Lumbar spinal stenosis
When the spinal canal in the lower back narrows it is known as lumbar spinal stenosis. You may suffer pain, weakness and even tingling in the leg. A lumbar laminectory procedure could give you relief from the condition so we are listing everything you need to know about the condition and the procedure. If you are well informed you can make a better decision about the surgery. Any questions that remain after reading this leaflet can be answered by your specialist or the medical team.
What causes spinal stenosis?
Some people are born with the problem but it is more likely that natural deterioration with age causes the spinal canal to narrow and ligaments to thicken. Arthritis or other bone problems can take their toll too.The spinal canal carries your spinal cord from your brain. It is protected by a tunnel formed by the curved bones or vertebrae of the spine. It is clever engineering – each vertebrae is connected to a facet bone and spongy discs separate them. Also vying for space in the canal are the spinal nerves and blood vessels. The nerves communicate with the brain to activate muscle movement and also with the skin to register touch and pain. A narrow canal leaves less room for the nerves and the blood vessels to perform at their best. Symptoms you might recognise if you suffer with this are exercise and standing for a time can mean problems with walking and pains and tingling in your leg. You may find some relief when you sit down or bend over.
a) Cross-section showing a normal spinal canal
b) A disc bridge pressing the nerves within the spine
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The positives about surgery
Relief from the leg pain and better mobility are the two most obvious positive reasons for surgery. At the same time the procedure stops the worsening of the condition.
Sufferers with severe symptoms or symptoms that are getting worse will find that surgery is to be expected. However if you are lucky enough to only suffer mild symptoms the surgery may not be advised.
Turning down surgery
Some people do get better over time but it is more likely your condition will get worse. Surgery can be reconsidered then.
A surgeon will take a maximum of three hours to complete this task and may even complete in an hour. An MRI scan confirms the exact site of the problem for the surgeon. The medical team will also check several other things including the operation you are expecting. With several anaesthetic techniques available, your anaesthetist will advise on the one right for you. Sometimes an antibiotic is given during surgery to help lessen the chances of infection. The surgeon will make a cut in the centre of your lower back and will access your spine by parting your muscles. This allows access for the removal of the ligament and bone to create the necessary additional space for the nerves and blood vessels to work properly.
Bone and ligament removed
a) Top View
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The surgeon will close the wound with stitches or clips; occasionally a tube or drain will be inserted to improve healing. This is usually removed after a day or two.
Important information about medication
Make sure you let your medical team know about any medicines you are taking before the procedure takes place. This includes blood-thinning medicine, herbal or other complementary medicines, dietary supplements and over-the-counter drugs.
Preparing for surgery
Adhering to this list will help your surgery go without problems:
- Stop smoking as soon as you know about the operation and preferably a few months beforehand. Nicotine does not aid healing but slows it down. Cutting out smoking will improve your chances of not suffering complications after the operation and of course is better for your general health.
- Lose weight or maintain a healthy weight. Again extra weight can add to post-surgery problems.
- Take regular exercise. As long as the exercise is approved by your doctor this will put you in the best place before surgery and help you to make a good recovery.
Reduce post surgical infection
- Do not wax or shave the area for a minimum of one week before surgery.
- Take a bath or shower on the day of the operation or at least, the day before.
- Make sure you are warm before and after surgery. Tell the medical team if you feel cold.
While the medical team will take every possible precaution to avoid any problems during or after surgery, it is worth knowing what the risks are.
These will be explained to you by your anaesthetist.
- Pain. Medicine will be prescribed and should be taken as instructed.
- Bleeding can occur during or after the operation. Extradural haematoma, to give it its correct term, may put pressure on your nerves and another operation may be the answer. The risk is 1 in 125.
- Problems with urinating. About 1 patient in every 125 suffers from this problem. Treatment usually involves inserting a catheter into the bladder to rectify the problem. The catheter is usually removed in one or two days.
- Infection of the wound. The risk is 1 in 40. You may usually take a shower three to four days following the surgery. Before this, alert the medical team if you feel you have a high temperature, or notice pus coming from the wound, if the wound looks red or is sore or painful. The usual treatment is a course of antibiotics but in some circumstances a second operation is necessary.
- A blood clot in the leg known as deep vein thrombosis or DVT. The risk of this is 1 in 125. The medical team will have you out of bed the day after surgery to prevent this. However you should tell them immediately if you notice any of these symptoms: leg pain, swelling or redness or veins near the surface that look noticeably larger. If a clot does form it is treated with medication or injections. You might also be asked to wear a special stocking.
- A blood clot in the lung (pulmonary embolus) that has travelled along your bloodstream. You should act immediately if you feel any of the symptoms: pain in the chest or upper back, shortness of breath or coughing up blood. Tell the medical team or call an ambulance if you are at home.
- Chest infection will be treated with antibiotics and physiotherapy.
- Heart attack or stroke (when the brain stops because the flow of blood to the brain is interrupted). These are serious conditions and you should let your medical team know immediately.
Problems specific to this procedure
- Continuing pain and numbness in the leg. Probably caused by spinal nerve damage. The risk is 1 in 250.
- Lack of feeling between your legs which causes problems with bladder and bowel movement. Men may also experience problems with erections. This is also due to spinal nerve damage which often corrects itself. There is a 3 in 5 risk that feeling will not return however.
- Neuropathic pain. This causes a burning pain usually caused by the release of pressure to the nerves. Special painkillers are usually prescribed to treat this condition.
- A dural tear occurs in the thin membrane which envelops the spinal nerves. The risk is less than 3 in 100 but these are higher if this is not your first operation for this condition. Dural tears cause spinal fluid to leak resulting in acute headaches or several days duration. Repairs are sometime made during the operation or a second procedure is necessary.
- Spinal infection. There s a risk of 1 in 100. A second procedure is necessary along with a long course of antibiotic medication.
- Spinal instability implies too much movement between the vertebrae. The usual cause is the removal of too much bone and ligament. A second procedure is likely to make the spine stable.
How long to recover
- From surgery you progress to a recovery area and then the ward.
- You will be up walking the next day.
- Keep the wound dry for 4 to 5 days. The medical team will advise on when dressing changes are necessary and when stitches or clips should come out.
- Discharge from hospital is usually two to three days unless the doctor advises a longer stay.
- If anything about the procedure causes concern either while in hospital or when discharged, talk to your medical team for advice.
Back to normal
- Follow instructions to avoid blood clots including taking any prescribed medicine and wearing special stockings if necessary.
- Daily exercise routines to be continued as advised by your physiotherapist. This will help your back to recover and also prevent the condition returning.
- Normal activities can be resumed when your medical team advise. Do not do any heavy lifting or twist your back. Be aware of good posture when you are sitting and walking. Regular exercise is recommended but you should check with your doctor first.
- Driving should not be undertaken until you are confident that your back is strong enough. Check with your doctor and your insurance policy.
85% of those who have this procedure make a good recovery and return to a normal active life.
Leg pain will be relieved. Backache may recur on occasions as natural wear affects your spine. Acute backache should be checked in case it is to do with spinal instability. Spinal fusion surgery is the usual treatment.
4 in 100 may experience a recurrence of spinal stenosis in the same place or elsewhere. A further procedure may be advised.
Lumbar spinal stenosis or spinal canal narrowing may cause weakness and pain in the legs. Lumbar laminectomy can stop the condition worsening and also relieve pain. The procedure is safe and effective and possible complications should not put you off. However knowing all there is to know about possible outcomes means you should be able to make an informed choice about whether or not to proceed with the surgery. Understanding the symptoms and what they mean ensures you can react quickly to obtain treatment. Use this information to help ask questions of your healthcare professional if necessary.
EIDO Healthcare Limited - The operation and treatment information on this website is produced using information from EIDO Healthcare Ltd and is licensed by Aspen Healthcare. The information should not replace advice that your relevant health professional would give you.