In America, the most common reason for spine surgery in individuals over the age of 65 is lumbar spinal stenosis. What is it? Spinal stenosis represents a narrowing of the area available for the dural sac (spinal cord remnant) and the nerve roots emanating from it. Typically, there is plenty of room for both the dural sac along with the bilateral nerve roots coming out at every level of the spine. There is actually enough room for these to be bathed in cerebrospinal fluid and be comfortable.

Arthritis sets in as people get older. Along with the spinal arthritis comes potential overgrowth of the soft tissues and bone as a result. This may begin to pinch on the amount of space available for the nerve roots and dural sac. If it’s bad enough, people may start having buttock, back, and leg pain. This is actually a structural problem. Thankfully, most individuals with spinal stenosis do not have severe resulting pain.

Resulting symptoms can occur from this overgrowth leading to reduced blood flow or excitement of nerve roots from the inflammation. This may result in several levels being affected. They symptoms vary between individuals depending on the region of pinching and the person’s reaction. In spite of all this, lumbar spinal stenosis is the most common reason for spine surgery in individuals over the age of 65.

What if pain exists, should surgery be done? This question has been debated for decades since spinal stenosis really is a quality of life condition. It doesn’t kill anyone, and the severity of symptoms should guide treatment. If the symptoms do not improve despite nonoperative pain management for 3 to 6 months, a decompressive surgery may be considered. Some evidence has shown limited effectiveness overall for this surgery.

A recent Spine article looked at numerous high quality studies in the literature to determine how well laminectomy decompressions work for stenosis. The results showed that in those who failed nonsurgical measures, surgery helped with pain, quality of life, and function more than simply conservative treatment. It did not, however, statistically help with walking ability.

These benefits slightly decreased over the years, but did not go away completely, even up to a decade. Beyond a decade was not reviewed. These results continued despite obesity, older age, lung issues, or other medical issues. The addition of comorbidities raised the risks of complications from surgery, so they should be weighed into the mix to decide the benefits versus the risks and whether or not to proceed with surgery.

The results were similar among almost every study evaluated, including whether or not the patient had one vertebra slipped on another, known as spondylolisthesis. The main issue is it’s a quality of life decision, and substantial conservative treatment should be attempted first.

Surgical risks in this age range cannot be ignored, even though they are small. At that point when nonoperative treatment fails, however, a number of high quality studies support the decision for a simple lumbar decompressive laminectomy.

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