Spinal stenosis is a condition where two spinal vertebrae separated by an intervertebral disc come closer as the disc wears off due to osteoarthritis, rheumatoid arthritis or trauma. When this happens, the spinal nerve that runs between them becomes compressed causing pain to the individual. The pain is usually exacerbated by physical activity and this may render the person incapacitated.
Spinal stenosis surgery is performed in order to decompress the affected spinal nerve and bring relief to the patient. The whole operation is done while the patient is unconscious through the use of general anesthesia. As a result, the patient will not experience anything while in the operating room. However, it is still important to know exactly what will be going on moments leading up to the surgery, during and moments after.
Moments before the spinal stenosis surgery
There are various steps to be taken in order to prepare for a spinal stenosis surgery. These are usually done weeks and days before the day of the operation. You can still expect some last-minute preparations about an hour or so before being transferred to the operating room. An intravenous (IV) line will be connected from a cannula inserted into the vein in your hand or upper arm. This IV line will be used to deliver antibiotics to prevent infection and any pain medications you may be in need if you are in severe pain due to the withdrawal of oral pain meds in the weeks leading to the date of surgery. It will also be essential for providing anesthesia which will make you unconscious.
You might also be given some fluid which will trigger a bowel movement. As the procedure might take a few hours, you may have an involuntary bowel movement while being unconscious. Hence the fluids are given to prevent such an incident. A catheter may also be inserted to empty your bladder during the operation for the same reason. It is better to keep in mind that these measures are not always taken unless the surgeon believes the operation is going to take more than a couple of hours.
Once this is done, you’re carted to the operating room. You might find the room to be quite colder than your hospital room. This is to enhance the sterility of the room and minimize the risk and the spread of infection. Anesthesia will be pumped through the IV line connected earlier. You will feel dizzy in a few minutes and fall unconscious.
During the spinal stenosis surgery
You will feel none of this because of the anesthesia but it is better to know what’s happening to you just so you are mentally prepared. There are basically 2 ways in which the surgeon is going to decompress your spinal nerves:
The non-invasive method
If the problematic intervertebral discs seem to be damaged slightly, then there may not be a need for an invasive procedure. This non-invasive method involves making a small incision of about 1 to 1.5 inches on the patient’s back, but at an angle rather than right over the mid line. The incision is also shallow cutting only through the skin layer after which the muscles and tissues are pushed aside to expose the spinal vertebrae. Sometimes, a second incision is made on the side of the torso to provide 2 points of access to the spine.
An instrument known as a retractor is then inserted into the space created to keep it open and provide access to the affected disc. The retractor is hollow. The surgeon inserts any necessary tools with a small camera through the retractor to guide their actions. Once the decompression is done, the retractor(s) are removed, the incision area(s) are sewn, bandaged and the procedure is completed.
The typical spinal stenosis surgery
The non-invasive approach to spinal stenosis surgery is not always used because it is only suitable for minor damages to the spinal vertebrae and intervertebral discs. Such minimal damage is often seen as a result of direct trauma to the back which only affects a small area that could be covered by a retractor. However, most cases of spinal stenosis are caused by osteoarthritis which is a gradual degeneration of the intervertebral discs. This usually results in the damage of more than a single disc and requires a complete spinal stenosis surgery.
During this surgery, an incision is made right along the patient’s back mid line which can be a few inches long. The incision is also deep, cutting through layers of muscle and tissue to provide access to the spinal column. After the affected vertebra is reached, the decompression is performed through different means to free up the spinal nerve that was being compressed. Afterwards, the skin is sewn and bandaged to conclude the operation.
Moments after the spinal stenosis surgery
When the surgery is complete, the patient is carted out of the OR where they often become conscious while in their hospital bed. You are likely to experience some pain during these moments only because pain medication is provided intravenously, otherwise, it would be extremely painful. You will also feel very groggy and will not be able to comprehend your surroundings or faces around you. This is completely normal and is a side effect of the anesthesia wearing off.
As for your back, you might be feeling very stiff due to the muscles and tissues that may have been damaged, and any kind of movement will send pain radiating all over your body. It’s best to rest for a while as your body tries to adjust and settle into the new environment. After a while, although you will be able to walk with some help, a toilet riser will be necessary when going to the bathroom.
The surgeon or doctor is likely to come and check on your progress while performing a physical examination of the surgical site to check for any complications. Signs like swelling, redness or pus may be indicative of complications, but these are easily addressed using antibiotics and anti-inflammatory drugs. A nurse may also clean the surgical site using an antiseptic and replace the bandage with fresh and a clean one to prevent infection.