Cervical spinal Stenosis
For cases of mild stenosis, with scarce symptoms, physiotherapy is often used in conjunction with medications. For severe stenosis with neurological disorders, it is instead advisable to surgically intervene.
The surgical decompression of the vertebral canal can be performed with an anterior, posterior or combined approach depending on whether the spinal cord compression is predominant on the anterior or posterior side or on both.
The anterior approach is similar to the one used to remove cervical herniations.
In the posterior approach, a posterior midline cervical incision extending approximately 15 cm
is performed; the paravertebral muscles are bilaterally detached reaching the laminae. At this point, it is possible to decide whether to proceed with a laminectomy (complete removal of the laminae) or with the so-called "open-door" laminotomy (the laminae are cut only on one side and weakened on the opposite side so the opening is in one piece, like with a zipper).
In the combined approach, decompression surgery is performed both anteriorly and posteriorly. Depending on the patient's age, general conditions and the number of levels that need to be decompressed, the surgeons may decide to perform a double surgery in a single operation session or to perform it at two different times.
The patient is invited to stand up the morning after surgery and is dismissed after two days from the hospital. The patient can resume her/his normal activities although she/he must avoid major strains for about a month.
Lumbar spinal Stenosis
At first, a conservative treatment (painkillers, physiotherapy) is recommended. If the symptomatology becomes disabling or it gets worse, surgery is employed.
The surgery is performed with a posterior approach and consists in a decompressive laminectomy, i.e the removal of the posterior portion of the vertebral canal formed by the laminae in order to expand it. Very often, in order to obtain complete decompression of intra-canal nervous structures, it is necessary to partially remove the facet joints (one of the structures which provides stability to the spine) as they are themselves the cause of stenosis. In these cases, to prevent future vertebral instability, a vertebral stabilization (arthrodesis) is also performed with appropriate fixation devices were needed.
The patient is invited to stand up the morning after surgery and is dismissed from the hospital after two days. The patient can resume her/his normal activities although he/she must avoid major strains for about a month.