An affliction causing nearly 11% of Americans a great deal of numbness, weakness, or pain, spinal stenosis is not an easy problem to manage. For patients burdened with spinal stenosis, pain can often impede even standing or walking as time goes on, sometimes leaving those patients desperate to find resolution that will get them moving as normal again.
At Centeno-Schultz Clinic, we use precisely guided injections of orthobiologics to strengthen and tighten your spine to improve structure and functionality as a means to treat spinal stenosis.
3 Questions to Ask Before You Get Spinal Stenosis Surgery
Spinal stenosis is often an age-related condition attributed to compounding osteoarthritis, where the cushion positioned between vertebral discs starts to break down over time, causing a narrowing of the spinal canal and pinched nerves throughout the back and legs.
Often, physicians recommend surgery to those suffering from spinal stenosis…but is surgery the only option? And is it the best option?
Before you agree to undergo invasive surgery for your spinal stenosis, there are a few questions you should consider:
#1: How effective is spinal stenosis surgery, anyway?
While surgery is a common enough recommendation for spinal stenosis treatment, the biggest question that should be on a patient’s mind is, Will this actually work?
What the Research Says…
One research study around spinal stenosis treatment examined patients who had surgery for their spinal stenosis versus those who did not have surgery; unfortunately, the trial found that, once patients got to four years after surgery (or more), there was no difference between those who had undergone surgery and those who had not (1). Another high-level study randomized patients, looking for differences between those who had gone through with spinal stenosis surgery versus patients who had simply adhered to a regular physical therapy regimen. Results concluded that surgery patients did no better than physical therapy patients when it came to long-term effectiveness against spinal stenosis (2).
This research seems to show that spinal stenosis surgery is no silver bullet for alleviating the symptoms that come with the condition. In fact, in the long-term, there is no evidence that an invasive procedure such as this one provides any better, more lasting relief than other spinal stenosis treatment options.
#2: What are the risks associated with spinal stenosis surgery? Is it dangerous?
It’s important to remember that spinal stenosis surgery is considered major surgery. As such, there are most definitely complications that can arise from this procedure, as with any major surgery. However, because this particular procedure is operating on areas around a patient’s spine, it’s important to weigh the severity of potential complications as well.
It is important to understand, as well, that when it comes to spinal surgeries, the definition of a “complication” may differ between the actual surgeons and the patients themselves, meaning that patients can often feel complications after the fact, as opposed to during the procedure itself (3). In one analysis that reviewed five different large studies, the complication rate of surgery as reported by surgeons who conducted the spinal stenosis procedure was a wide range: between 10 and 24%. That can be anywhere from 1 in 10 patients, to 1 in 4 patients. Reported complications include infection, nerve damage, the need for follow-up surgery, and even increased pain, among other issues, all from a procedure that is supposed to alleviate those very concerns.
#3: Can I avoid spinal stenosis surgery altogether? Are there alternatives for spinal stenosis treatment?
There are a handful of different spinal stenosis treatment options that do not involve major surgery, though some are more invasive than others.
One option is a Coflex device, which is a metal spacer that is implanted in between the spinous processes, often after surgical decompression (8). The thought process behind implanting this device is that it will preserve some motion. However, complications can arise through implantation, which may include destruction of the normal fascia, muscles, and ligaments in the area.
Another spinal stenosis treatment option is something called the MILD procedure. This is a type of spinal stenosis treatment that cuts the ligamentum flavum, or the swollen ligament that often places pressure on the spinal cord or nerves. The idea is that this ligament will retract back like a rubber band (9). While this does, in fact, open up the area, it also reduces spinal stability, since this ligament, uncut, helps to keep things stable.
There are also spinal stenosis treatment options that can be performed or implanted using just x-ray guidance, with no surgical procedure at all. For instance, a newer implant-based solution such as interspinous spacers, like the Superion device, that can be inserted during fluoroscopy (10). However, though the device is placed without surgery, the implant still can destroy the original ligament architecture, putting more pressure on the discs.
There is, however, another way. The process we have patients undergo at Centeno-Schultz is one that both avoids surgery and avoids hurting or altering a patient’s original ligament structure. Our procedure is called the Perc-Flavoplasty, and is the only spinal stenosis treatment procedure of its kind, designed to maintain a patient’s normal anatomy with no metal implantations. Our patients not only appreciate the less invasive procedure, they report afterward that they feel much better.
We use precise, image-guided injections in the Perc-Flavoplasty, ensuring that we find the exact area causing a patient pain, ensuring the best possible results. All of our physicians are musculoskeletal specialists with advanced training, and our procedures are backed by extensive research and published patient outcome data. One recent patient, a 66-year-old female working in healthcare, came to use with severe central canal stenosis in her low back; she was able to only stand for 15 minutes at a time before seeing us. After three injection-based treatments using both fluoroscopy and ultrasound guidance, all in our Perc-Flavoplasty method, the patient is now able to stand for more than an hour at a time and is even planning an upcoming vacation where she will be walking for miles at a time. Our method is safe, effective, and non-surgical; most importantly, it provides lasting results for spinal stenosis pain.
- Lurie JD, Tosteson TD, Tosteson A, et al. Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2015;40(2):63–76. doi: 10.1097/BRS.0000000000000731
- Delitto A, Piva SR, Moore CG, Fritz JM, Wisniewski SR, Josbeno DA, et al. Surgery Versus Nonsurgical Treatment of Lumbar Spinal Stenosis: A Randomized Trial. Ann Intern Med. 2015;162:465–473. doi: 10.7326/M14-1420
- Ratliff JK, Lebude B, Albert T, Anene-Maidoh T, Anderson G, Dagostino P, Maltenfort M, Hilibrand A, Sharan A, Vaccaro AR. Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery. J Neurosurg Spine. 2009 Jun;10(6):578-84. doi: 10.3171/2009.2.SPINE0935.
- Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;2016(1):CD010264. Published 2016 Jan 29.doi: 10.1002/14651858.CD010264.pub2
- Epstein NE, Hollingsworth RD. Nursing Review Section of Surgical Neurology International Part 2: Lumbar Spinal Stenosis. Surg Neurol Int. 2017;8:139. Published 2017 Jul 7.doi: 10.4103/sni.sni_150_17
- Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016 Jan 4;352:h6234. doi: 10.1136/bmj.h6234.
- Vail D, Azad TD, O’Connell C, Han SS, Veeravagu A, Ratliff JK. Postoperative Opioid Use, Complications, and Costs in Surgical ManagementofLumbarSpondylolisthesis.Spine(PhilaPa1976).2018;43(15):1080–1088.doi: 10.1097/BRS.0000000000002509
- Li D, Hai Y, Meng X, Yang J, Yin P. Topping-off surgery vs posterior lumbar interbody fusion for degenerative lumbar disease: a comparativestudyofclinicalefficacyandadjacentsegmentdegeneration.JOrthopSurgRes.2019;14(1):197.Published2019Jun28. doi: 10.1186/s13018-019-1245-3
- Chen H, Kelling J. Mild procedure for lumbar decompression: a review. Pain Pract. 2013 Feb;13(2):146-53. doi: 10.1111/j.1533-2500.2012.00574.x.
- Nunley PD, Deer TR, Benyamin RM, Staats PS, Block JE. Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis. J Pain Res. 2018;11:2943–2948. Published 2018 Nov 20. doi: 10.2147/JPR.S182322