Surgery for Spinal Stenosis

When surgery is necessary for spinal stenosis, the Weill Cornell Brain and Spine Center takes the least invasive approach possible. Our spine surgeons have developed expertise in some of the most advanced minimally invasive surgery for spinal stenosis:

• Endoscopic Decompression: The least invasive option available, this advanced technique requires only the tiniest of incisions (7 mm, or less than a quarter of an inch). A specially trained neurosurgeon inserts a slender endoscope into the incision, and the wafer-thin camera and tools are guided to the location of the stenosis under X-ray navigation. There is no cutting into muscle, making the procedure essentially painless, and patients go home the same day. Many patients who would previously have required fusion surgery can now avoid that by having an endoscopic decompression instead. In this procedure, a neurosurgeon with advanced training decompresses the nerve by opening the foramen (the passage through which the nerve passes). 
  
• Lumbar Laminectomy: This is one of the most common procedures used to treat spinal stenosis today. It can be performed with open or minimally invasive techniques, depending on the diagnosis. The procedure involves removal of the lamina (the part of the vertebra that covers the spinal canal, which houses the spinal cord), bone spurs and excess ligament, thus reducing compression.
• Posterior Cervical Laminectomy: Laminectomy is surgical procedure used to treat severe cases of cervical spinal stenosis. Surgery is performed under general anesthesia, and the pressure of the spine is decreased by removing the portion of the vertebrae that is compressing the spine and nerve structures. Bone grafts are inserted into the spine and held in place by rods and screws, which stabilizes the neck and creates a fusion of the vertebrae. Over time, as the neck heals, new bone grows around the screws and fuse the spine. Patients usually wear a hard, cervical collar for 6 weeks after surgery.
• XLIF (Extreme Lateral Interbody Fusion): This advanced method of minimally invasive surgery approaches the spine from the side, avoiding the major muscles of the back. A spine surgeon makes a small incision in the patient’s side, between the lower ribs and pelvis, and inserts a special surgical instrument just above the disc space. The surgeon removes the damaged disc tissue and inserts a spacer between the vertebrae.  The surgical team monitors the position and correct placement of the spacer, sometimes using special   screws   or a plate on the side of the spine to offer additional stability. Patients typically are walking within a few hours of the XLIF procedure and are then discharged the next day. Most patients are back to work within approximately two weeks.   (Download the “About Lateral Access Surgery” brochure here.)
• Minimally Invasive Lumbar Fusion: This surgery fuses the bones of the spine in the lower back together so that there is no longer any motion between them. This reduces spinal pressure, pain, and nerve damage. Minimally invasive lumbar fusions do not require the large incision or the muscle retraction typically used in conventional fusions. Patients undergoing this procedure have a fast recovery time. A recent advance is the use of a computerized image guidance system for many patients undergoing lumbar fusion. This has the advantage of aiding the surgeon in optimal placement of screws and avoiding injury to delicate nerve tissue.

Until recently, all patients undergoing lumbar fusion required a bone graft either from the hip region or from a bone bank.  Newer bone grafting substances are now used to promote healthy fusion. In most patients undergoing lumbar spinal fusion, metal titanium instrumentation is also used. This will typically involve placing pedicle screws into the bone and connecting these with a rod. (See Doctors Who Treat Spinal Stenosis.)

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