Why?

Spinal stenosis is a frequently occurring and debilitating condition that limits patient’s activity levels.

Within the aging lumbar spine thickening of the ligamentum flavum and increased size of the lumbar facet joints at the back of the spine occurs causes narrowing of the spinal canal. This results in pressure on the nerve roots and central neural elements.

With exercise patients may experience leg pain and describe a feeling of heaviness within the legs. The condition is often associated with lumbar back pain.

In an attempt to relieve the pressure on the nerves, patients tend to stoop forward when walking, rest intermittently and ultimately they are forced to limit their activity levels.

Physiotherapy and Analgesics

The course of the problem has some uncertainty, but a general rule can by applied that with physiotherapy and analgesics 20% will improve with time, 60% will stay the same and 20%will worsen with time.

Nerve Root Sleeve Injections (NRSI)

NRSI means an injection around a nerve root and is used both therapeutically and diagnostically. Therapeutically, to relieve leg or arm pain, which is produced by pressure on a nerve root, or diagnostically to help determine which area within the spine is the cause of the problem. This can be extremely useful when surgery is being planned.

Caudal Epidural

The epidural space lies outside the spinal nerves but still within the central spinal canal. The needle is placed within this space and is similar to a NRSI, but treats several nerves. This is beneficial if several areas are affected, such as in central spinal stenosis, but does not have the same diagnostic ability as a NRSI.

Prior to surgery

Prior to surgery you will be explained the natural history of the condition (what is likely to happen without treatment). Other treatment options will then be discussed and the surgical procedure will be explained including the postoperative care and potential complications (see Complications), prior to you consenting to undergo the operation.

Spinal Decompression

Following a general anaesthetic the patient is placed on their front. Bone a soft tissue is removed from the back of the spine to directly relieve the pressure from the nerves.

X-Stop (Interspinous Process Distraction Procedure)

Traditionally when conservative treatment of spinal stenosis has failed the only surgical option available was a spinal decompression or laminectomy. The pressure on the nerves is relieved by directly removing the ligamnetum flavum and bone that is causing the neural compression. This can be an involved surgical procedure and may not be suitable for all patients.

More recently a technique allowing decompression of the nerves by indirect means has been established. The X-stop is an interspinous distraction device that is surgically inserted between the spinous processes of the affected segments of the lumbar spine. This device distracts the lumbar segment and holds it in a degree of flexion, creating a larger area within the spine and consequently relives the pressure on the nerves without requiring the exposure of the nerves.

Results have shown a significantly better clinical outcome in patients treated with the X-stop compared with patients undergoing conservative treatment for spinal stenosis.

This procedure is less invasive way of managing spinal stenosis, most suited in patients for whom a lengthy general anaesthetic is inappropriate and rapid post-operative mobilisation is necessary.

Post operative care

On the evening of the surgery or the following day you will be able to mobilise with the help of the nursing staff. Because the surgery is not invasive, patients are generally able to do this sooner than following a decompression. You will reviewed by your operating surgeon the day after surgery and the majority of patients will go home that day. You will be seen by a physiotherapist prior to discharge home and encouraged to mobilise as much as possible. Plans will be made for physiotherapy treatment within the outpatient department.

How long until I am better?

When pressure is taken off a nerve the first symptom to improve is pain, which may be immediate. It takes a longer time for muscle weakness to improve. If there has been any muscle wasting (loss of muscle bulk) this frequently never recovers, even though the strength often does. The last symptom to improve is numbness, which sometimes never recovers fully. After surgery it is not uncommon to have various aches and pains in and around the wound, and in the bony pelvis, hips and thighs. These usually improve with time. For the first few weeks postoperatively, your sciatica may return because of nerve swelling. It is not suitable for all patients with spinal stenosis.