Canal stenosis occurs when the spinal canal becomes too narrow, placing pressure on the spinal cord and/or nerve roots. In this article, we will describe the procedure of spinal canal stenosis surgery, its risks, and the recovery process.
The spinal cord is a part of the central nervous system that exits the base of the brainstem and extends down through the spinal canal. The spinal canal also houses the spinal nerves. Stenosis, or narrowing of the spinal canal can occur in one or more areas of the spine. Spinal stenosis is a degenerative pathology that usually occurs at older ages, and usually progresses slowly.
Types of canal stenosis
Canal stenosis is classified according to the area of the spinal column where it occurs:
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Lumbar canal stenosis, when it is found in the lumber spine, between the L1-L5 vertebrae. It has various symptoms, including low back pain, radiated pain, or weakness in the legs. The symptoms are usually relieved by bending over forward either from a standing or sitting position.
- Cervical canal stenosis, when it is found in the cervical spine, between vertebrae C1-C7. Symptoms include pain and stiffness in the neck, numbness and tingling, loss of strength in arms and hands, loss of balance and dizziness.
If you have symptoms of spinal stenosis, your doctor may first try conservative treatments before recommending surgery. The most common conservative treatments are analgesic medications to relieve pain, corticosteroid injections that provide pain relief for a longer period of time, and physical therapy and exercise sessions to strengthen your back muscles, help maintain the flexibility and stability of your spine, and improve balance.
Most patients with lumbar or cervical stenosis respond well to such non-surgical treatments, but if there is no improvement and the pain is such that it interferes with your ability to lead your normal daily life, or if you suffer progressive neurological symptoms, your doctor may recommend surgery.
The causes of spinal stenosis can be classified into three groups: degenerative – a result of changes in the tissues of the spine due to natural degenerative processes; congenital -- present from birth due to changes in the spinal tissues during embryonic development; and traumatic – originating with an injury that causes changes in the tissues of the spine. There may also be other causes such as tumors.
What is involved in canal stenosis surgery?
The spine specialists at Instituto Clavel consider canal stenosis surgery when the symptoms such as weakness, numbness, or pain in the extremities indicate severe or progressive compression of a nerve or the spinal cord.
One of the main goals of lumbar or cervical stenosis surgery is to decompress the area of the spinal cord and/or nerve roots. By giving them more space, the inflammation of the nerves will decrease and so will the pain. The operation is also expected to increase motor strength in the patient’s limbs.
There are two types of surgery typically used for canal stenosis: decompression, in which the surgeon will remove tissue pressing against a nerve structure, leaving more space within the spinal canal or foramen where the nerve exits; and stabilization, to limit movement between the vertebrae (for example in cases of vertebral listhesis).
To remove the tissue pressing on the nerve, the surgeon will perform one of these types of surgery:
- Decompressive laminectomy. This is the most common procedure, and can either be a lumbar laminectomy or a cervical laminectomy. In this procedure, the posterior part of the affected spinal bone is removed, to create more space around the nerves and relieve pressure on them.
- Hemilaminectomy. This type of surgery is recommended for patients with unilateral symptoms and stenosis. The procedure involves resecting the lamina on the affected side, while conserving the integrity of the interspinous and supraspinous ligaments, minimizing spinal instability.
- Discectomy and fusion. Disc degeneration sometimes plays a key role in narrowing the intervertebral foramen and causing canal stenosis. In these cases, it may be necessary to remove the degenerated disc, fill the space between the bones and fuse the adjacent vertebrae.
Here's a video about lumbar laminectomy:
Risks of canal stenosis surgery
As with any surgery, there are possible complications. People who smoke, who are elderly, or overweight, have diabetes, or have several medical problems, are more likely to be at risk when undergoing canal stenosis surgery.
Among the possible risks and complications, there is the possibility of infection, bleeding, a tear in the membrane covering the spinal cord and nerves (cerebrospinal fluid fistula); or nerve damage.
Recovery after canal stenosis surgery
After a laminectomy, the patient’s recovery and rehabilitation are addressed on an individualized basis. As a rule, the patient will be able to start walking the day after the operation, and can expect to be discharged from the hospital within 48 hours. One week after surgery, the patient will have an appointment to get their stitches removed and make sure that the surgical incision has healed properly. About four to six weeks later, the patient will see the surgeon for a follow-up evaluation.
We recommend that the patient take daily walks even in the first weeks after surgery, but they should not try to resume most physical activity until about 10 weeks after the operation. At that time, with the guidance of the physical therapy or rehabilitation team, the patient may begin with low impact exercises. Learn more about rehabilitation after lumbar spinal stenosis surgery here.
At Instituto Clavel we are always at your disposal to answer any questions you might have about canal stenosis or any other spinal condition. If you want to know more about canal stenosis surgery and rehabilitation afterwards, do not hesitate to contact our team.
Categories: Surgery, Cervical pain, Lumbar pain