What to know about surgery for cervical spinal stenosis

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People may require surgery to treat spinal stenosis if nonsurgical options, such as medications and physical therapy, have not been effective.

If people have severe symptoms, such as weakness or numbness, they may need surgery straight away.

Laminectomy is a surgical procedure to relieve nerve compression. Doctors remove bone spurs, which are growths of extra bone that can develop with stenosis.

Spinal fusion is another type of surgery that joins together vertebrae that have come away from their usual position.

Laminoplasty is a type of surgery to treat spinal stenosis in the neck. The lamina is part of the bone in the vertebrae. Laminoplasty repositions the lamina to create more space within the spinal cord.

This section looks at what to expect before, during, and after surgery for spinal stenosis.

Before

Before spinal stenosis surgery, a doctor will carry out a physical exam and take imaging tests to examine the spine. This may include:

• X-rays of the bones
• MRI scan, which can show any damage to soft tissue such as ligaments, disks, and nerve roots
• CT scan to show any issues with the spinal canal and surrounding areas

A person will need to let a doctor know if they are taking any medications or supplements before having surgery.

People should follow any preparation instructions before surgery, such as what to wear, eat, and drink before the procedure.

During

For surgery such as laminoplasty, a person will have a general anesthetic. A surgeon will then carry out the procedure, which may involve:

• making an incision into the back of the neck and moving tissue, muscle, and ligaments out of the way to reach the lamina
• cutting into the lamina and creating a hinge to open the lamina out and create more space in the spine
• placing a metal plate, or sometimes a bone graft, to secure the new placement of the lamina
• returning the tissues, muscles, and ligaments back into position and closing the incision in the neck

The procedure may vary depending on the type of surgery people are having. If a person is having minimally invasive surgery, a surgeon will make smaller incisions to carry out the procedure.

People may experience less pain and a quicker recovery after having minimally invasive surgery compared with major surgery.

Recovery

A person will remain in hospital while the effects of anesthetic wear off. Doctors will monitor them for any side effects of surgery.

According to the American Academy of Orthopedic Surgeons, people will usually need to stay in the hospital overnight, although they are sometimes able to go home on the day of surgery.

If a surgeon operates on the front of the neck, the person may have some hoarseness or difficulty eating for a few weeks after surgery. People may need to wear a cervical collar to support the neck.

After spinal fusion surgery, it can take 6–12 months for the bone to fuse and become solid.

Following surgery, people may only be able to carry out light activity, but they may be able to gradually increase this as a doctor instructs.

Physical therapy can help people recover and regain proper function after surgery. People may be able to begin physical therapy 4–6 weeks after surgery.

Depending on their job requirements, a person may be able to return to work after a few days or weeks following surgery. It may take 3–4 months or longer before people can return to a full range of activities.

Surgery for spinal stenosis may help to relieve compression on the nerves and spinal cord, realign the spine, and restore spinal health. Different types of surgery can have different benefits and risk factors.

Laminectomy is a common surgical procedure for treating spinal stenosis. The procedure generally has a quick recovery rate, a low rate of adverse side effects, and improves symptoms.

Laminoplasty may help preserve a greater range of motion compared with laminectomy and prevent the negative side effects that can result from spinal fusion surgery.

Potential risks of surgery on the cervical spine include:

• bleeding
• infection
• injury to nerves or the nerve covering
• injury to the spinal cord
• anesthetic reaction
• treatment failure or need for repeat surgery
• life threatening side effects, such as heart attack or stroke

The type of surgery may also affect possible risks or complications. If a person has anterior surgery to the front of the neck, risks include:

• voice changes
• breathing difficulties
• problems with surgical plates or implants
• swallowing problems
• injury to the esophagus
• pain at the site of bone removal
• bones not joining together with spinal fusion surgery

In most cases, the outlook after cervical spine surgery is positive and will relieve pain and other symptoms. After recovery, most people will be able to return to their usual everyday activities.

This section answers some frequently asked questions about surgery for spinal stenosis.

When should you have surgery for cervical spinal stenosis?

People may need surgery for cervical spinal stenosis if nonsurgical approaches and medications are not effective or if they have severe symptoms.

How do you fix stenosis in the neck?

Treatments include physical therapy, medications, and surgery to relieve compression. Surgery may not be suitable for everyone with spinal stenosis.

What is the success rate of neck surgery for spinal stenosis?

The success rate of laminectomy is 90%, with a satisfaction rate of 75% in people receiving the surgery.

Symptoms such as weakness and pain may resolve quickly, while other abnormal sensations may take up to 2 years to resolve.

Surgery for cervical spinal stenosis aims to relieve compression in the neck.

There are different types of surgery, depending on the location of the problem, medical history, and preference. Surgery may help to relieve pressure on the spine and ease symptoms.