Beware These Lumbar Stenosis Surgery Pitfalls

Lumbar stenosis surgery isn’t always 100 percent successful. That’s why it’s important to carefully assess your personal risk factors before going under the knife.

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If you’re thinking about surgery for sciatica, which can cause shooting pain down the back of your leg from your buttocks to below the knee, it’s important to try non-operative treatments for six to 12 weeks before considering lower back surgery to relieve this troublesome symptom.

Stenosis surgery sciatica surgery pitfallsMaximize your chance of a successful stenosis surgery“Anyone contemplating surgery for sciatica should go through a full course of conservative treatment, including physical therapy, aerobic exercise and oral pain medication as well as epidural steroid injections,” says James Lin, MD, MS, an orthopedic surgeon at The Mount Sinai Hospital in New York City.  

Sciatica and Stenosis

Sciatica is caused by stenosis, which is a narrowing of the spinal canal. In about 90 percent of cases, this stenosis comes from a herniated disc compressing the sciatica nerve roots.

It’s pretty simple. The damaged disc juts out and can pinch the roots of the sciatic nerve, the largest single nerve (actually two, one on the left and one on the right) in the human body. This pinching can cause pain, numbness, tingling and muscle weakness. Let it go too long and you can experience incontinence and permanent nerve and muscle damage.

Stenosis surgery pitfalls - narrowStenosis, which can cause painful sciatica, is a narrowing of the spinal canalStenosis Surgery Options

Surgery for lumbar stenosis depends on the cause of your sciatica:

  • If a single herniated disc is pressing on the nerve root, then removal of that portion of the disc that’s causing the compression (a procedure called discectomy or microdiscectomy) may be all that is necessary.
  • If your stenosis is caused by a bony problem such as an arthritic bone spur, then creating space in the spinal canal by removing part of the lamina, the back of the spinal column, (hemilaminectomy) or the entire lamina (laminectomy) may be performed.

With non-operative treatment over the course of several weeks to months, however, the swelling in the nerve may go down, improving sciatica symptoms. Sometimes, adds Dr. Lin, “The disc gets resorbed over time and becomes less irritating to the nerve. “

Stenosis Surgery Success Factors

Still, if you’re considering surgery for sciatica symptoms because you’ve failed nonoperative treatment, Dr. Lin recommends talking with your surgeon to discuss your overall risks versus the potential benefits. That discussion is likely to focus on traditional risk factors, such as:

  • Your age
  • Your health status—whether you have underlying health conditions
  • Your bodyweight
  • Whether you smoke

Being 65 or older, having other health problems, being overweight or a smoker can put you at above average risk for experiencing complications from spine surgery, Dr. Lin says.

A recent study in Spine, which involved 529 patients who had surgery for sciatica because of lumbar spinal stenosis, identified three additional risk factors that may affect the outcome of lumbar stenosis surgery for sciatica, including:

  • Depression:In the study, patients who continued to have sciatica symptoms after surgery were more likely to be taking antidepressant or anticonvulsant medication
  • Reporting a lower health-related quality of life
  • Having had previous spine surgery

Stenosis surgery pitfalls - depression Depression is associated with poor stenosis surgery outcomes, according to a June 2020 studyThere may not be much you can do about these risk factors because they’re not as modifiable as say—losing weight or quitting smoking, Dr. Lin says. But just knowing they may factor into the possible success of your sciatica surgery is something to keep in mind. “The best way to understand what you’re going to get out of surgery is to understand what your risk is and that risk is not the same for everyone,” he says.

Control What You Can

“Ultimately, a lot of surgery success is dependent on making sure patients are optimized before surgery,” Dr Lin says. To increase the chances of successful surgery for sciatica because of lumbar stenosis or lumber radiculopathy after you’ve tried conservative (non-operative) treatments, take these important steps:

  • Be a loser. “If your body mass index is over 35, your risks of surgery go up,” Dr. Lin says. Weight loss is difficult, but it has been shown to improve outcomes.

    A sensible diet with a moderate caloric deficit is essential for weight loss. Exercise can be helpful as well. Dr. Lin recommends light aerobic exercise, such as stationary or recumbent cycling. “It’s hard to exercise if you’re in pain, but it helps increase your cardiovascular system and make sure your heart and lungs are healthy enough to undergo the stress of surgery,” Dr. Lin says.

    If exercise is excruciating, ask your doctor about anti-inflammatory, muscle relaxants or steroid medication; those nonoperative treatments can provide pain relief that may enable you to exercise.
     
  • Be a quitter. Smoking can increase the rate your spine degenerates and impairs your body’s ability to heal after surgery. “If spinal surgery is elective, meaning there’s no medical emergency, I strongly encourage my patients to quit smoking before surgery,” Dr. Lin says. To increase your chances of kicking the habit, get support. Visit cancer.org/smokeout or call the national tobacco quit line at 800-784-8669.
  • Be proactive. If you’ve been prescribed an antidepressant for depression, don’t quit your medication to try to improve your chances of sciatica surgery success. “Mental health is very important. If someone needs medication for depression, they shouldn’t stop it for spine surgery,” Dr. Lin says. Ditto for anticonvulsant medication. “Stopping your anticonvulsant medication for spine surgery is likely to do more harm than good.”

Stenosis surgery pitfalls - weightKeeping your weight down with a healthy diet and exercise can increase your odds of a successful stenosis surgeryStill, if you have a pre-existing condition like depression, you should bring your mental health provider or other specialists into the pre-surgical discussion. “Whether to have surgery for sciatica needs to be a joint decision among the patient, their mental health provider and the spine surgeon,” Dr. Lin says.

Not sure if lumbar stenosis surgery is right for you? Get an expert opinion. Find a spine specialist near you who can help.

Updated on: 07/14/20
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Surgery for Sciatica
Eeric Truumees, MD
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Surgery for Sciatica

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