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Spinal stenosis causes the spine to become narrowed. It usually affects those older than 50, but can affect those of all ages. As the spinal canal narrows, pressure is placed on the spinal cord and nerves which can result in pain. For many patients, non-surgical methods are not effective, causing patients to need back surgery for spinal stenosis. Surgery is done to widen the spinal canal and relieve the pressure the narrowing was causing.
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Decompressive laminectomy is the most common type of surgery performed for this condition. It involves making more space for nerves by removing the roof of the vertebrae. The surgeon may or may not use fusion.
A laminectomy involves only removing a small piece of the lamina. The purpose is also to relieve nerve pressure.
A medial facetectomy involves removing part of the facet. This is done to increase space.
A foraminotomy involves removing the formain. This is done to make more space over a nerve canal. This may be done with a laminectomy or alone.
A cervical corpectomy involves removing a part of a vertebrae and any adjacent intervertebral discs. This is done to decompress the spinal nerves and cervical spinal cord. To stabilize the spine, the surgeon may use screws and a metal plate along with a bone graft.
An anterior discectomy and fusion involves making a small incision in the anterior neck to reach the cervical spine. The surgeon them removes the intervertebral disc and replaces it with a small plug of bone. Over time, this will fuse the vertebrae.
A laminoplasty involves getting to the cervical spine through the posterior neck. The surgeon then reconstructs the cervical spine's posterior elements to create more space for the spinal canal.
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Patients will spend at least a few days in the hospital following surgery. How long depends on several factors, such as how well the surgery went, the patient's general health and the type of surgery performed. Once home, the patient will be instructed on how to go about increasing activity levels. It will take several weeks before the patient is able to return to work, regular household chores and strenuous activities and his or her doctor will guide them through this.
Pain is normal following surgery on the spine. While in the hospital, pain will be controlled by a medical team. Once the patient goes home, his or her doctor will send home prescription medications and pain medications will be included. The patient should take these exactly as prescribed. If they are not adequately controlling pain, the patient should consult his or her physician.
After a couple of weeks, the patient will begin rehabilitation. This will involve physical therapy exercises to strengthen, increase flexibility and improve range of motion. This will be done under the direction of a trained health care professional.
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Every surgery carries risks. The risks that could occur with any surgical procedure include bleeding, blood clots, infection and anesthesia reactions.
Those who are elderly, diabetic patients, those with many health problems, overweight patients and smokers are at a higher risk for complications.
Complications specific to back surgery for spinal stenosis may include the bones not fusing to heal, nerve injury, failure to relieve symptoms, dural tear, failure of rods or screws, need for further surgery and return of symptoms.
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American Academy of Orthopedic Surgeons. (2009). Lumbar Spinal Stenosis. Retrieved on March 22, 2011 from the American Academy of Orthopedic Surgeons: http://orthoinfo.aaos.org/topic.cfm?topic=a00329
American College of Rheumatology. (2006). Spinal Stenosis. Retrieved on March 22, 2011 from the American College of Rheumatology: http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/stenosis.asp