Spinal Stenosis Treatment Options

Nonoperative Treatment options for spinal stenosis include:

1. Physical therapy will help to strengthen the muscles that support the back and reduce pressure on the spinal nerves.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help to reduce inflammation and relieve pain.
3. Epidural steroid injections can help to reduce inflammation and relieve pain.
4. It is important to avoid activities that can worsens symptoms.
5. Low impact activities such as Yoga, Tai Chi, cycling, aquatic therapy, and walking are low impact activities that can relieve pressure on the spine and improve pain and mobility.
6. Chiropractic adjustments can help to improve spinal alignment and relieve pressure on the spinal nerves.
7. Acupuncture can help relieve pain and improve mobility.
8. Assistive devices such as braces, canes and walkers can improve stability and ease symptoms.

Most cases of spinal stenosis can be managed effectively with conservative treatments. However, in severe cases where conservative treatments are not effective, surgery may be recommended to relieve the pressure on the spinal cord or nerves and to prevent further nerve damage.

Surgical treatment options

Surgical procedures focus on decompression to relieve pressure on the spinal cord and nerves or stabilization surgery to treat instability by limiting motion between the vertebrae. The best surgical approach depends on several factors including the patient’s specific condition and its severity, anatomy and general health.

Decompression surgery options

Decompression surgery opens the bony vertebral canal through which the spinal cord and nerves pass.

Laminectomy

This procedure involves removing the entire bony lamina, the arch of the spine, over the affected vertebrae, to create more space for the spinal cord and nerve roots. It is designed to decompress the spinal cord and nerve roots to relieve pain, weakness and numbness in the legs or arms, and loss of bowel and bladder control, and to improve function. It may be performed as an open procedure or as a minimally invasive procedure typically performed under general anesthesia.  It can be used for back or neck pain from spinal stenosis.

• A traditional laminectomy is performed as an open procedure. It involves an incision of several inches made above the area of the spine that is affected, and soft tissues and muscles are cut to allow access to the spinal cord and nerves. In addition to decompression, Dr. Girardi may also remove arthritic facet joints, a portion of thickened spinal ligaments and bone spurs. The benefit of this procedure include the ability to access the spinal column directly, which may be necessary in cases of severe spinal stenosis. The risk is a possible increase in spinal instability. A hospital stay of one to two days are necessary. Full recovery can take up to six months.
• Minimally invasive laminectomy involves the use of an endoscope, tubular retractors and small incisions. The tubular retractors separate the tissues which avoids cutting. Dr. Girardi may wear special glasses, use surgical microscope or an endoscope to magnify and illuminate the surgical field.

He will decompress the area and use special instruments to remove bone spurs and other structures that are putting pressure on the spinal cord and nerve roots. The advantages of this minimally invasive procedure are the less damage to soft tissues, less blood loss, small incisions and faster recovery.

Dr. Girardi will determine whether you are a candidate for open or minimally invasive laminectomy.

Laminotomy

A laminotomy is less invasive than a laminectomy. It leaves in place the natural bony support of the lamina which decreases the risk of spinal instability. A small incision is made, and a small portion of the lamina is removed. A portion of the spinal ligaments is removed to decompress the spinal cord or nerve to alleviate symptoms.  Laminotomy may be performed using a minimally invasive approach, such as a micro-laminotomy using an endoscope, or using an open surgical technique. The choice of surgical approach will depend on several factors, including the severity of the stenosis, the patient’s age and overall health, and any other medical conditions.

Foraminotomy

A foraminotomy is a surgical procedure that enlarges the foramen, which is the opening in the spinal column that allows the nerve roots to exit the spinal canal and branch out to other parts of the body. This procedure is typically performed to relieve pressure on a nerve root that has become compressed or pinched due to conditions such as spinal stenosis, herniated discs, or bone spurs. A foraminotomy can be performed during open surgery or minimally invasive techniques. The goal of the procedure is to alleviate the symptoms of nerve compression, such as pain, numbness, tingling, or weakness in the arms or legs.

The benefits minimally invasive spine surgery are less blood loss, smaller incisions, less muscle damage, and faster recovery times. Full recovery from. minimally invasive decompressions surgery can take up to three months, but depends on the extent of surgery, and the patient’s overall health.

Stabilization surgery

When the patient has spinal instability or laminectomies to multiple vertebrae, the spine can become unstable. The treatment is surgical spinal fusion. It is a surgical procedure in which two or more vertebrae in the spine are permanently joined together, or “fused,” to provide stability to the spinal column. The goal of spinal fusion is to eliminate motion between the affected vertebrae and reduce pain or discomfort caused by certain spinal conditions, such as degenerative disc disease, spinal stenosis, scoliosis, and herniated discs.

During a spinal fusion procedure, any damaged or diseased vertebral disc material is removed, and bone graft material is placed between the vertebrae. The bone graft material can be taken from the patient’s own body (autograft) or from a donor (allograft). Metal rods, screws, and other hardware may be used to hold the vertebrae in place while the bone graft heals and fuses the vertebrae together. This is major surgery and can require up to a year or more to achieve full recovery.