Decompression surgery for spinal stenosis

What is it?

Spinal stenosis occurs when the spinal cord (cervical and thoracic spine) or nerve roots (lumbar spine) become compressed in the spinal canal. This is usually from a combination of age-related wear and tear changes such as arthritis in the facet joints, disc bulge and overgrown ligament.

In the low back (lumbar spine), spinal stenosis usually causes symptoms such as aching, pain and numbness down the legs when upright. Spinal stenosis can cause progressive reduction in walking distance and standing time. Symptoms may be relieved by sitting and may cause you to walk with a stooped forwards posture.

In the neck and chest (cervical and thoracic spine), spinal stenosis can cause symptoms of spinal cord compression such as numbness and tingling in the hands or feet, loss of hand dexterity and unsteadiness when walking.

Diagnosis and treatment options 

If it is suspected that you have spinal stenosis, then it is likely that you will be recommended to undergo an MRI scan of the affected area of your spine. You may also need a spinal X-ray to look for instability of the spine.

Treatment of spinal stenosis is either:

• Conservative: pain relief and physiotherapy or
• Surgical: decompression (an operation under general anaesthesia)

The best treatment for you will depend on the severity and duration of your symptoms as well as your individual risk-profile for surgery. All treatment options will be fully discussed with you.

Outcomes and complications

Outcomes for lumbar decompression for stenosis are good with more than 80% reported improvement in leg symptoms and walking function. (Spine Tango data)

Cervical or thoracic decompression for stenosis is aimed at preventing further deterioration in spinal cord function and has an 80-90% success rate. Up to 60% of patients report some improvement in spinal cord function, but it is usual for some symptoms of spinal cord dysfunction to remain. (Spine Tango data)

As with all surgery there is always some risk of complication. These will be discussed prior to going ahead with any procedure. For this type of surgery, risks include:

• Wound infection - 2-3%
• Bleeding - 1%
• Spinal fluid leak - 5%
• Spinal pain worsens - less than 5%
• Nerve or spinal cord injury causing numbness, weakness or paralysis in the limbs or problems with bladder, bowel or sexual function - less than 1 in 1000
• Complications associated with general anaesthesia (heart problems, chest complications, blood clots, infection) - these risks may increase with certain medical conditions

Data from Spine Tango.