When surgery is necessary for spinal stenosis, our neurosurgeons take the least invasive approach possible. Our spine surgeons have developed expertise in some of the most advanced minimally invasive surgery for spinal stenosis:
- Endoscopic Decompression: The least invasive option available, this advanced technique requires only the tiniest of incisions (7 mm, or less than a quarter of an inch). A specially trained neurosurgeon inserts a slender endoscope into the incision, and the wafer-thin camera and tools are guided to the location of the stenosis under X-ray or CT navigation. The excess bone and ligament are then shaved in order to decompress the nerves. There is no cutting into muscle, making the procedure essentially painless, and patients go home the same day. Many patients who would previously have required fusion surgery can now avoid that by having an endoscopic decompression instead.
- Lumbar Laminectomy: This is one of the most common procedures used to treat spinal stenosis today. It can be performed with open or minimally invasive techniques, depending on the diagnosis.The procedure involves shaving away bone to remove a portion of the lamina (bone surrounding the spinal canal), excess bone spurs, and thickened ligament, thus reducing compression of the nerves.
- Posterior Cervical Laminectomy: This procedure is used to treat compression or stenosis in the neck. Similar to a lumbar laminectomy, in a cervical laminectomy (a portion of bone surrounding the spinal canal) the lamina in the cervical spine is removed to relieve pressure on the spinal cord. On a case-by-case basis, a fusion may be required as well in which screws and rods are used to hold the spine in place and promote fusion between levels in the spine
- Minimally Invasive Lumbar Fusion: This surgery fuses the bones of the spine in the lower back together so that there is no longer any motion between them. This reduces spinal pressure, pain, and nerve damage. Minimally invasive lumbar fusions do not require the large incision or the muscle retraction typically used in conventional fusions. An interbody spacer may also be placed in the disc space once the damaged disc is removed to promote bony fusion – this is known as a transforaminal interbody fusion (TLIF). Patients undergoing this procedure have a fast recovery time. A recent advance is the use of a computerized image guidance system for many patients undergoing lumbar fusion. This has the advantage of aiding the surgeon in optimal placement of screws and avoiding injury to delicate nerve tissue.
- XLIF (Extreme Lateral Interbody Fusion): This advanced method of minimally invasive surgery approaches the spine from the side, avoiding the muscles of the back. A spine surgeon makes a small incision in the patient’s side, between the lower ribs and pelvis. The surgeon removes the damaged disc tissue and inserts a spacer between the vertebrae. Screws maybe placed either from the side or in the back in order to provide addtional stability. The nerves are carefully monitored throughout this procedure. Patients typically are walking within a few hours of the XLIF procedure and are then discharged the next day. Most patients are back to work within approximately two weeks. (Download the “About Lateral Access Surgery” brochure here.)
Until recently, all patients undergoing lumbar fusion required a bone graft either from the hip region or from a bone bank. Newer bone grafting substances are now used to promote healthy fusion. In most patients undergoing lumbar spinal fusion, metal titanium instrumentation is also used. This will typically involve placing pedicle screws into the bone and connecting these with a rod. (See Doctors Who Treat Spinal Stenosis.)
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