neural claudication and can identify stenosis, bone spurs, and slipped discs.

• X-rays use electromagnetic beams of energy to create images of the patient’s bones. Although the spinal cord, spinal nerves, and other soft tissues generally can’t be viewed using an x-ray, this test allows for a general examination of the bone tissue in the spine. 
• MRIs (magnetic resonance imaging) use radiofrequency energy, magnets, and computers to develop bone and soft tissue images. Unlike an x-ray, an MRI can help physicians evaluate soft tissue injuries in the spine, like a slipped disc. 
• CT (computed tomography) scans combine x-rays and a computer to form images of soft tissues and bones.

These tests can evaluate the general condition of the spinal bones and soft tissues to determine if neural claudication is present. This, along with a physical exam and patient interview, will help your physician diagnose your spinal symptoms. 

Conservative Treatments

Conservative treatments may be sufficient to relieve neurogenic claudication. Physicians generally start patients out with a conservative treatment plan before considering surgery. 

Some of the most common non-surgical treatments for neurogenic claudication include:

• Physical therapy

Physical therapy for neural claudication usually involves exercises for spinal flexion, abdominal exercises to improve stability, and lifestyle recommendations. Massage and heat/ice therapy may also be implemented for pain relief. 

• Medications

Anti-inflammatory medications can help relieve pain and inflammation caused by neurogenic claudication. These medications may be found over-the-counter or prescribed, depending on the severity of the case. 

• Injections 

Epidural steroid injections can be used to relieve pain from irritated nerves in the spine. When injected into the affected area, the steroid medication works to reduce pain signals from the injured nerves, leading to less pain and discomfort. 

Keep in mind that epidural steroid injections should generally only be applied three to six times annually. If you get too many injections, there’s a risk of decreasing the strength of the vertebrae and adjacent muscle tissue. 

In moderate to severe cases of neurogenic claudication that don’t respond to conservative protocols, surgery may be recommended. Spinal decompression surgery can improve your comfort and quality of life if neurogenic claudication is interfering with your daily activities. 

Spinal decompression surgery is typically performed to remove portions of the vertebrae that are impinging on a nerve. This pinched nerve is the source of pain, weakness, and cramping in cases of neurogenic claudication. 

Any procedure that relieves pressure on spinal nerves to resolve symptoms of spinal compression, including neurogenic claudication, is referred to as spinal decompression surgery. There are a few different approaches to spinal decompression, including discectomy, laminotomy, laminectomy, foraminotomy, foraminectomy, corpectomy, and osteophyte removal. 

Your surgeon will determine the best method of spinal decompression to suit your circumstances. 

Spinal Fusion

Following the spinal decompression treatment, a secondary operation is performed to stabilize the spine in the area where vertebral material was removed. In the past, spinal fusion back surgery was the sole available surgical stabilization procedure performed with spinal decompression.

Spinal fusion involves connecting neighboring two vertebrae so that they eventually form one bone. To do this, the surgeon will position bone graft material in between the vertebrae.

To keep the vertebrae in position during the bone graft’s healing process, your surgeon may also perform posterior fixation. This involves using screws and rods to reinforce the alignment of the spine. 

Downsides

Although spinal fusion can prevent further damage from spinal instability, it has several downsides. For one, patients commonly need to stay in the hospital for up to four days after spinal fusion. After the patient returns home, it can take many months for the vertebrae to fuse together and for the spine to heal. 

Spine fusion surgery eliminates the natural independent motion of the fused vertebrae. It can contribute to the deterioration of adjacent vertebrae, potentially leading to further complications.  

Additionally, spinal fusion compromises the mobility of the spine. Patients may require special tools to pick up items off of the floor because they can no longer bend over after spinal fusion. 

Alternative Solutions

The TOPS (Total Posterior Solution) System provides an alternative to spinal fusion that preserves the full range of natural motion of each vertebra. It’s a mechanical device that supplants the tissues removed during spinal decompression. 

With the TOPS spinal implant, it’s possible to reinforce the stability of the spine after spinal decompression surgery without compromising the patient’s range of movement. This device moves with the spine so that the patient can resume their normal activities soon after surgery. 

The TOPS device also provides a faster, more comfortable recovery process after spinal decompression. This spinal implant reduces the trauma on the spinal tissues after decompression. 

If you experience pain that interferes with your quality of life, seek qualified medical help and get the facts about all of your treatment options. Today’s advanced procedures provide excellent outcomes for spinal conditions including neural claudications. 

What is Lumbar Spinal Stenosis?

Spinal stenosis is a prevalent spinal disorder in the U.S. and across the globe. In fact, the condition affects an estimated 250,000 to 500,000 U.S. residents. 

This spinal disorder can occur in the lower, or lumbar, region of the spine, which is known as lumbar spinal stenosis. Or, it may occur in the neck, or cervical, region of the spine, which is known as cervical spinal stenosis. Lumbar spinal stenosis is the most common form of this condition, and it’s the topic of our article. 

What is Lumbar Spinal Stenosis?

Spinal stenosis is a common condition, especially among patients who are aged 50 and over. It occurs when the spinal canal abnormally becomes narrower. The word “stenosis” can be traced back to ancient Greek and refers to narrowing, or constriction.

As the spinal canal progressively narrows over time, it strains the nerves that extend outward from the spine and travel into the extremities. This can cause a range of symptoms.

What Are Lumbar Spinal Stenosis Symptoms?

The symptoms of lumbar spinal stenosis can differ from patient to patient. However, pain, tingling, and numbness in the extremities are among the most common signs of this spinal disorder. 

Other symptoms of lumbar spinal stenosis may include:

• Numbness or tingling in a foot or leg
• Weakness in a foot or leg
• Pain or cramping in one or both legs
• Lower back pain

There might be other non-specific symptoms of spinal stenosis. So, please consult with your doctor for a precise diagnosis.

What Causes Lumbar Spinal Stenosis?

Most cases of spinal stenosis occur for unknown reasons. However, the causes of lumbar spinal stenosis are rooted in specific parts of the spine’s anatomy, such as: 

• The intervertebral discs

An intervertebral disc is located between each of the bones in the spine. It provides cushioning for the bone and prevents damage by absorbing impact. These discs break down with age and may even become herniated, meaning that the disc interior protrudes from a crack in the disc interior. 

A damaged intervertebral disc can take up extra space in the spinal canal, potentially leading to spinal stenosis. 

• The facet joints

The facet joints connect the vertebrae of the spine to one another. These joints support a large amount of weight and undergo a significant amount of stress. As a result, they’re vulnerable to wear and tear, as well as various injuries. Damage to the facet joints (and the cartilage within these joints) can trigger spinal stenosis.  

• The spinal cord

When the spinal cord and/or the nerve roots become compressed, it may trigger pain and neurological symptoms. When the spinal cord and nerve roots are involved in spinal stenosis, the patient is rarely asymptomatic. 

What is Inherited Spinal Stenosis?

The narrowing, or tightening, of the spinal canal, may result from abnormal bone and/or tissue growth. or due to a hereditary disorder. This is referred to as inherited spinal stenosis. 

Some people are born with a spinal canal that’s narrower than average. This can cause the patient to experience spinal stenosis symptoms much earlier in life than the average patient. Additionally, patients who are born with scoliosis may experience spinal stenosis.

Scoliosis is an atypical, sideways curve of the spine. It’s commonly recognized and diagnosed in children and adolescents. In patients with scoliosis, the curved spine may place stress on the spinal cord, potentially leading to spinal stenosis. 

What is Degenerative Spinal Stenosis?

Degenerative spinal stenosis refers to cases of this condition that are caused by wear and tear on the spine. This is the most common type of spinal stenosis. 

Spinal degeneration is a normal effect of aging. It occurs as the intervertebral discs and facet joints weaken from repeated strain over time. Factors including a sedentary lifestyle, poor posture, obesity, injuries, smoking, and other spinal disorders (such as scoliosis) can speed up the process of spinal degeneration.  

Effects of aging that can contribute to the development of degenerative spinal stenosis include:

• The cartilage in the facet joints gradually wears down, which increases friction in the spine and may cause bone spurs to form. 
• The intervertebral discs become drier, flatter, and weaker. The discs may become damaged, leading to a slipped or herniated disc. 
• As the cushioning in the spine from intervertebral discs decreases, the spinal cord and/or nerve roots can become strained. 

Leading a healthy lifestyle by exercising, eating a nutritious diet, and maintaining an optimal weight can help prevent spinal stenosis.

What Are The Best Treatments For Lumbar Spinal Stenosis?

Options for spinal stenosis treatment include:

• Spinal stenosis exercises

Various exercises can help with spinal stenosis by improving strength and mobility in the affected areas. You can perform these exercises at home to support your lumbar spinal stenosis recovery. 

Examples of spinal stenosis exercises include:

• Bridges

This exercise engages the glute muscles, which support the pelvis and can help reduce the strain on the lumbar spine. 

• Pelvic tilts

This simple exercise engages the transverse abdominis, which is a deep abdominal muscle that promotes proper spinal alignment and helps protect the lower spine. 

• Knee-to-chest exercise

This exercise stretches and helps relieve tension in the lower back muscles. It also flexes the spine, which relieves pain from spinal stenosis by temporarily creating more space in the spinal canal. 

• Physical therapy

Physical therapy may improve symptoms of lumbar spinal stenosis by relieving pressure on the spinal cord. For lumbar spinal stenosis, physical therapy typically involves stretches for the lower back, legs, and hips, as well as strengthening exercises for the abdominal muscles, which support the lower spine. Your physical therapist may work with you on mobility exercises to improve your range of motion in the lower back. 

Additionally, physical therapy may involve treatments that can help with pain, tension, and inflammation. These treatments include heat/cold therapy, electrostimulation, massage, etc. 

• Medication

Both over-the-counter and prescription medications may be used to reduce pain and inflammation from lumbar spinal stenosis. Talk to your doctor before starting a new medication for spinal stenosis symptoms in the lumbar spine.

Surgery For Lumbar Spinal Stenosis

In extreme cases, surgery for lumbar spinal stenosis may be recommended. Typically, doctors don’t recommend lumbar spinal stenosis surgery unless the patient has first undergone at least 6 months of conservative treatment. 

For lumbar spinal stenosis, spinal decompression surgery is often performed. This type of surgical procedure involves removing portions of the vertebrae that are impinging on the roots of nerves emanating from the spine. By relieving this pressure, the procedure gives patients symptom relief and provides the spinal nerves with enough space to heal. 

Laminectomy is the most common form of spinal decompression surgery for spinal stenosis of the lumbar region. In this procedure, the surgeon removes all or part of the lamina, which forms the ceiling of the spinal canal. Other types of spinal decompression surgery include foraminotomy and discectomy.   

Spinal Fusion in Lumbar Spinal Stenosis Surgery

Following the spinal decompression procedure, spinal fusion back surgery has traditionally been performed to stabilize the spine. Spinal fusion involves placing bone graft material in between the affected vertebrae. Over time, the bone graft will cause the vertebrae to permanently fuse.

Unfortunately, this stabilization procedure eliminates the independent motion of the fused vertebrae and can contribute to the deterioration of adjacent vertebrae. Patients can lose a significant amount of motion in the lower back after spinal fusion.

Alternatives to Spinal Fusion 

Spinal fusion alternatives, such as non-fusion implants, can offer stability without limiting the patient’s mobility after spinal stenosis surgery. The TOPS™ System, for example, provides an alternative to spinal fusion that maintains the spine’s full range of motion. It’s been proven in clinical studies conducted worldwide to provide superior outcomes than spinal fusion following spinal decompression surgery. 

Patients seeking surgical relief for an abnormal narrowing of the spine now have access to a wider range of treatment options than ever. Talk to your doctor about the best course of treatment for your needs. 

What is Lumbar Spinal Decompression?

Lower back pain has long been a prevalent health concern around the world. In 2017, the prevalence of lower back pain was estimated to be approximately 7.5% of the world’s population. This totals about 577 million people.

There are numerous causes of lower back pain, as well as countless treatments that can help relieve it. Lumbar spinal decompression is one treatment strategy for alleviating lower back pain caused by a pinched nerve. 

This article will discuss lumbar spinal decompression, when it’s implemented, and what patients can expect from the procedure. 

Why is Lower Back Pain So Common?

Imagine if the branches of a tree were as large at the top as they are at the bottom. Now, imagine that a heavy load is placed on the ends of the very highest branches. This would put an enormous amount of stress on the lower portion of the tree trunk.

This is comparable to what we experience as humans with our spinal columns. The human spinal column is like the trunk of a tree, but we’re as large on the top of the trunk as we are at the bottom. This puts a high amount of stress on the lower back, which is also called the lumbar region of the spine.  

The strain of lifting objects and twisting the spine over the course of a lifetime is exacerbated by degenerative spinal changes that occur with age. So, it’s not surprising that most of the back problems that bring patients to spinal specialists are centered in the lower, or lumbar, region of the spine.

Lumbar Spine Disorders

The stresses discussed above, along with disease and/or injury, can result in a host of spinal disorders. Bulging or herniated discs, spinal stenosis, and spondylolisthesis are among the most common.

• Bulging disc

A bulging disc is a spinal disorder that occurs when the exterior of an intervertebral disc weakens, typically from the natural aging process. This can cause the disc to bulge out into one side of the spinal canal. 

• Herniated disc

A herniated disc is essentially one step further than a bulging disc. It occurs when the soft interior of the disc protrudes out through a crack in the weakened disc exterior. 

• Spinal stenosis

Spinal stenosis can result from a bulging or herniated disc, as well as a range of other factors. It’s a spinal condition characterized by an abnormal narrowing of the spinal canal.

Reduced space in the spinal canal can place stress on the spinal nerves or the spinal cord. But, decompression for lumbar spinal stenosis can effectively alleviate this stress. 

• Spondylolisthesis

Spondylolisthesis is a condition that develops when one of the vertebrae is unstable and slips out of its regular position. The displaced vertebra settles on the vertebra beneath it. 

These disorders can place unnatural pressure on the nerves that emanate from the spinal column. This may cause pain, restricted mobility, and other symptoms of a pinched nerve.

What is a Lumbar Decompression Surgery?

Spinal decompression is a method of easing pressure on impinged spinal nerves. It can be performed either non-surgically or surgically. Lumbar spine decompression simply refers to decompression procedures performed on the lower portion of the spine.

The surgical solution for a lumbar pinched nerve involves removing a small amount of tissue from vertebrae in the lumbar region. The surgeon will remove the tissue that’s impinging, or putting pressure, on a nerve. This process is referred to as lumbar spinal decompression surgery.

How is Lumbar Decompression Surgery Performed?

There are various types of lumbar decompression surgery that may be implemented for different spinal disorders. The most common forms of surgical lumbar decompression include:

Laminectomy and Laminotomy

Laminectomy and laminotomy are two surgical methods of lumbar decompression that involve the lamina. The lamina acts like the roof of the spinal canal and protects the spinal cord. 

• In a laminectomy, the surgeon removes the majority of the lamina at the affected spinal segment. 
• In laminotomy, the surgeon only removes a small portion of the lamina. 

Laminoplasty

Laminoplasty is a procedure that involves making two cuts in the lamina so that it swings outward, like a door. After creating a hinge with the lamina of the affected vertebra, the spinal surgeon will position small bone wedges to keep the “door” from closing. Commonly referred to as open-door laminoplasty, this procedure can effectively alleviate pressure on the spinal nerves without removing the lamina. 

Foraminotomy

In foraminotomy, the surgeon creates more space around the area where nerve roots exit the spinal canal. This area is known as the intervertebral foramen. It acts as a passageway, linking the spinal canal to the periphery. 

By opening up the intervertebral foramen in foraminotomy, the spinal surgeon can alleviate pressure on the spinal nerves. 

Discectomy

Discectomy is a spinal decompression procedure that involves removing damaged intervertebral disc tissue. The spinal surgeon may remove some or all of the damaged disc, depending on the patient’s needs.

Lumbar Decompression Surgery With Spinal Fusion

Removing tissue in lumbar decompression surgery can lead to spinal instability. So, historically, spinal fusion back surgery has been performed in conjunction with lumbar decompression surgery to stabilize the spine. 

In spinal fusion, the surgeon places bone graft material in between the affected vertebrae. As weeks and months pass after the procedure, the vertebrae will fuse, forming a singular bone. By completely preventing motion in this segment, fusion effectively prevents instability following spinal decompression surgery.  

Unfortunately, lumbar decompression and fusion can have certain negative effects on the body, including:

• Reduced range of motion

The key downside of spinal fusion is that it prevents all motion in the fused segment. This eliminates the patient’s ability to flex, twist, and bend the spine normally. As a result, patients may no longer be able to partake in their favorite sports and activities after spinal fusion surgery. 

• Damage to adjacent vertebrae

The spinal segments that are adjacent to the fused vertebrae must undergo additional stress to compensate for the fusion. This can lead to a complication known as adjacent segment disease (ASD), with which the adjacent vertebrae deteriorate at a more rapid rate. ASD can lead to lower back pain, radiating pain, difficulty walking or standing, and neurological symptoms. 

Are Alternatives To Spinal Fusion Available?

Today, the TOPS™ (Total Posterior Spine) System provides an alternative to spinal fusion that preserves the spine’s natural full range of motion. This advanced spinal implant has been shown to provide better outcomes than fusion in clinical studies performed around the world. 

The TOPS™ System provides an important additional treatment option for individuals with moderate to severe pinched nerve symptoms. It can provide a major improvement in lower back pain for patients who don’t respond to non-surgical lumbar spinal decompression therapy.

How Long Does It Take to Recover From Lumbar Decompression Surgery?

The recovery period for lumbar decompression surgery can vary depending on the exact procedure and whether or not spinal fusion is performed. However, patients can generally expect to wait four to six weeks before reaching their expected degree of mobility and returning to work. 

Spinal fusion prolongs the recovery process for lumbar decompression surgery. It can take up to a year to fully recover from fusion. With this in mind, the TOPS™ System can significantly reduce the lumbar decompression surgery recovery time, allowing patients to return to physical activity much sooner.

Is Lumbar Decompression Surgery Serious?

Lumbar decompression surgery is an invasive procedure. So, as with any surgical procedure, it comes with certain risks.

With that said, lumbar decompression is widely performed and considered safe. Advancements in medical technology have even made minimally-invasive lumbar decompression surgery possible. This allows for greater safety and a lower risk of complications. 

If you have symptoms of a pinched nerve, don’t hesitate to talk to your doctor about the complete scope of treatment options available to you. 

Back Treatment Options

In our previous blog we discussed the tremendous stresses borne by the lumbar, or lower portion of the spine comprising the five lowest vertebrae. In fact, lumbar back pain is a significant health issue, affecting about 70 to 85 percent of Americans at some point in their lives, according the National Institutes of Health (NIH). Among the most common causes of lumbar spinal problems is the degeneration of bones and tissue in the spine that occur as a normal part of aging. But one doesn’t have to be older to have lumbar spinal problems. Back pain is the most frequent cause of activity limitation in people under the age of 45, according to the NIH. Trauma or injury, poor posture and biomechanics, genetics, obesity and poor muscle tone can all result in lumbar spinal problems that cause pain, limit mobility, and have other serious health consequences. These conditions include spinal stenosis, bulging disc, herniated disc, slipped disc, radiculopathy and spondylolisthesis.

A variety of treatment options are available for individuals affected by conditions causing lumbar back pain. Individuals with moderate to severe cases of these conditions who do not respond to conservative treatment options such as medication, physical therapy and lifestyle changes, may opt for a surgical solution. Frequently this involves cutting away portions of a lumbar vertebra that is impinging, or putting pressure on a nerve emanating from the spinal column. Such spinal decompression surgery can have a dramatic impact on relieving pain and restoring mobility. However, removing bony elements also weakens and destabilizes the spine, so historically a procedure known as lumbar fusion, or lumbar spinal fusion has been performed in conjunction with spinal decompression back surgery of the lower spine. In this procedure the vertebra from which tissue was removed is fused to an adjacent vertebra. This stabilizes and strengthens the spine, but lumbar fusion eliminates the natural flexion and independent motion of the fused vertebrae. Today lumbar decompression surgery patients have an alternative to lumbar fusion: the TOPS™ (Total Posterior Spine) System. TOPS preserves the full range of the spine’s natural motion, and has been shown to provide better outcomes than fusion in clinical studies performed around the world. If you are considering surgery for a lumbar spinal problem, ask your physician about all your surgical options.