It is important to accept two things about spinal stenosis:

Spinal stenosis is part of the aging process. As you get older, your spine will get older, and there is a reasonable chance your stenosis symptoms will get worse. You will walk shorter distances and will not be able to stand for as long as you do now.

Spinal stenosis symptoms get worse very slowly. Your chance of having the nerves totally pinched and becoming paralyzed are close to zero. In a patient who regularly visits his/her doctor at least once or twice a year, this does not happen. Even though your symptoms will get worse, you have a lot of time (months) to decide what you wish to do about your condition. It may get worse quickly with an inciting incident.

This brochure covers:

What to Do?

Now that you have been told you have spinal stenosis, what should you do? If you are noticing limitations in your distance walking or time standing, you are probably going to need surgery on your back some day.

Remember, there is a lot of time (weeks to months to years) to think about the suggested treatment and to get other opinions. Your spinal stenosis may be mild enough that you should just lose weight and exercise. Other treatments that may help are anti-inflammatory pills, epidural cortisone injections, bracing, etc. If you wish to wait on your surgery, you likely won't come to any harm and may even get some temporary help (months) from these other treatments.

When Should I Have Surgery?

You should have surgery when you are ready. When you can no longer live with your pain, or it really limits your ability to walk or stand, it is time to consider surgery.

You may be urged to have surgery in the near future if you have weakness in your legs or you start having trouble controlling your bladder or bowels.

Am I Too Old for This Surgery?

This is a good question and can only be answered by you. If you have places to go, things to do, and people to meet, and can't do it because your legs won't let you, then you are not too old for surgery. Obviously, there are more risks to surgery as you get older, but today's anesthetic techniques, along with the improvements in the types of surgery performed, make this a relatively safe procedure.

If I Decide to Have Surgery, What Will You Do?

The size of your spinal canal needs to be enlarged. To do this in surgery, some bone and ligaments are removed from the spinal canal to make room for the nerves. How is this done? Through skilled "carpentry", with special instruments and the microscope, we are able to look in many areas of the spinal canal to remove the sources of pressure on the nerves. This is known as a decompression.

A fusion may be recommended if you have slipped vertebrae (this is usually easy to see on regular x-rays), and you have a lot of back pain in addition to your leg symptoms. This is to give more stability.

Will I Need a Blood Transfusion?

Everything possible is done during surgery to avoid much blood loss. You are much more likely to need blood if you are having a fusion. Our blood donor source is very safe and reliable. However, to avoid a transfusion of someone else's blood, you may pre-donate your own blood. Our staff will help you with these arrangements.

Prior to surgery:

You should stop any medication that increases bleeding. These drugs, aspirin and other anti-inflammatories such as Motrine, should be stopped for at least seven days before surgery.

Finally, you should start healthy habits such as taking multivitamins with iron to build yourself up and NO SMOKING. Smoking destroys fusions along with all the other terrible things it does to the body.

What Should I Expect After Surgery?

The first day after surgery is the hardest. You will have medication for the pain. The nurses and doctors will do their best to make you comfortable. The physical therapist will teach you how to get in and out of bed, and will help you to start walking.

The second day you will likely be thinking more positively, getting out of bed and eating.

Decompression (Without Fusion)

You will usually be on your way home two to five days after surgery. You should go home to "home cooking" as soon as you can. You will probably have a small back brace for support. You will have medicine for the pain.

Decompression and Fusion

If a fusion is added to the decompression, then you will be in the hospital a few days longer (three to seven days) and be just a little slower getting going. If you have had a fusion, you will need the addition of multivitamins with Iron and Calcium (or TUMS) to help the fusion become solid. We recommend 1200-1800 mg of Calcium a day.

What Do I Do When I Get Home?

Walk! Walk! Walk! Walk! Your therapy is walking - as much as is comfortable. Sometimes your age and other joint pains will slow you down, but try to walk as much as you can. Use whatever you need to help you walk - a walker, cane (or canes), or your partner. As the weeks go by, you will start to walk further and need less help. The goal is 45 minutes of walking twice a day.

Wound Care

Your wound is closed with stitches that dissolve. You have no need to have stitches removed. Leave your wound uncovered; they seem to heal better. Skin tapes (steri-strips) help close the wound and will gradually fall off over a period of seven to ten days.

You may shower within 24 hours of your operation. It is best to wait five to seven days to soak in the bathtub. It is not necessary to cover your incision. When you are finished bathing, just pat the wound dry with a soft towel.

Pain Medication

You will be sent home with pain medication. You should not need strong pain pills for very long after surgery. If you need more pain medication, be sure to give the office 24 hours to refill your prescription.

Constipation

Some patients find that after surgery, they have trouble getting their bowels to move. This can happen because of:

• Decreased activity
• Pain pills
• Iron pills
• Effects of anesthesia

You can help prevent this by:

• Eating a lot of fresh fruits
• Eating a lot of fresh vegetables
• Drinking plenty of water

If you do have trouble with bowel movements, there are several stool softeners that can be purchased without a prescription (e.g. Surfake, Correctol). Along with the stool softener, use Metamucil on a daily basis. Suppositories and enemas are also at the drugstore if you need them. Walking also helps constipation! Again, the best treatment is prevention.

Diet

Get onto your regular diet as soon as possible. If you have had a fusion, you should add multivitamins with Iron and Calcium (at least 1200 mg a day) or TUMS, to your diet. There is a chance we will add some bone-building medication such as Fosamaxe and/or Miacalcine.

Activity

Walking is plenty of exercise. Stairs are also great exercise. If you have had a fusion and decompression, we do not recommend anything other than walking and stairs. If you have had a decompression only, and a few weeks after the surgery wish to swim or ride a stationary bicycle, go for it! Limited bending is also allowed at this time for the patients who have had a decompression. If you have had a fusion, don't bend for at least two months. Call the office before trying other activities - if you feel ready to do more before your follow-up visit.

Brace (Corset) Guidelines

Most patients feel better when wearing a light brace (corset) when they are up. The corset will not prevent you from twisting or bending, but will remind you of your proper posture. Remember:

Wear your corset when you are sitting, standing or walking.

Wear your corset for one to three months. You may remove the insert if it is uncomfortable. A cotton T-shirt will make the brace more comfortable.

Do not wear the corset to bed. You do not need to ware the corset if you get up to go to the bathroom.

Shoes

Wear whatever is comfortable. Good walking shoes are important to your walking program to prevent foot pain.

Beds

You should not need anything other than your regular bed. It will be hard to get in and out of your bed the first few days, but it is good exercise.

Sex

If you have had a decompression, you may have sex with your partner within two weeks. If you have had a fusion as well as the decompression, wait a little longer (two to four weeks).

Driving Your Car

Wait a few weeks before driving if you have had a decompression. If you have also had a fusion, wait about four weeks before you ride in a car and about six to eight weeks before you drive. You should not drive while you are taking pain medication.

What Are the Chances My Problem Will Recur

As long as you live, you get older! (Brilliant!) Your spine will change with age, and it is possible to develop problems at other spine levels that may cause stenosis. At the time of surgery, every level that is causing or looks like it will cause stenosis symptoms is worked on. This reduces your chance of having stenosis again to less than 15%.

Follow-up

You will be called about a week after you are home to see if you have any questions and to schedule your follow-up appointment.

Someone is available every day to answer your questions, and that staff person can find your surgeon, if necessary. (303-839-5383)

You should be seen in the office six to eight weeks after surgery.

If you are from far away (out of state), you may be able to complete the follow-up by phone and save an extra trip back to Denver.

What Should I Expect as a Result of Surgery?

Results cannot be guaranteed. Although complications are occasionally reported, they rarely happen. You will not be perfect with surgery, just better.

At least 75% of the patients are walking much better after the surgery with less leg pain.

Some patients are left with some back pain that will keep them from doing heavy labor such as ditch digging, furniture moving, etc.

Fortunately, most patients who have this operation are in an age group where they don't wish to do these activities. All they want is comfort for daily activities and that can usually be achieved.