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Decompressive laminectomy is the most common
type of surgery done to treat
lumbar (low back) spinal stenosis. This surgery is done to relieve
pressure on the
spinal nerve roots caused by age-related changes in the spine. It also is done to treat other conditions, such as injuries to the spine,
herniated discs, or tumors. In many cases, reducing
pressure on the
nerve roots can relieve pain and allow you to resume
normal daily activities.
Laminectomy removes bone (parts of the
vertebrae) and/or thickened tissue that is narrowing the spinal canal and
squeezing the spinal nerve roots. This procedure is done by surgically
cutting into the back.
In some cases, spinal fusion (arthrodesis) may be done at the same time to help
stabilize sections of the
spine treated with decompressive laminectomy. Spinal
fusion is major surgery, usually lasting several hours. There are different
methods of spinal fusion:
There are a variety of specialized techniques that can be
used in spinal fusion, although the basic procedure is the same. Techniques
vary from what type of bone or metal implants are used to whether the surgery
is done from the front (anterior) or back (posterior) of the body. The method
chosen depends on a number of things, including your age and health
condition, how many vertebrae are involved, the severity of nerve root pressure and associated symptoms, and the
surgeon's experience. Spinal fusion increases the possibility of complications
and the recovery time after surgery.
Depending on your health and the
extent of the surgery, it may take several months or more before you are able
to return to your normal daily activities.
Surgery for spinal stenosis is
The decision to have surgery is
not based on imaging test results alone. Even if the results of imaging tests
show increased pressure on the spinal cord and spinal nerve roots, the decision
to have surgery also depends on the severity of symptoms and your ability to
do normal daily activities.
In some cases,
spinal fusion will be done at the same time to
stabilize the spine. Spinal fusion might make it easier for you to move around
(improve function) and relieve your pain. It can also help keep the bones from
moving into positions that squeeze the spinal canal and put pressure on the
spinal nerve roots.
Surgery for spinal stenosis usually
is elective but may be recommended if symptoms cannot be relieved with
nonsurgical treatment. In general, experts feel that surgery has good results
and relieves pain in the lower extremities for people who have severe symptoms
of spinal stenosis and who have few other serious health problems.
symptoms may return after several years. A second surgery
may be needed if:
Spinal fusion may be done at the same time as decompressive
laminectomy. Spinal fusion may help to stabilize sections of the spine that
have been treated with decompressive laminectomy. In general, fusion is only
done if an area of the spine is unstable, which means the bones of the spine (vertebrae) move
too much or do not move in a normal way. This extra movement causes wear and tear on the nerves or other soft tissues, leading
to irritation and pain. The goal of fusion is to keep the damaged bones in the
spine from moving so that the soft tissues are protected.
Complications from spinal stenosis surgery may
result from the impact of other existing medical problems and the severity of
the spinal problem. Also, all surgery poses risks of complications.
These complications may be more serious in an older adult.
Possible complications include:
If you have
diabetes or circulation problems or if you are a
smoker, you may be at greater risk for complications.
Most experts recommend that
people with spinal stenosis try nonsurgical treatments before choosing surgery.
Surgery for lumbar spinal stenosis is most
likely to relieve pain, numbness, and weakness that are mostly in your legs.
Surgery may not work as well for relieving pain that is mostly in your
Surgery is usually effective if
you have severe leg pain and numbness and you have not been able to move around
well for a long time. But in some cases, the symptoms return after surgery. It
is also possible that nerve symptoms, including numbness and clumsiness, may
not be relieved or may return.
laminectomy and fusion, spinal stenosis may develop directly above or below the
surgery site. Repeated surgeries for spinal stenosis increase your risk of
complications and instability in the spine.
Age should not be a factor in deciding whether to have decompressive
laminectomy. But if you have other medical conditions
that will make this procedure and follow-up rehabilitation less successful,
surgery may not be recommended.
Complete the surgery information form (PDF)surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Weinstein JN, et al. (2008). Surgical versus nonsurgical therapy for lumbar spinal stenosis. New England Journal of Medicine, 358(8): 794–810.
Weinstein JN, et al. (2010). Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine, 35(14): 1329–1338.
Atlas SJ, et al. (2005). Long-term outcomes of
surgical and nonsurgical management of lumbar spinal stenosis: 8- to 10-year
results from the Maine Lumbar Spine Study. Spine, 30(8):
Pearson A, et al. (2011). Predominant leg pain is associated with better surgical outcomes in degenerative spondylolistheses and spinal stenosis: Results from the Spine Patient Outcomes Research Trial (SPORT). Spine, 36(3): 219–229.
February 13, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Robert B. Keller, MD - Orthopedics
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