Surgery for Spinal Stenosis?

Question

X-Ray indicated that my wife has what is called as spinal stenosis. Physical therapy has not helped much and now surgery seems to be the only option. I'm told that the success rate is about 70% and there are other horor stories that make is wonder whether it's worth taking the risk. I would appreciate if you would share your experience or someone in your family who has gone through the surgery. Thanks

Answer 1

You don't state whether the stenosis is in the neck or lower back.  There is also no mention as to whether or not there is going to be any fusion or fusions done.  I know that the process is painful and she has gone through therapy but how much work is she doing at home.  The therapy can only go so far without her doing the movements asked of her.  The program should include flexibility and strengthening plus heavy emphysis on posture.  The stenosis cannot be reversed but it can be controlled through constant exercising.  What is your wife's weight like.  If she is overweight then bringing down the weight will help significantly.  Lastly if she is going to undergo the procedure check with as many neurosurgeons as possible.  Do go with someone that you are comfortable with and who does a lot of this type of procedure.  Ask about whether the procedure is going to include a fusion or not.  Longterm fusions don't always workout as they place a lot of stress on the vertebrae above or below the fusion.  Before the procedure make sure that your wife is a strong as she can for the procedure will certainly decrease her strength levels.

Answer 2

My father had spinal stenosis surgery March 1. He is definitely better but patience is necessary not so much for the surgery recovery but that it takes time for what I would call "remembered" pain to go away. According to my father's surgeon what has happened is that the nerves have been sending pain signals to the brain and it takes time for them to "learn" that there isn't really pain there anymore. Sort of like the nerves need to heal and forget the pain that used to be there. The surgeon said it would take 6 months for this to happen but for an older person (80ish) it can easily take 12 months.

Be sure to ask around for a good back surgeon. We found one through our primary care physician whose father had this surgery done by a specific surgeon. That's a good enough referral for me especially when the father is brought to a local surgeon from out of state.

Surgery is worth the risk if there aren't any other health issues with surgery. The pain from spinal stenosis will NOT go away over time.  

Answer 3

As a PT, and a spine specialist, and the daughter of someone with advanced spinal stenosis, I have a lot to offer.

First, just because the stenosis shows up on an x-ray does not mean it is the source of her symptoms.  Second, there are kind of two basic type of stenosis...ones caused by soft tissue obstructions, and those caused by boney obstructions.  The soft tissue obstructions are often reversible...but I'll get into that for a moment.  Since she's had an x-ray (no mention of MRI) we can assume some type of evidence of boney obstruction.  ....yet, again, just because it's there does not mean it's the cause of her symptoms.  Stenosis often appear on x-rays...especially after the age of 50...even in those who have no back pain whatsoever.

True boney stenosis has a very predictable pattern.  Back and leg pain (can be one leg or both, but usually both) upon rising and walking that happens EVERY time she walks and is relieved EVERYTIME she sits down or bends over.  Sitting is usually never a problem and is often the position of greatest relief. This is because of the position of the spinal canal in such maneuvers.  For these folks, PT can only show one how to manage the symptoms temporarily, but we know they will return. Advanced stenosis can lead to loss of sensation and position sense in the feet, loss of balance, etc. For these folks, surgery for a decompressive laminectomy is usually the choice of surgery to open the spinal canal. Yet, multiple decompressions often lead to a fusion.

Are your wife's symptoms more variable? Are there times she can walk without pain? Does beding backwards or sideways, etc make her feel better? Does sitting ever cause her symptoms? If so, we must consider that there is a more changable lesion present.  Without getting into too much medical detail, there is a large group of patients whose symptoms can be rapidly reversed with a very specific approach to classification and treatment.  I am not sure what your wifes PT entailed, but if her PT is not a certified MDT provider, I would suggest you check one out: http://www.mckenziemdt.org  I've seen many people who were told they have stenosis actually have complete relief of their symptoms in a few short visits...often times after they have "failed" "traditional PT" of heat, massage, ultrasound, and "stabilization" exercises.

Now, my father was a true boney stenosis type person...he could sit all day long without pain, but couldn't walk more than 50 feet...complete with inability to feel his feet when walking and loss of balance.  He underwent spinal decompression...numerous times. It was successful in restoring his leg function and sense of balance, yet he continues to have significant back pain...but only when standing and walking.  He did finally opt for a fusion, but because of his advanced stage of disease, was fused from T-4-L-4...We know he will always have back pain...our goals are simple at this point...to be able to go to the store without a walker or shopping cart...to walk a few hundred feet unassisted.  It's now 3 months post operative and his ability to stand is better, but he has a long way to go.  Granted, my dad represents some of the most advanced stages of the disease.

In the end, I would first see if your wifes PT is certified in MDT.  That way, you can getting a better handle on the presentation of her classification...is this a truely stenotic presentation? Or is there a possibility of reversal.  Don't put all your eggs in one basket based on an x-ray.  There are still a lot more possibilities to explore.  In my opinion, 50% of people who are given the diagnosis of "stenosis" based on an x-ray have symptoms that are absolutely not realted to their x-ray and are often reversible.  

Good luck