Surgical Options

The goal of spinal stenosis surgery is to take away bone or neural elements that are impinging on the nerves that are trying to extend to the rest of your body (called a decompression). There are a few different surgical treatments that can possibly help relieve your pain from spinal stenosis.

  • Direct decompression with coflex® Interlaminar Stabilization®
  • Direct decompression alone
  • Direct decompression with pedicle screw fusion

Direct Decompression with coflex Interlaminar Stabilization

The coflex device is a motion-preserving titanium implant that goes in the back of your spine to treat moderate to severe spinal stenosis. After the surgeon performs a direct decompression that removes bone, facet, ligament and/or disc segments from the narrowed spinal canal, your spine can become unstable. The coflex device is then inserted directly following a decompression procedure to help keep your spine stable while maintaining normal height and motion in your spine.

What is done:

  • After a microsurgical direct decompression, the motion-preserving implant is implanted through a minimal incision and is placed on the lamina (the strongest posterior bone in the spine) to keep your spine stable
  • This placement off-loads facet joints, maintaining the height between your bones for nerves to exit freely
  • Both leg pain and back pain are relieved long-term^
  • Motion is maintained in both the treated area as well as the area above the device

Considerations:

  • The coflex device is not for everyone; a patient must have failed at least 6 months of conservative treatment, and have confirmation of lumbar spinal stenosis with moderate to severe leg pain with or without back pain
coflex Interlaminar Stabilization
coflex Interlaminar Stabilization

Direct Decompression Alone

A direct decompression surgery is the most common surgical option to treat spinal stenosis. This procedure involves removing diseased or inflamed tissue that may affect the spinal nerves. This tissue may include bone, ligament, pieces of disc, or anything that narrows the spinal canal and/or neural foramen (where the nerves exit to the sides of the spine).

What is done:

  • A laminectomy or laminotomy is performed to access and address the stenosing structures
  • No device is implanted
  • Can be done as a minimally invasive procedure
  • Can be effective at relieving leg pain for the short-term

Considerations:

  • Usually does not address back pain long-term
  • Can destabilize the spine
  • Over time, the spine can re-stenose
  • Future intervention with epidural injections and/or surgery is more likely*
Direct Decompression
Direct Decompression

Direct Decompression with Pedicle Screw Fusion

Spinal fusion surgery is the most involved type of surgery to address spinal stenosis. It should be reserved for patients with spinal instability (>Grade 1 spondylolisthesis) or other traumatic conditions.

Spinal fusion first requires a direct decompression to relieve the symptoms of spinal stenosis. However, since it typically requires a significant amount of bone and/or tissue removal, the spine can become unstable as a result. To address this instability, a surgeon will “fuse” two vertebrae together using a bone graft from your body or synthetic tissue.

What is done:

  • After the decompression and disc removal, implants are placed within the spine (cages, screws and rods)
  • Bone graft is placed to create biological fusion and permanently fix the spine in place

Considerations:

  • Can be highly invasive
  • Healing time is months to years
  • Motion segments above and below the fusion have a high chance of degrading faster, requiring future surgery
Pedicle Screw Fusion
Pedicle Screw Fusion with Cage
Pedicle Screw Fusion Posterior View
Pedicle Screw Fusion Posterior View

*Claims based on ESCADA data, published in Journal of Neurosurgery: Spine. Volume 28 Issue 4, April 2018

^Claims based on FDA PMA P110008, October 2012.

This content is for educational purposes only and does not replace having a conversation with your doctor.