In the broadest sense, there are two types of lumbar surgery for stenosis. Minimally Invasive and Open.
The thinking is obvious, minimally invasive techniques are better than open techniques. Less trauma during surgery, shorter recovery time, less medications, less risks.
Yet a new paper calls all this into question:
“The incidence of nerve root injuries following any of the multiple minimally invasive surgical techniques resulted in more nerve root injuries when compared with open conventional lumbar surgical techniques. Considering the majority of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients?” 1In another new study: “We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment.
No clear benefits were observed with surgery versus non-surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects.”2
If you have stenosis, and your surgeon said to you – surgery or non-surgical treatments? Both will provide the same benefit. One, however has up to a 24% side effect and one has none. Which treatment do you want?
Doctors go into a diagnosis of lumbar spinal stenosis with the thought that there is osteoarthritis – a bony overgrowth on the spinal nerves. The symptoms of patients can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication – nerve inflammation). In the patients who primarily complain of radiculopathy (radiating leg pain) with an stable spine, a decompression surgery may be recommended to remove bone from around the nerve root to give the nerve root more space. The fear of course is that surgery to a stable spine will make it unstable.3A fusion procedure to limit the movement between two vertebrae and hopefully stop the compression of nerves is another option. As mentioned by independent research above – surgery for spinal stenosis should only be considered after conservative therapies have been exhausted. Surgical treatment of lumbar spinal disorders, including fusion, is associated with a substantial risk of intraoperative and perioperative complications.4
It is important to note that in instances where stenosis is so severe that the patient has lost circulation to the legs or bladder control – a surgical consult should be made immediately.
Targeted interventional delivery of corticosteroids remains a mainstay of treatment for spinal pain syndromes because this approach has a wider therapeutic index than other approaches. However, considerable uncertainty persists concerning which patients with chronic pain are most likely to benefit from corticosteroid injections. Matching this treatment option with specific spinal pain syndromes remains a major challenge.5
We avoid the use of epidurals as they are temporary fixes and long-term problems. The medical literature is now long in studies that have shown that these treatments are contributors to accelerated deterioration of spinal and joint degeneration.
Bone growth occurs in the spine because the bone is trying to stabilize the spine from excessive movement or laxity. Fusion surgery is recommended as a means to accelerate that type of stabilization. Regenerative medicine including PRP and Stem Cell Therapy (watch the video) works in a completely different way. They stabilize the spine by strengthening the often forgotten and under appreciated spinal ligaments and tendons. These techniques help stabilize the spine, which is imperative as unstable joints can lead to – or further exacerbate – the arthritis that causes spinal stenosis.
New research is now calling for doctors to provide more accurate diagnosis to determine the cause of lumbar back pain – with a focus on the spinal ligaments.6,7
I invite you to explore other research on this site or to ask your questions about stabilizing the spine with injection therapy – use the form at the bottom. Please see my articles for more discussions:
- Back and Hip pain generators – the ligaments of the pelvis and spine
- Misconceptions on the importance of MRI for spinal surgery
- Bone Marrow aspirated stem cells injected into the back
1. Epstein NE. More nerve root injuries occur with minimally invasive lumbar surgery: Let’s tell someone. Surg Neurol Int. 2016 Jan 25;7(Suppl 3):S96-S101. doi: 10.4103/2152-7806.174896. eCollection 2016.
2. Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016 Jan 29;1:CD010264. doi: 10.1002/14651858.CD010264.pub2. Review. PubMed PMID: 26824399.
3. Overdevest GM, Moojen WA, Arts MP, Vleggeert-Lankamp CL, Jacobs WC, Peul WC. Management of lumbar spinal stenosis: a survey among Dutch spine surgeons. Acta Neurochir (Wien). 2014 Aug 7. [Epub ahead of print]
4. Proietti L, Scaramuzzo L, Schiro’ GR, Sessa S, Logroscino CA. Complications in lumbar spine surgery: A retrospective analysis. Indian J Orthop. 2013 Jul;47(4):340-5. doi: 10.4103/0019-5413.114909.
5. Schilling LS, Markman JD. Corticosteroids for Pain of Spinal Origin: Epidural and Intraarticular Administration. Rheum Dis Clin North Am. 2016 Feb;42(1):137-55. doi: 10.1016/j.rdc.2015.08.003. Review. PubMed PMID: 26611556.
6. Romero-Vargas S, Obil-Chavarria C, Zárate-Kalfopolus B, Rosales-Olivares LM, Alpizar-Aguirre A, Reyes-Sánchez AA. [Profile of the patient with lumbar failed surgery syndrome at National Institute of Rehabilitation. Comparative analysis]. Cir Cir. 2015 May 15. pii: S0009-7411(15)00007-9. doi: 10.1016/j.circir.2015.04.006. [Epub ahead of print]
7. Ishimoto† Y, Noriko Y, Shigeyuki M, Hiroshi Y, et al. Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: The Wakayama Spine Study. Osteoarthritis Cartilage. 2013 Mar 5. pii: S1063-4584(13)00706-1. doi: 10.1016/j.joca.2013.02.656. [Epub ahead of print]