What is lumbar spinal stenosis?

Lumbar spinal stenosis is where the spinal canal narrows in your lower back.

The spinal canal tends to narrow as we get older caused by bony overgrowth from wear and tear in the facet joints, thickening of surrounding ligaments and bulging of the discs.

A narrowed spinal canal means that there is not enough space for the nerves and blood vessels. You may have difficulty walking and leg pain, often with a tingling sensation.

What are the benefits of surgery?

The aim is to prevent your symptoms getting worse. You may get less pain and be able to walk further. Some people have a major improvement.

Are there any alternatives to surgery?

If your symptoms are mild, you may not need any treatment. If your symptoms are severe or are getting worse, surgery is usually the only option.

What will happen if I decide not to have the operation or the operation is delayed?

Your symptoms are unlikely to get worse quickly. For a few patients their symptoms will even get better with time.

If you develop any of the following symptoms, contact your healthcare team.

• Change in control of your bladder and bowel and difficulty getting an erection.
• Pain in both legs.
• New weakness your doctor does not know about.
• Numbness or loss of sensation in your genitals or back passage.

What does the operation involve?

The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible.

The operation usually takes 1 to 2 hours.

Your surgeon will make a vertical cut on the centre of your lower back. They will part the muscles to get to your spine. Your surgeon will remove enough bone and ligament tissue to open up the narrowed part of the canal, giving the nerves and blood vessels more room.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health. Nicotine is known to prevent wounds from healing properly following lower-back surgery, and increases the risk of unsightly scarring and chronic pain.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• Bleeding during or after the operation. This can cause pressure on the nerves (extradural haematoma).
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Difficulty passing urine.
• Venous thromboembolism (VTE) — this is a blood clot in your leg (deep-vein thrombosis - DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection — you may need antibiotics and physiotherapy. Your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.
• Heart attack or stroke. Sometimes a heart attack or stroke can cause death.

Specific complications of this operation

• Worse pain or numbness down your leg.
• Numbness between your legs, loss of normal bowel and bladder control and, for men, problems having an erection. Although the nerves should get better over time, 3 in 5 people do not get completely back to normal.
• Neuropathic pain. This is a burning pain that may happen once the pressure on the nerves has been released.
• Tear of the thin membrane that covers the nerves in your spine (dural tear). The risk is higher if this is your second lumbar laminectomy.
• Infection in your spine.
• Spinal instability.
• The problem coming back. You may need another procedure to fix it.
• Difficulty passing urine.

Consequences of this procedure

• pain
• unsightly scarring of your skin

How soon will I recover?

You should be able to go home after 1 to 2 days.

Do not lift anything heavy or twist your body. Make sure you keep a good posture when sitting and walking.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Spinal stenosis can sometimes come back at the same place or at a different place in your spine.

Summary

Lumbar spinal stenosis is where the spinal canal narrows in your lower back. This may cause pain or weakness in your legs. The aim of surgery is to prevent your symptoms getting worse.

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