This is a procedure that is done to expand a narrow spinal canal as in Lumbar canal stenosis that results in symptoms that are not responsive to conservative measures such as pain killers and cortisone injections.
Indications include ‘Neurogenic claudication’ wherein one can’t walk distances without having to stop due to leg symptoms that prevent further walking. Other indications include weakness of lower limbs, bowel/bladder disturbances that can be attributed to canal stenosis or ‘Cauda Equina’ compression and pain in the lower limbs.
Surgery essentially involves removal of arthritic joints, ligaments and disc prolapses, all or a combination of which can contribute to canal stenosis.
Operative Procedure
Under general anaesthetic, the patient is placed prone (face down) on the operating table. With X-ray the correct level is marked. After incision and muscle separation from the spinous processes and laminae, the laminae are removed with special instruments and a drill is used to further expand the opening. The overgrown ligaments are then removed and the spinal canal is thus opened up. After adequate control of bleeding the wound is closed after placement of a drain to suck out blood that may ooze out over the ensuing few hours and removed in a day or two. The bone parts that are removed need not be replaced and that is safe to do so without any significant consequence later.
Risks/Complications
- Infection – Uncommon; superficial infections being more common than deep
- Bleeding – Again an uncommon complication, rarely requiring surgery to evacuate blood clots
- Non-resolution of neurological symptoms, more common, depending on the duration of pre-operative symptoms and also the severity of compression prior to surgery
- Worsening of weakness or paralysis – extremely rate
- Fluid leak from the sac covering the nerves – rectified during surgery
- Anaesthetic/medical complications including drug hypersensitivities, lung complications, DVT, pulmonary embolism, death.
Post-Operative Period
The drain is removed in 1-2 days usually. Patient is allowed to get up and walk with help the day after surgery and physiotherapy is commenced. Usually, hospital stay is 4-5 days after which one can be discharged home or to a rehabilitation facility. At discharge a few waterproof dressings are given for usage during showers. The patient is allowed to lift weights of up to 5 kgs initially and then gradually increase weights over the ensuing few weeks. Driving can commence from 2-4 weeks depending on how the back feels. Post-operative follow up is usually between 4-8 weeks.
