Spinal stenosis is a condition where the spaces within the spine narrow, putting pressure on the spinal cord and nerves. This can cause pain, numbness, tingling, and weakness in the back and legs. When conservative treatments like medication and physical therapy are no longer effective, spinal stenosis surgery may be recommended to relieve compression on the spinal cord and nerves. Recovery time after stenosis surgery depends on many factors, including the specific procedure performed and the individual patient’s overall health. On average, recovery can take between 6 weeks to 6 months.
What is spinal stenosis?
Spinal stenosis refers to the abnormal narrowing of the spinal canal, lateral recesses, or neural foramen of the spine. This narrowing results in compression of the spinal cord and nerves exiting the spinal cord. There are a few different types of spinal stenosis:
Central stenosis
This involves narrowing of the central spinal canal where the spinal cord runs through. Pressure on the spinal cord can cause pain, numbness, tingling, and weakness in the legs and buttocks.
Foraminal stenosis
Foraminal stenosis is the narrowing of the foramen, the small openings between the vertebrae where nerves exit the spine. This can compress the nerve roots and cause symptoms of radiculopathy like pain, numbness, and weakness along the compressed nerve.
Lateral recess stenosis
The lateral recesses are located to the left and right of the spinal cord. Narrowing here compresses nerve roots exiting laterally and can cause radiculopathy symptoms down the legs.
What causes spinal stenosis?
There are a few possible causes of spinal stenosis:
Degenerative changes
As we age, wear and tear can lead to degeneration of the spine. Conditions like arthritis and disc degeneration cause the spinal canal to narrow. Bone spurs may also form and intrude into the space.
Injury
Previous injury to the spine like fractures and dislocations can alter the spacing and alignment of the vertebrae over time. Scar tissue can also build up and compress the nerves.
Congenital
Some people are born with a narrow spinal canal. This predisposes them to spinal stenosis as degeneration occurs later in life.
Symptoms of spinal stenosis
Common symptoms of spinal stenosis include:
- Pain in the back or legs, especially when standing or walking
- Numbness, tingling or weakness in the legs, feet, buttocks or groin
- Cramping in the legs or feet
- Loss of bladder and bowel control (in severe cases)
Symptoms are often relieved when sitting down or leaning over. People with stenosis tend to feel better riding a bike than walking.
When is surgery needed for stenosis?
Most cases of spinal stenosis are first treated conservatively with medication, physical therapy, braces, and injections. Surgery may be considered if:
- Symptoms significantly interfere with daily activities
- Symptoms persist despite at least 3-6 months of conservative treatment
- There is progressive neurologic dysfunction like leg weakness
- Cauda equina syndrome develops, indicating severe compression of the lowest part of the spinal cord
The main goal of surgery is to relieve compression on the spinal cord and nerves to alleviate symptoms.
Types of surgery for spinal stenosis
There are a few surgical options to widen the spinal canal and decompress the cord and nerves:
Laminectomy
This procedure removes the lamina, the back part of the vertebrae that covers the spinal canal. Removing the lamina creates more space for the spinal cord and nerves.
Laminotomy
Rather than completely removing the lamina, keyhole-sized openings are made in the lamina to relieve pressure on affected nerves. This is a less invasive option that spares much of the supporting bone and soft tissue structures of the spine.
Foraminotomy
When foraminal stenosis is present, an opening can be drilled through the side of the vertebrae to widen the foramen. This decompresses any pinched nerves exiting through the foramen.
Fusion
If there is excessive instability or deformity, the involved vertebrae may be fused together for stabilization. Rods, screws, cages or bone grafts are used to promote bone fusion.
Laminoplasty
This technique “opens up” the lamina on one side to expand the spinal canal. The expanded lamina is then secured with hardware to maintain the open position.
Recovery timeline after spinal stenosis surgery
Recovery time depends on the specific surgery performed and overall health of the patient. On average:
Hospital stay
Patients typically stay 1-3 days in the hospital after surgery for monitoring and pain control. Those undergoing less invasive procedures may only stay overnight.
1 week after surgery
At this point, any surgical drains and stitches will be removed. Patients work with physical therapists on gentle mobility exercises like walking. Pain medication can make patients drowsy at first. Mild pain around the incision is normal.
2-4 weeks after surgery
Follow-up appointment with the surgeon to monitor recovery. May involve an x-ray or MRI. Many patients switch from prescription pain medication to over-the-counter options like Tylenol or Advil. Can resume light activities around the house but avoid lifting anything over 10 pounds.
6 weeks after surgery
Generally cleared to return to desk work or other sedentary jobs at this point. Most patients report significant improvement in pre-operative symptoms like leg pain and numbness. Physical therapy focuses on core strengthening and more active movements. Regular walking is encouraged. Still refrain from strenuous activities.
3 months after surgery
Around this time, all restrictions are lifted. Patients can resume their full regular activities including exercise. Complete recovery from any pre-operative weakness or numbness can take up to 6-12 months for some.
Factors affecting spinal stenosis surgery recovery
The specific recovery timeline varies significantly based on:
Type of surgery
More invasive procedures like multi-level laminectomies or those involving fusion generally have longer recovery times, up to 6 months. Minimally invasive keyhole procedures allow for quicker healing.
Patient’s age and fitness level
Younger, more active patients in good physical shape tend to bounce back faster compared to older, less healthy individuals. Strong core muscles facilitate recovery.
Number of spine levels operated on
Operating on multiple vertebral levels typically leads to longer recovery compared to surgery at a single level. Fusion involving multiple segments takes the longest to heal.
Presence of complications
Complications like bleeding, infection or cerebrospinal fluid leak can prolong hospitalization and delay recovery. Nerve injury can also impair the healing process.
Adherence to instructions
Following all postoperative instructions from your surgeon and physical therapy program will optimize your results. Not overdoing activities speeds up recovery.
Tips for recovering after spinal stenosis surgery
Here are some tips to help facilitate smooth recovery after stenosis decompression surgery:
- Take short, frequent walks around the house to regain mobility and prevent blood clot formation
- Avoid sitting or standing for long periods; change positions regularly
- Wear a brace for extra lumbar support if recommended by your surgeon
- Practice good posture when sitting, standing, and walking
- Stop activity if you feel significant pain, numbness or weakness
- Perform recommended stretching and strengthening exercises as directed
- Stay hydrated and eat a high protein diet to promote healing
- Ask for help from family and friends especially for tasks like shopping, cleaning and laundry
- Get plenty of rest; naps and good sleep are important
- Quit smoking to optimize bone and soft tissue healing
Let pain be your guide when gradually increasing activity levels during recovery. Avoid bending, lifting or twisting excessively during the first few months. Report any symptoms concerning for complication to your surgeon like fever, severe pain, or loss of strength or sensation in the legs. With patience and care, most patients achieve significant relief from spinal stenosis with surgery and make a full recovery within 6-12 months.
Conclusion
Recovery after spinal stenosis surgery varies considerably based on the specific procedure performed and the patient’s overall health status. On average, hospitalization lasts 1-3 days, with a gradual return to light activities over 2-6 weeks. By 6-12 weeks, most patients can resume desk work. Around 3 months, all restrictions are lifted although maximal recovery continues up to a year after surgery. Following postoperative instructions, attending physical therapy, staying active and giving the body enough rest all help optimize results. While every patient’s experience is unique, spinal stenosis surgery can provide significant relief from symptoms like leg and back pain when conservative measures fail. With proper postoperative care, patients can get back to enjoying their favorite activities after recovery.
