Guide to Advanced Surgery for The Spine
Why Choose Cedars-Sinai Marina del Rey Hospital for Spinal Stenosis Treatment?
The highly skilled and well-trained spinal surgeons at Cedars-Sinai Marina del Rey Hospital will evaluate patients with spinal stenosis and provide individualized treatment advice. Depending on the symptoms and severity of your condition, our doctors will choose from the many non-surgical and surgical treatment options available and come up with a plan that is right for you.
Spinal stenosis is a condition characterized by the abnormal narrowing of the spinal column, which is where the spinal cord runs. Stenosis usually occurs due to lesions or deposits inside the column. These lesions may affect any part of the spine, but they most commonly occur in the lower back and neck areas. Spinal stenosis can exert pressure on the spinal cord and its nerves.
The two types of spinal stenosis are lumbar stenosis and cervical stenosis. Lumbar spinal stenosis is more common, but cervical spinal stenosis causes more danger as it involves compression of the spinal cord.
Lumbar stenosis is associated with the compression of the spinal nerve roots in the lower back area, which causes symptoms linked to sciatica, such as tingling, weakness, or numbness radiating from the lower back and into the buttocks and legs (particularly when engaging in physical activity).
Cervical spinal stenosis is even more dangerous, as it compresses the spinal cord and leads to a series of serious symptoms, such as major weakness in the body and possibly paralysis. Spinal stenosis can develop as a result of advancing age, degenerative disc disease, and developmental problems in the spine before birth, and several other diseases, such as arthritis, scoliosis, osteoporosis and lordosis (swayback), obesity, genetics, or poor body posture.
Surgical Procedures for Spinal Stenosis Performed at Cedars-Sinai Marina del Rey Hospital
Surgery for spinal stenosis is considered when non-surgical treatments fail to bring relief, or when the patient is immobilized due to their condition. The purpose of surgery is to alleviate the pressure on the spinal cord by increasing the space in the spinal canal. On an imaging test, if the spinal cord or nerves are found to be tightly squeezed, the doctor may recommend any of the following surgical procedures to relieve the pressure. This surgery may be done either from the front or back of the neck and involves the removal of some of the disc bones and tissue that may obstruct the nerve roots. In the case of patients who have severe spinal instability, spinal fusion is done in addition to decompression surgery. Spinal fusion involves removing a small piece of bone from the hip and grafting it onto the spine with metal plates and screws, which will give support and stability to the spine.
The surgical procedures used to treat spinal stenosis include:
- Laminectomy: In this procedure, the back portion (lamina) of the affected vertebra is removed or connected to the adjoining vertebrae with a metal plate or a bone graft. This process helps in strengthening the spine.
- Laminotomy: in this procedure, a hole that sufficiently relieves the pressure at a particular spot of the lamina is created.
- Foraminotomy: In this procedure, the area where the nerve roots exit the spinal canal (foramen) is enlarged to create more space.
- Decompressive laminectomy: The most commonly performed surgery for spinal stenosis disorder, in which the lamina of the vertebrae is removed, creating more space in the spinal canal for the nerves.
- Discectomy: In this procedure, the herniated or bulging discs are removed to increase the canal space.
- Laminoplasty: This procedure is carried out on the neck vertebrae by creating a hinge on the lamina. This, in turn, opens up space within the spinal canal. A metal part is then positioned to bridge the gap in the opened section of the spine.
All of these surgical procedures are performed to create additional space in the spinal canal and to relieve the symptoms of spinal stenosis disorders. However, following surgery, some patients may face different problems, such as infection, tearing of the membrane, blood clots in the legs or veins, and other neurological defects.
Drugs and Other Treatments for Spinal Stenosis
The treatment for stenosis may vary based on the location of the stenosis and the severity of the symptoms.
Steroid injections »
Exercise and physiotherapy »
Thoracic Stenosis »
Cervical Spinal Stenosis »
Lumbar Spinal Stenosis »
Symptoms of Spinal Stenosis
- Numbness and tingling in the arms, legs, hands, and feet
- Weakness and imbalance while walking
- Pain or feeling of cramps in the legs after standing for a long period of time or while walking. The pain usually goes away when the person bends forward or sits down
- Pain in the lower back and buttock region
Diagnosis of Spinal Stenosis
As the symptoms of spinal stenosis and the symptoms of age-related conditions are similar, diagnosis may be difficult. Imaging tests give an accurate view of the stenosis. Other diagnostic procedures used to confirm a stenosis diagnosis are:
- Medical history: A doctor will need to know about a patient's symptoms, history, injuries, and other health-related incidents to derive a proper diagnosis.
- Physical examination: A doctor will have a patient perform certain activities to help them learn more about the stenosis.
- Blood test: This is usually done to rule out other diseases, such as multiple sclerosis and vitamin B12 deficiency.
- Imaging tests:
- X-rays: X-rays can help identify any changes in the bones, such as bone spurs. These spurs may narrow the space within the spinal column.
- Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) is the best imaging test for diagnosing different types of stenosis. This test is more beneficial than an X-ray because it creates a clear cross-sectional image of the spine and arteries. This scan uses powerful magnetic and radio waves to show any damage to the discs or ligaments, as well as the presence of plaques and tumors. MRI tests can also show if there is any pressure being exerted on the spinal cord or its nerves.
- CT myelogram: A CT scan combined with a myelogram provides an excellent picture of the nerve details when it is performed during an examination of back pain. CT myelogram involves the injection of a radiographically opaque dye that gets absorbed into a sac present around the nerve roots. The CT scan shows how the bone is affecting the nerve roots. CT myelogram is a sensitive test to detect nerve impingement and can be used to identify even minute scratches and injuries.
- Computer Axial Tomography: CAT scans are often used for the diagnosis of spinal stenosis. In this scan, X-rays are projected and the cross-sectional image is viewed on a monitor.
Risk Factors for Spinal Stenosis
Most patients diagnosed with spinal stenosis are over the age of 50. When spinal stenosis occurs in younger people, it may be due to a genetic disease affecting the bone and muscle development throughout the body. Advancing age is a major risk factor for lumbar spinal stenosis because it is associated with spinal degeneration. Another risk factor is osteoporosis, as this disease can cause compression and fracture of the lumbar vertebrae. The size of a patient's spinal canal and the degree of impingement of the surrounding ligaments and bones onto the spinal canal are also risk factors.
Causes of Spinal Stenosis
Most of the time, spinal stenosis develops when there is a reduction in the amount of space available within the spinal column. Causes of spinal stenosis may include:
- Overgrowth of bone: Growth of spinal bones into the spinal canal may decrease the space in the spinal column. This may happen due to wear and tear damage that occurs due to osteoarthritis of the spinal bones. A bone disease called Paget’s disease can also cause bone overgrowth in the spine.
- Herniated disks: The soft pads that act as shock absorbers between the vertebrae may dry up as a person gets older. Due to cracks on the outer surface of the disk, some of the material may break away and exert pressure on the spinal cord and its nerves.
- Thickened ligaments: The ligaments that hold the bones of the spine together may thicken and become stiff over time. These thickened ligaments can swell into the spinal canal.
- Tumors: Sometimes, abnormal cancerous growth can develop inside the space between the spinal cord and vertebrae, or within the membranes that cover the spinal cord. People born with a small spinal canal are vulnerable to this type of disorder.
- Spinal injuries: Accidental trauma can cause dislocations or fractures of one or more vertebrae. Broken bone due to a spinal fracture can damage the spinal canal. Surgery may also lead to swelling of adjacent tissues, which exerts pressure over the spinal cord and its nerves.
Causes of Cervical Spinal Stenosis
Changes in the shape and size of the spinal canal are a major cause of cervical stenosis. Normally, these changes occur in people above the age of 50. Advancing age results in bulging of the spongy discs that sit in between the bones of the spine. The ligaments that connect the spinal bones may thicken or get destroyed, resulting in excessive growth of bones in the joints. These conditions can decrease the space in the spinal canal, which eventually leads to cervical spinal stenosis.
In some cases, the spinal canal is narrowed at birth as the result of developmental defects in the bones.
Hot or cold therapy: The application of heat or ice packs on the affected area of the neck or lower back can relieve the symptoms of spinal stenosis to a certain extent.
Adopting healthy lifestyle habits can greatly contribute to preventing spinal stenosis. As a person gets older, their spinal bones are subjected to continuous wear and tear. Some proactive measures can help in preventing the wear and tear of the spine, and thus, in preventing the development of spinal stenosis. These measures include:
- Diet: Avoid or decrease your intake of red meat, salt, sugar, solid fats, and refined grains. Eat plenty of fruits and vegetables. Low-fat milk and dairy products may be consumed.
- Physical exercises: Regular physical exercise can help in controlling body weight by burning down excess fat. It also helps in improving the flexibility of your body.
- Avoid smoking: Research has found that smoking weakens intervertebral discs and causes back pain, which in turn contracts the spinal canals. Also, smoking decreases your bone density, making it vulnerable to vertebral fractures.
- Maintain a healthy weight: Your spine supports your entire body weight and allows the forward and backward movement of your body. Increased weight compresses the intervertebral discs in the spine, and as a result, the chance of developing spinal stenosis increases.
- Improve flexibility: Practicing flexibility and stretching exercises daily can strengthen the ligaments in the spine and reduce the risk of undergoing disc and ligament degeneration.
Are you experiencing symptoms of spinal stenosis? If you have lower back pain, or numbness and weakness in your legs, the spinal surgeons at Cedars-Sinai Marina del Rey Hospital can help advise you on a course of treatment.