Decompressive Laminectomy for Lumbar Spinal Stenosis

How Well It Works

Surgery for spinal stenosis usually is elective. But the doctor might recommend it if symptoms can't be relieved with nonsurgical treatment.

Research shows that:

• If nonsurgical treatments don't work well enough, surgery might help to relieve pain and improve movement.^{footnote 1footnote 1}
• People who had surgery notice more improvement in their symptoms and can be more active than people who did not have surgery. This difference continues for at least 4 years after surgery.^{footnote 2footnote 2}
• After 10 years:
  • People treated with surgery were as satisfied as those treated without surgery.
  • People who had surgery were generally able to be more active and had less leg pain than those who had nonsurgical treatment.^{footnote 3footnote 3}
• Surgery appears to be more effective for leg pain than for back pain, but it may help both.^{footnote 4footnote 4}

But symptoms may return after several years. Some people may need a second surgery if:

• Spinal stenosis develops in another area of the spine.
• The earlier surgery hasn't controlled symptoms.
• The spine becomes unstable, or fusion does not occur.
• Regrowth of tissue (lamina) presses on the spinal cord or spinal nerve roots.

Spinal fusion may be done at the same time as laminectomy. Spinal fusion may help to stabilize sections of the spine that have been treated with laminectomy. In general, fusion is only done if an area of the spine is unstable. This means that the bones of the spine (vertebrae) move too much or don't move in a normal way. This extra movement causes wear and tear on the nerves or other soft tissues, leading to irritation and pain. The goal of fusion is to keep the damaged bones in the spine from moving so that the soft tissues are protected.

Risks

Complications from spinal stenosis surgery may depend on what other medical problems you have and how severe your spinal problem is. Also, all surgery poses risks of complications. These complications may be more serious in an older adult.

Possible complications include:

• Problems from anesthesiaanesthesia.
• A deep infection in the surgical wound.
• A skin infection.
• Blood clots.
• An unstable spine.
• Nerve injury, including weakness, numbness, or paralysis.
• Tears in the fibrous tissue that covers the spinal cord and the nerve near the spinal cord. This sometimes requires a second surgery.
• Trouble passing urine, or loss of bladder or bowel control.
• Long-term (chronic) pain, which develops after surgery in some cases.
• Death from problems caused by surgery. But this is rare.

If you have diabetes or circulation problems or if you smoke, you may be at greater risk for complications.