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Lumbar Spinal Stenosis Surgery in India

Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back, known as the lumbar area. This usually happens when bone or tissue—or both—grow in the openings in the spinal bones. This growth can squeeze and irritate nerves that branch out from the spinal cord.This type of Surgery is done to relieve pressure on the nerve roots. This can help reduce pain, numbness, and weakness in your legs.

Symptoms may include:

  • Pain, weakness or numbness in the legs, calves or buttocks
  • Cramping in the calves with walking, requiring frequent short rests to walk a distance
  • Pain radiating into one or both thighs and legs
  • In rare cases, loss of motor functioning of the legs, loss of normal bowel or bladder function
  • Pain may improve with bending forward, sitting or lying down
  • There are two main surgical options to treat lumbar spinal stenosis: laminectomy and spinal fusion. Both options can result in excellent pain relief.
  • This procedure involves removing the bone, bone spurs, and ligaments that are compressing the nerves. This procedure may also be called a “decompression.”
  • Spinal fusion. If arthritis has progressed to spinal instability, a combination of decompression and stabilization or spinal fusion may be recommended.

Lumbar spinal stenosis (LSS) is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves at the level of the lumbar vertebra. This is usually due to the common occurrence of spinal degeneration that occurs with aging. Low back pain is a very common problem these days. The prime cause of this pain is lumbar spinal stenosis. Lumbar spinal stenosis can be categorized into two types- Degenrative (age-related) and the other is Congenital (present at birth). Degenerative is most common than congenital.

Symptoms of Lumbar Spinal Stenosis

The most common symptom is leg pain that happens when you walk or stand and feels better when you sit. You feel pain in your legs, because the nerve roots that pass through the lower spine extend to the legs.  People often have leg pain when the spine is extended-when they are standing straight or leaning backward

Other symptoms may include:

  • Numbness, weakness, and cramping in the legs, feet, or buttocks.
  • Stiffness in the legs and thighs.
  • Low back pain.
  • In severe cases, loss of bladder and bowel control.

causes Lumbar Spinal Stenosis

  • The most common cause of lumbar spinal stenosis is changes in the spine that can happen as you get older.
  • These changes include thickening of soft tissues, development of bony spurs, and gradual breakdown of spinal discs and joints. Any of these conditions can narrow the spinal canal.

These age-related changes often happen when you have certain disorders:
Arthritis of the spine wears away joint cartilage and causes bony growths (spurs).
Certain bone diseases, such as Paget’s disease and ankylosing spondylitis, may soften the spinal bones or cause too much bone to grow.

Also, other conditions may cause spinal stenosis, such as:
An abnormally narrow spinal canal, which can be an inherited condition.
Spondylolysis, which is a defect or fracture on one or both of the wing-shaped parts of a vertebra. A vertebra may slide forward or backward over the bone below and may squeeze the spinal cord or a nerve root.

Spinal fracture.

Cancer.
Fibrosis, which is excess, ropy tissue much like scar tissue. It can come from having spine surgery in the past.
Diagnosis of Lumbar Spinal Stenosis
To diagnose spinal stenosis, the surgeon will ask about your medical history .The severity of the condition and the presence of numbness or weakness can be determined with the help of patient’s physical exam The surgeon may also order one or more tests, such as:

X rays

  • Magnetic resonance imaging (MRI) – a test that uses radio waves to look at your spine
  • Computerized axial tomography (CAT) – a series of x rays that give your doctor a detailed image of your spine
  • Myelogram – a test in which the doctor injects liquid dye into your spinal column
  • Bone scan – a test in which you are given a shot of radioactive substance that shows where bone is breaking down or being formed.
  • Treatment of Lumbar Spinal Stenosis
  • Surgery is done to relieve pressure on the nerve roots. This can help reduce pain, numbness, and weakness in your legs.
  • Surgery may be recommended if
  • Your pain, numbness, or weakness is so bad that it gets in the way of normal daily activities and hurts your quality of life.
  • You are in otherwise good health.
  • The are two types of treatment for Lumbar Spinal Stenosis

1) Surgical Treatment Lumbar Spinal Stenosis

Types of spine surgery:
Laminectomy: The most common type of surgery for this condition, laminectomy involves the removal of the lamina, a portion of the vertebra, to make room for the nerves. Some ligaments and bone spurs may also be removed. The surgery requires making an incision into the back.

Foraminotomy: The foramen is the area in the vertebrae where the nerve roots exit. The procedure involves expanding this area to provide more space for the nerve roots.

Spinal fusion: This procedure is done in cases of instability and involves joining the bones together with screws or bone grafts to provide spinal stability. It may be combined with laminectomy surgery. The surgery lasts several hours and can be done using one of two methods:

Bone is removed from elsewhere in the body or obtained from a bone bank. This bone is used to create a bridge between vertebrae and stimulates the growth of new bone.

Metal implants, such as rods, hooks, wires, or screws, are secured to the vertebrae to hold them together until new bone grows between them.

2) Non Surgical Treatment Lumbar Spinal Stenosis

There are several non-surgical options your doctor may recommend to treat your spinal stenosis. Often, treatment combines more than one type of therapy.

Medication: There is a wide variety of medications available to relieve inflammation, pain, and muscle spasm
Injections: The most common type of injection used to help alleviate the symptoms of spinal stenosis is an epidural injection. This type of injection places medication (usually a steroid) into the space that surrounds specific nerve roots (the epidural space). The medication helps to reduce inflammation and acute pain that radiates into the arms or legs. Usually a course of three injections are given over a period of several weeks.

Physical therapy (PT): PT usually combines inactive therapy and therapeutic exercise. Inactive therapy includes heat or ice packs, ultrasound, electrical stimulation, and massage. These treatments help to ready the patient for active therapy by relaxing tight muscles and easing pain or discomfort. Therapeutic exercise includes stretching and prescribed exercises to help stabilize the spine, build strength and endurance, and increase flexibility.

Lumbar traction : Commonly used by physical therapists for herniated disks, muscle spasms and other back conditions, traction involves applying force to the spine so that the vertebrae are pulled apart slightly, which may help relieve pressure on disks, ligaments and nerves. It can be done in different ways—through a pulley-type system, for example, or manually.

Chiropractic manipulation: This is a very safe nonsurgical method. If a patient is suffering from disc herniation or osteoporosis then extra care should be taken. In the cases of disc herniation or osteoporosis, manipulation of the spine can result in injuries or can even worsen symptoms

Acupuncture: In order to treat less severe cases of lumbar stenosis, acupuncture is considered as very helpful. Acupuncture has been regarded as a very safe nonsurgical treatment.

New Advanced Surgical Approaches for Lumbar Spinal Stenosis

Minimally Invasive Decompression

It is Safe, Effective, Non-Surgical Treatment for Lumbar Spinal Stenosis (LSS).In this procedure

Specialized tools are inserted through a tiny incision in your back
This removes small pieces of bone and excess ligament that cause the narrowing of the canal
An imaging machine is used to help guide your physician through the procedure
Restoration of space in the spinal canal decreases the compression of the nerves
This reduces pain and restores mobility

Benefits of Minimum Invasive Decompression

  • No general anesthesia required
  • No implants or stitches
  • Low complication risk

Interspinous Process Devices

Recent developments in spinal surgery implants promise less invasive procedures with superior effectiveness to conventional surgery.1 Particularly in (older) patients with spinal stenosis due to arthrosis of the facet joints, implantation of an interspinous process device is regularly offered. IPD involves an implant (called a spacer) made from titanium alloy. This implant is inserted as a spacer between your spinous processes.

Benefits of Interspinous Process Decompression

The most important benefit of IPD is that your surgeon creates more space for your spinal cord and nerves in your spinal canal without removing any of your bone (as in a traditional laminectomy) and with less trauma to your muscles and ligaments.

Other benefits of interspinous process decompression:

Helps preserve some motion in your spine (Fusion can limit how well you can move, but the IPD implant can help you maintain some motion.)

  • Less blood loss
  • Less risk of infection
  • Can be done on an outpatient basis