Spinal stenosis surgery, also known as decompression surgery, aims to relieve pressure on the spinal cord and nerves by widening the spinal canal. The size of the incision needed for this surgery depends on several factors, including the location of the stenosis, the specific procedure being performed, and the surgeon’s preference.
Overview of Spinal Stenosis
Spinal stenosis refers to the abnormal narrowing of the spinal canal, the passageway in the spine where the spinal cord and nerves are located. This narrowing puts pressure on the spinal cord and nerves, resulting in symptoms like pain, numbness, and weakness in the back, legs, arms, and neck. Some common causes of spinal stenosis include:
- Degenerative changes – Disk degeneration, bone spurs, thickened ligaments, and enlarged facet joints can all contribute to narrowing.
- Spinal injuries – Past fractures, dislocations, and instability can lead to stenosis over time.
- Congenital abnormalities – Some people are simply born with an abnormally narrow spinal canal.
Spinal stenosis is most commonly seen in the neck (cervical stenosis) and lower back (lumbar stenosis). Treatment options range from medications and physical therapy to surgery in severe cases. Decompression surgery is one of the main surgical options used to treat spinal stenosis.
Goals of Decompression Surgery
The main goals of spinal stenosis decompression surgery are to:
- Widen the spinal canal and decompress the spinal cord/nerves
- Relieve symptoms like pain, numbness, and weakness
- Improve functionality and quality of life
This is achieved by removing or trimming structures surrounding the spinal canal that may be contributing to the narrowing. Potential structures that can be removed include bone, ligaments, disk material, and thickened soft tissue.
Surgical Approaches and Techniques
There are several different decompression surgery techniques and approaches, which influence incision size:
Laminectomy
This procedure removes the back part of a vertebra (lamina) to create more space within the spinal canal. A surgeon may perform a laminectomy alone or in combination with other decompression techniques. The typical incision size is around 2-3 inches long.
Laminotomy
Similar to a laminectomy, but this procedure only involves removing a small portion of the lamina. This more targeted approach may result in a smaller 1-2 inch incision.
Foraminotomy
In this procedure, the surgeon removes bone and tissue around the neural foramen, which is the opening where a spinal nerve root exits the spinal canal. Foraminotomies enlarge this opening to relieve pinching of the nerve. Incisions are usually 1-2 inches long.
Facetectomy
This technique involves removing part or all of the facet joints, which are the joints linking vertebrae in the spine. Enlarging the foraminal space by facet removal can decompress pinched nerves. Incision length is typically 1-2 inches.
Discectomy
If a herniated disc is contributing to spinal stenosis, a discectomy may be performed to remove the protruding disc material. This can decompress the nerves while widening the spinal canal. Standard microdiscectomy incisions range from 1-3 inches long.
Corpectomy
A corpectomy is the removal of an entire vertebral body. This major procedure is only done when significant vertebral body pathology is causing severe spinal stenosis and cord compression. An anterior (from the front) incision up to 6 inches long may be made for corpectomy access.
Surgical Approach
The spine can be accessed through the front (anterior) or back (posterior). The approach impacts incision size and location:
- Posterior: This is the most common approach for stenosis surgery, with incisions made in the midline of the back over the spine. Posterior incisions tend to be smaller.
- Anterior: The anterior neck is accessed from the front of the throat. For the lower back, the surgeon accesses the spine through the abdomen requiring a larger incision.
- Combined: Some complex cases may use both anterior and posterior incisions for access to the full length of the spine.
Number of Incisions
Depending on the location of the stenosis and how much of the spine needs to be decompressed, the surgeon may only need to make one incision or several incisions. For example:
- One incision may be sufficient for a single level laminectomy.
- Two incisions may be needed for a two level decompression at adjacent vertebrae.
- Multiple incisions could be required for multilevel stenosis affecting several regions of the spine.
In general, the more levels affected and the greater the extent of decompression needed, the higher number of incisions required.
Minimally Invasive Surgery
Some surgeons perform decompressive procedures through smaller incisions using minimally invasive techniques assisted by magnification devices or tiny cameras. These high-tech surgeries result in less damage to surrounding muscles and tissue. Single incisions well under 1 inch long are possible with minimally invasive spinal stenosis surgery.
Conclusion
In summary, the size of the incision for spinal stenosis surgery depends on several factors:
- Location of the stenosis (cervical vs lumbar)
- Surgical techniques used to decompress the area
- Surgical approach to the spine (anterior vs posterior)
- Number of levels being addressed
- Use of minimally invasive methods
- Surgeon’s preferences and experience
While small minimally invasive incisions under an inch are possible, most traditional posterior decompression surgeries involve incisions ranging from 1-3 inches in length. More extensive procedures correcting multilevel stenosis or using a combined approach may require larger incisions up to 6 inches long. But in general, spinal stenosis decompression is done through relatively small incisions focused over the direct area of pathology.