November 22, 2024
Spinal stenosis is a condition in which the passageway for the nerves in the spine (or spinal canal) narrows.
When the spinal canal narrows, the nerves is compressed, causing pain and numbness from the lower back to the legs. Intermittent claudication, in which pain and numbness occur in the buttocks and legs when walking and ease up when resting, is a characteristic symptom of spinal stenosis.
The more severe the symptoms, the more likely surgery will be considered, so in this article we will explain in detail how the surgery procedure is carried out.
Spinal Stenosis Surgery
Surgical Treatment
The most common surgical treatments for spinal stenosis are lumbar laminectomy and spinal fusion.
Lumbar Laminectomy
This is a procedure that is performed using an endoscope. Under general anesthesia, a skin incision of around 18 to 20 mm is made in the back, and an endoscope tube is passed through the incision. The procedure involves removing part of the lamina and the thickened ligamentum flavum to relieve pressure on the nerves and widen the spinal canal.
If there is also spondylolisthesis or spinal stenosis, fusion surgery may be required after the laminectomy.
脊椎固定術
This is a surgery to fix the spine using an endoscope and X-ray fluoroscopy. Under general anesthesia, the skin on the back is cut open, the degenerated intervertebral disc is removed, and an artificial implant called a cage filled with bone taken from the hipbone is inserted to reshape the spine. After that, the vertebrae are fixed with screws and rods.
This fixation surgery is indicated in cases of lumbar spondylolisthesis or instability.
Ambulatory surgery: the Florence and Q-Florence methods
The Florence and Q-Florence methods are minimally invasive treatments with low risk that can be performed for spinal canal stenosis.
A device is inserted percutaneously under local anesthesia and sedation to widen the narrowed spinal canal.
By inserting the device, it is possible to maintain spinal rotation and flexion, stabilize the vertebrae, widen the spinal canal, and reduce protrusion of the intervertebral disc and thickenening of the ligamentum flavum. Pain is relieved by widening the narrowed spinal canal.
Currently, the Florence method and Q-Florence method are only performed at our hospital.
The Q-Florence method (in Japanese)
Process of the surgical procedure
Preparation
This may vary depending on the type of surgery, but first of all, preparations need to be made before the surgery.
Since some of the medication that the patient is taking may affect the surgery, these will be checked in advance by the doctor or nurses. The patient will then be asked to stop taking whatever medication may affect the surgery.
Smoking and drinking alcohol will also affect the surgery, so the patient will be asked to refrain from either of these before the surgery to reduce the risks.
Anesthesia
On the day of the surgery, the nurse will measure your temperature, blood pressure and SPO2 (oxygen saturation levels).
Once you enter the operating room, the anesthetist will administer the anesthesia.
Conventional surgical procedures (laminectomy, fusion) are performed under general anesthesia. The anesthetic will render the patient unconscious during the surgery. Since respiratory functions tend to weaken during general anesthesia, artificial respiration will also be used.
Conversely, the minimally invasive procedures of the Florence and Q-Florence methods are performed under local anesthesia and sedation. The patient remains conscious, and there is little risk and almost no after-effects.
The surgery proper
Both conventional surgical procedures and the Florence and Q-Florence methods begin with an incision in the back. However, in the case of laminectomy and fusion, the incision is 2-3cm (sometimes longer), but in the case of the Florence and Q-Florence methods, it is only 1-2cm.
After the incision in the back has been made, in the case of surgical operations (laminectomy, fusion), the muscles are cut open, the ligaments and spine are shaved down, before being fixed in place with screws and rods.
On the other hand, in the case of the Florence or Q-Florence methods, a device is inserted while preserving the ligaments using a special instrument. Because the ligamentum flavum and supraspinous ligament, which stabilize the lumbar spine, are not removed, the device does not shift or the spine does not become unstable after the operation.
At the end of the surgery, the skin is stitched up, whether the surgery is a surgical procedure or a minimally invasive procedure.
The operation time for laminectomy and spinal fusion is about 1 to 2 hours, and for the Florence and Q-Florence methods it is about 30 minutes.
Post-surgery
Once the surgery proper is over, the patient wakes up from the anesthesia and recuperates in the recovery room.
In the case of laminectomy or spinal fusion, the patient will need to stay in hospital for 1 to 2 weeks, but in the case of the Florence or Q-Florence methods, after resting for 2 to 3 hours after the procedure, the patient can walk home the same day.
If you have been diagnosed with spinal stenosis, please consider a consultation at our hospital.
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