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Should I Have Surgery for Painful Spinal Stenosis?
In the US, the predominant reason for spinal surgery in those over age 65 is spinal stenosis. What exactly is spinal stenosis? It represents a narrowing of the region that is available for the dural sac (which is what’s left of the spinal cord) and the nerve roots that come out from it. Usually, there is lots of room for both the nerve roots and the dural sac. Typically, there is enough room for cerebrospinal fluid to bathe the region.
As individuals age, arthritis sets in. This brings with it the potential for soft tissue and bony overgrowth as a result. This may start to pinch on the space available for the dural sac and nerve roots. If severe enough, individuals may start having buttock, back, and leg pain. This becomes a structural issue. Thankfully, most folks with spinal stenosis do not end up with severe pain.
Symptoms may ensue from the overgrowth causing decreased blood flow or nerve root excitement from inflamed tissue. This can end up affecting numerous areas and levels. The symptoms are varied between patients depending on the region of pinching and the individuals reaction. Despite this, it is the most common indication for spine surgery in folks over the age of 65.
Should surgery be done if pain exists? This question has been looked at for a lot of years especially since spinal stenosis represents a quality of life decision. It’s never fatal, and treatment should be guided by symptoms. If the symptoms worsen despite nonsurgical treatment for three to six months, a decompressive procedure can be considered. Some evidence has shown limited effectiveness for this surgery.
A recent review in Spine looked at over 10 high quality studies to determine the effectiveness of decompressive surgery for stenosis. The results overall showed that in patients who had failed conservative treatment for 3 to 6 months, surgery improved function, pain, and quality of life more than conservative measures. It did not, however, statistically improve walking ability.
These benefits were noted to decrease over time but not go away completely, even up to 10 years. Over ten year results were not established. These results were in place regardless of advancing age, obesity, lung issues, several levels, or other medical problems. Concomitant medical problems do increase the risks of complications, so they should be weighed against the benefits in deciding whether to have the surgery or not.
The results were similar among all the studies evaluated whether or not the patients had spondylolisthesis, which is one vertebra having slipped on another. The overriding factor is that it is a quality of life decision, and considerable conservative treatment should be attempted first.
Surgical risks in this age population cannot be ignored, even though small. At the point when nonsurgical treatment fails, a number of high quality studies support the decision to perform a lumbar laminectomy procedure.
Want to find out more about pain management doctors in Arizona, then visit Preferred Pain Center’s site on how to choose the best Phoenix chiropractors for your needs.
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Filed under back pain by on Dec 3rd, 2011. 
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