Spinal stenosis surgery is considered for symptom management after conservative measures have resulted in little improvement in spinal stenosis symptoms. The operation will be decided upon by you and your healthcare provider if you are an appropriate candidate for spinal stenosis surgery and scheduled at a hospital several weeks in advance.
Make sure to arrive early several hours before the time of your scheduled surgery to give yourself time to navigate the hospital and fill out all necessary paperwork.
Before the Surgery
On the day of your spinal stenosis surgery, you will be taken to a pre-operative room where you will be asked to change into a gown. You will undergo a brief physical examination and answer questions about your medical history from the surgical team.
You will lay down on a hospital bed and a nurse will place an IV in your arm or hand for delivering fluids and medications. The surgical team will use the hospital bed to transport you in and out of the operating room.
You will be taken into the operating room equipped with an operating table and several screens, monitors, and medical technology for assessing your status before, during, and after the operation. The surgical team will assist you onto the operating table and you will be given anesthesia medication to put you to sleep for the surgery.
Once sedated under anesthesia, you will be intubated with an endotracheal tube that will be connected to a ventilator to assist you with breathing during the surgery. You will already be sedated and asleep before this part of the procedure and will not feel anything.
The surgical team will sterilize the skin around the area of your back where an incision will be made. An antiseptic solution will be used to kill bacteria and prevent the risk of infection. Once sanitized, your body will be covered with sterilized linens to keep the surgical site clean.
During the Surgery
There are several different techniques that can be used for surgical management of spinal stenosis depending on what the root cause of the issue is. Spinal stenosis surgery may include one or more of the following:
- Discectomy: a procedure to remove a damaged disc between vertebrae of the spine
- Laminectomy: a procedure to remove a portion of the vertebrae, especially if there is a bone spur
- Foraminotomy: a procedure to widen the foramina, the openings in the vertebrae where the nerve roots exit from the spinal cord
- Spinal fusion: A procedure where two or more vertebrae are fused together
It is possible that the surgeon may not know the full extent of surgical work to be performed until the operation is started. Always confirm with your healthcare provider about what procedure you will be undergoing and ask about the possibility of whether you may need additional surgical work during the operation.
For all procedures, the surgeon will make an incision vertically along the spine to access the problematic vertebrae that are causing your spinal stenosis symptoms.
Discectomy
If a bulging or herniated disc is causing compression of the spinal cord or nerve roots, a small portion of the disc that is causing the compression will be removed in order to relieve pressure from surrounding structures. This can be accomplished by either an open discectomy or a minimally invasive discectomy.
An open discectomy is performed by making an incision 1-2 inches in length for a single vertebral level. The muscles of the back are pulled to the side with a retractor in order to expose the vertebrae of the spine.
For a minimally invasive discectomy, a small incision less than 1 inch in length is made along one of the sides of the spine and a small tube is inserted into the space between adjacent vertebrae.
This tube will be used to separate the back muscles and create a tunnel that will allow the surgeon to access the vertebrae of the spine and insert a camera, light, and surgical tools to remove the desired disc portion.
In both cases, most of the disc will remain intact. During the operation, X-rays will be used to verify the correct level of the spine.
Laminectomy
If bone spurs, or excessive bone growth called osteophytes, have formed in the spine due to arthritic and degenerative changes, a laminectomy can be performed to remove the bony lamina portion of a vertebra to decrease compression of the spinal cord or nerve roots:
- An incision 1-2 inches in length will be made along the spine to access the affected vertebrae and X-rays will be used to confirm the correct location.
- A bone drill will be used to first saw through and remove the spinous process and then the lamina of each affected vertebra to remove portions of bone.
- The ligamentum flavum, the thick ligament that connects one vertebra to another, will also be cut and removed at the level of the affected vertebral segments as well as any excess bone growth or bone spurs.
Foraminotomy
If the openings between the vertebrae, or foramina, where the nerve roots exit from the spinal cord become narrowed, a foraminotomy may be performed. A surgical drill is used to enlarge the foramina to decrease pinching of the exiting spinal nerve roots.
This procedure is usually performed similarly to a minimally invasive discectomy where an inserted tube is used to separate the back muscles and allow access to the vertebrae of the spine. Minimally invasive procedures cause less disruption to the back muscles and may shorten recovery time.
It is common for discectomies, laminectomies, and foraminotomies to all be performed at the same time to free up more space in the spine to decrease compression and alleviate related symptoms. These procedures typically take one to two hours to complete in total depending on how many vertebrae are affected.
Spinal Fusion
In certain cases, a spinal fusion may need to be performed in which the disc between adjacent vertebrae is completely removed and the vertebrae are fused together with metal rods and screws. A spinal fusion may be required if:
- An entire disc is causing severe spinal cord and/or nerve root compression and needs to be removed
- Multiple laminectomies were performed, making the spine unstable
- One vertebra has slipped forward over another, requiring stabilization
Spinal fusion surgery requires a bone graft to act as a spacer between vertebrae where the disc was removed. If laminectomies were performed, the portion of bone removed from the vertebrae can be used as a spacer between the vertebrae.
Alternatively, a small section of bone can be harvested from the top of the pelvis called the iliac crest through a small incision along the top of the hip. Metal rods and screws are drilled into the vertebrae to insert the bone graft and help hold the two vertebrae segments together. The surgery usually takes three to four hours to complete.
Once any and all procedures are completed, the surgeon with suture the incision together with stitches and a bandage will be placed over the incision site.
After the Surgery
After the incision is sutured up with stitches, the anesthesia medication will be removed. The breathing tube will be removed as you slowly begin to wake up from the anesthesia and you will be transported to a recovery room where your heart rate, breathing, and blood pressure will be monitored.
After surgery, you will spend several hours in the recovery room with access to medical staff 24 hours a day to address your needs after the operation. Your length of stay in the hospital will vary based on the type of procedure performed.
For a discectomy, laminectomy, or foraminotomy, you can expect to stay one to two days. For a spinal fusion surgery, you can expect to stay three to four days in the hospital for observation to make sure you are stable and your pain is controlled before you are sent home.
You can expect to receive a visit from a physiatrist, a rehabilitation medicine doctor that will help manage your pain levels and symptoms after surgery.
A physical therapist will also visit your room to assess how you are able to move after the operation, including getting in and out of bed and walking. The physical therapist will also ask you questions about your living arrangements at home to make sure that you are able to be safely discharged.
If you live alone and/or need significant help with everyday tasks like getting out of bed, walking, and going to and from the bathroom, you may need to be sent to a subacute rehabilitation facility before being able to safely return home.
A Word From Verywell
Because the issue behind your spinal stenosis symptoms is not always the most clear on imaging like X-rays or magnetic resonance imaging (MRI), the surgeon performing your surgery may not know the full extent of what surgical work needs to be performed until an incision is made and the spine is clearly visible in the operating room.
Make sure to consult with your healthcare provider about what procedures are intended and ask about the possibility of requiring further work than originally anticipated so you know what to expect.
