Kevin Morrill, M.D. Answers Questions On: Spinal Stenosis

Not necessarily. Spinal stenosis is the narrowing of the spinal canal, and it can cause serious pain. It can result from degenerated discs, arthritic facet joints, and other problems. The first line of treatment is usually physical therapy or steroid injections. If that doesn’t work, we’ll consider surgery.

If surgery is necessary, you want to seek out a surgeon with experience in this area to make sure it gets done right the first time.

There are many aspects to spinal fusion that affect the ultimate success of the operation, such as the quality of the bone graft and the preparation of the fusion bed. I have no hesitation about using the patient’s own bone as graft material when appropriate; it is the gold standard. Many surgeons will not use a patient’s own bone during a fusion because it takes a long time and causes the patient some pain. But it's one of those investments up front that pays dividends in patient outcomes.

About half of my practice consists of revisions of spinal fusions that were not successful. The vast majority of these fusion failures were done with manufactured products or cadaver bone tissue. I also perform complex, multilevel fusions [spinal fusions of more than one spinal level, or segment] for patients with severe chronic pain that has not been relieved by more conservative interventions.

Because back pain is such a common problem, new technologies are often promoted heavily. For example, some community-based spine clinics tout “laser surgery” to prospective patients. However, the use of lasers in spine operations has not been proven to offer any benefits. Most often, when a patient goes to such a center, he or she ends up receiving a conventional surgical procedure.

Older patients may have heard about artificial disks as a potential treatment for degenerative conditions of the aging spine. With current artificial disk products, however, the ideal patient is actually a person no older than 50 who has single-segment, straightforward spinal disease that would be equally well treated with a fusion. In this patient population, a good disk replacement is better than a good fusion, but fusion is still pretty good. And a bad disk replacement is worse than a bad fusion.

As an academic medical center, we don’t embrace treatment fads. Instead, we evaluate new techniques based on rigorous studies. And we make judicious use of whatever advanced technology or new products are promising or have some evidence of benefit. There are no one-size-fits-all solutions. So patient education and customized treatments are extremely important components of our care.