What is spinal stenosis?
James S. Hawkins, MD, is a spinal surgery specialist on staff at Banner Estrella Medical Center.
Question: My father has significant leg pain when standing or walking. He has been told by his physician that he has spinal stenosis. Is it necessary for him to have a surgery and are there less invasive solutions?
Answer: Significant leg and buttock pain that occurs with standing or walking and resolves with sitting, bending forward or lying down are the classic symptoms of spinal stenosis. There are some new and exciting solutions to this problem.
Traditionally, spinal stenosis in the elderly is common and can be debilitating. They will have only limited improvement of symptoms over time and some will actually worsen. Typically the first treatments are physical therapy, anti-inflammatory medicines, and possibly epidural steroid injections. If these fail to provide relief and all other causes for the symptoms are eliminated, then surgery is often recommended.
The traditional surgery for spinal stenosis is a lumbar decompression. This involves removing a portion of the bone and ligament by performing a laminectomy or laminotomy to take pressure off the nerves to the legs. There is, however, a new procedure to decrease the spinal stenosis and thereby the debilitating leg and buttock pain by placing a spacer in the lower lumbar spine. This intraspinous spacer has been recently approved by the FDA and has had excellent results thus far.
The idea of the spacer is to maintain the normal distance between the bones in the lumbar spine and to prevent the collapse and subsequent pinching of the nerves when the patient stands. The spacer is placed with a simple surgery. With the spacer in place, when the patient stands the distance between the bones is maintained and there is less in folding of soft tissues so the nerve is not pinched.
One of the key benefits of the device is that there is no bone or any significant ligaments removed. It is a relatively small incision with little muscular stripping. Most patients will do this under general anesthetic, but some can be just with local medicines only. It is also typical for the patient to go home the same day of surgery or outpatient procedure.