What Is the Best Treatment for Spinal Stenosis?

The best treatment for spinal stenosis can range from patient to patient. Thankfully, many patients with spinal stenosis achieve symptom relief with non-surgical treatments, like physical therapy and lifestyle adjustments. But, when these therapies aren’t sufficient, surgery may be needed to fully resolve spinal stenosis. 

This article will explore the best treatment option to cure spinal stenosis in patients who don’t respond to non-invasive treatments. 

Table of Contents

An Overview of Spinal Stenosis

Spinal stenosis is a condition characterized by limited space in the spinal canal. The patient may either be born with a narrow backbone, or it may narrow over time (most commonly due to age-related degeneration).

In its early phases, spinal stenosis may not trigger symptoms. However, as the condition progresses and the spinal canal narrows, spinal nerves can become compressed. Nerve impingement from spinal stenosis can lead to:

  • Chronic back pain
  • Numbness
  • Tingling
  • Weakness
  • Pain that radiates into the extremities (a leg or foot)
  • Difficulty walking, especially for prolonged periods

In the late stages of spinal stenosis, patients may experience more severe neurological symptoms, such as bladder and/or bowel dysfunction. Problems with sexual function may also occur in patients with severe spinal stenosis. 

What Happens if You Let Spinal Stenosis Go Untreated?

If you let spinal stenosis go untreated, your symptoms will worsen over time and eventually impact your quality of life. Left untreated, this spinal condition leads to increased nerve compression and irritation. Eventually, failing to receive professional treatment for spinal stenosis can lead to permanent spinal cord damage. 

What Is the Best Treatment for Spinal Stenosis of the Lower Back?

In many cases, the best treatment for spinal stenosis of the lower back is decompressive laminectomy. This form of spinal decompression involves removing all or some of the lamina to create more space in the spinal canal. Given that spinal stenosis is characterized by the narrowing of the spinal canal, this procedure can resolve stenosis symptoms. 

What is a Laminectomy?

A laminectomy is a type of spinal decompression surgery. During the procedure, a surgeon removes the smallest possible portion of the lamina from the affected spinal segment. The lamina is a piece of bone that covers the posterior side of the backbone. 

According to a study published in Surgical Neurology International, lumbar laminectomy is one of the most commonly performed lumbar procedures for spinal stenosis. It’s been a prevalent form of spinal surgery for multiple decades, with an average of 34 laminectomy discharges per 100,000 adults annually from 1998 to 2008. 

What Is the Difference Between a Laminectomy and a Decompression?

The difference between a laminectomy and a decompression is that laminectomy is a specific procedure, while decompression is a treatment category. Many different procedures fall under the decompression category, including laminectomy. 

Other forms of decompression surgery include:

  • Laminotomy 

Laminotomy involves removing only a part of the lamina, while laminectomy involves removing all (or almost all) of the lamina. 

  • Discectomy

Discectomy, as the name suggests, involves removing some or all of an intervertebral disc. This decompression procedure is mainly done for patients with a herniated, slipped, or bulging disc. 

  • Foraminotomy 

During a foraminotomy, the surgeon creates more space around one of the bones in the spinal canal (known as the foramen). This area creates the opening through which nerve roots exit the spinal canal. By enlarging it, your surgeon can resolve nerve root impingement. 

Decompression can also refer to non-surgical spinal treatments. Many chiropractors perform non-surgical spinal decompression, which typically involves motorized traction therapy. During this treatment, the patient lies on a decompression table, which uses medical technology to realign the spinal structures.    

How Is Decompression Laminectomy Done?

Decompression laminectomy is done in the following steps:

  1. Administer anesthesia.

A laminectomy is performed while the patient is fully asleep. So, to start, the patient is given general anesthesia. Once the patient has fallen asleep, the incision site is cleaned and prepped. 

If spinal fusion will be performed with decompression laminectomy, the surgeon may prep the hip area to acquire a bone graft. However, a donor bone graft may also be used.  

  1. Make an incision and access the spine. 

Next, the surgeon will make an incision to access the spine. The conventional approach is a posterior incision, which is made over the back. With this approach, the back muscles must be moved to the side so that the surgeon can reach the spinal canal. 

  1. Remove the lamina with specialized tools for each affected vertebra. 

With complete access to the spine, the surgeon can remove the lamina. X-ray technology may be used to confirm the affected vertebra(e). Special tools, such as bone-biting tools or drills, are then used to extract the lamina, and the process is repeated for each affected vertebra.

At this point, the surgeon may also extract bone spurs and/or thickened spinal ligaments to fully resolve the patient’s spinal stenosis symptoms.  

  1. Complete spinal fusion, if needed. 

Conventionally, surgeons perform spinal fusion with a laminectomy to reduce the risk of instability. Fusion, which would be done between steps three and four listed above, involves positioning bone graft material in between the targeted vertebrae. This graft causes the vertebrae to slowly fuse. 

Today, many patients want to avoid spinal fusion due to the associated risks. These risks include lost mobility and adjacent disc degeneration. Non-fusion spinal implants can be used as an alternative to reliably stabilize the spine without these complications. 

  1. Suture the incisions closed. 

To finish the decompression laminectomy procedure, the surgeon will close the skin and muscle incisions with staples and/or sutures. The patient is then transferred to a recovery area in the hospital, with comprehensive monitoring. Patients are typically released from the hospital in one to two days after decompression laminectomy (or three to four days if spinal fusion is done). 

What Is L4 L5 Decompression Surgery?

L4 L5 decompression surgery is a form of spinal surgery that’s done on the L4-L5 segment of the lumbar spine. It’s performed as a treatment for nerve compression in the lumbar spine, which can be triggered by spinal stenosis, spondylolisthesis, herniated disc, and related conditions. 

The L4 L5 level is the most commonly affected and surgically treated spinal level for lumbar spinal stenosis. The lumbar spine is generally more susceptible to spinal stenosis because it has greater mobility and undergoes more strain than the rest of the spine. 

Decompression Laminectomy With the TOPS System

Decompression laminectomy with the TOPS System can cure spinal stenosis and eliminate the need for spinal fusion to stabilize the spine. As a mechanical implant device intended to be used in the L2 and L5 segments, the TOPS System is an ideal option for lumbar spinal stenosis patients. 

The TOPS System replaces the tissues removed during decompressive laminectomy. It moves in all directions, allowing the patient a complete yet controlled range of spinal mobility. As a result, patients can comfortably flex, bend, walk, twist, and partake in various activities after laminectomy with TOPS.

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As an alternative to spinal fusion with decompression laminectomy, the TOPS System is an advanced treatment option for patients with lumbar spinal stenosis. Reach out to a specialist in your area for more information.