Spinal stenosis can occur as a result of arthritis, injury, or as part of the aging process. Learn more about spinal stenosis, including its causes and symptoms, and the types of minimally invasive surgeries that can treat it.
What is Spinal Stenosis?
When the spinal canal narrows, pressure is put on the spinal cord and the nerve roots found there. This condition is called spinal stenosis.
Spinal stenosis can be caused by the following:
- Arthritis. Rheumatoid arthritis and osteoarthritis of the spine result in deterioration of the cartilage that cushions your vertebrae. This can cause your facet joints (the joints between the vertebrae) to thicken. It can also cause osteophytes, or bone spurs, to form.
- Disc problems. Degenerative disease, injury, or wear and tear can lead to disc damage. For example, when an intervertebral disc is herniated, its gel-like inner tissue bulges out of the weakened outer layer. This reduces space in your spinal canal and can cause nerve compression.
- Thickened ligaments. Your vertebrae are connected by ligaments that help keep your spine stable. These ligaments may grow thicker in reaction to destabilization of your spine, causing compression of your spinal cord.
What Are the Symptoms of Spinal Stenosis?
The most common symptoms of spinal stenosis are pain, numbness, and weakness. Depending on where the compression occurs in your spine, the location of these symptoms varies. For example, lumbar (lower back) stenosis leads to symptoms in the back, buttocks, and legs, while cervical (neck) stenosis affects the shoulders, arms, and hands. Spinal stenosis can also cause loss of coordination, difficulty walking, and reduced bowel and bladder control.
Types of Minimally Invasive Surgery for Spinal Stenosis
The general term for reducing pressure on your spinal cord and/or nerves is decompression. A wide variety of minimally invasive decompression procedures have been developed to treat spinal stenosis. Minimally invasive surgeries use tiny incisions and tools, resulting in less blood loss and quicker healing times.
A discectomy involves trimming a damaged intervertebral disc to reduce pressure on your spinal cord. If a significant portion—or all—of the disc is removed, fusion may then be performed to stabilize the spine.
The goal of fusion is to prevent unwanted movement in your spine by causing bone to grow between the vertebrae. Your orthopedic surgeon will fuse together two or more of your vertebrae using a bone graft or tools such as screws, wires, or rods. Fusion can be done separately or in addition to decompression procedures that may destabilize your spine.
Laminae are thin pieces of bone at the back of your vertebrae. If a lamina has begun to thicken or develop bone spurs, removing it in a process called a laminectomy will allow more room within your spinal canal. A laminectomy might also include trimming spinal ligaments, facet joints, and spinous processes (the bony growths you can feel along the back of your spine) to create even more room.
Foramen are the passageways at the sides of your vertebrae that protect your nerve roots as they exit the spinal cord. Bone spurs or herniated discs can reduce the size of the foramen, causing compression of the nerve roots. A foraminotomy makes the foramen bigger by removing tiny portions of bone or disc material that are causing the compression.
Living with Spinal Stenosis?
If you are experiencing symptoms of spinal stenosis, contact Arkansas Surgical Hospital for help making an appointment with one of our specialists.
Stress fractures are common injuries experienced by people of all ages and activity levels. Learn more about the different types of stress fractures and the treatment options available at Arkansas Surgical Hospital.
Low-Risk Stress Fractures
Low-risk stress fractures can usually heal without requiring surgery. They are not likely to develop complications. Common locations of low-risk stress fractures include your fibula, which is next to your shin bone, and your calcaneus, or heel bone.
Conservative treatment involving RICE (rest, ice, compression, and elevation), NSAIDs (non-steroidal anti-inflammatory drugs), and limited weightbearing is the standard first line of treatment. This treatment can last anywhere from around six weeks to a full year and is typically enough to heal your stress fracture when there are no complications. However, low-risk stress fractures can sometimes progress to high-risk stress fractures if conservative measures do not help.
High-Risk Stress Fractures
Stress fractures are categorized as high-risk if there is a high chance of displacement, delayed union, non-union, or completion (a complete break) of the fracture. These stress fractures often occur in areas with low blood supply, which is necessary for bone development. Examples of these areas include certain bones in your feet, such as the metatarsals (the long, tubular bones in the middle of your foot) and the navicular (a concave bone towards the inner side of your foot).
Other high-risk stress fracture locations include “tension-side” bones, which means they bear weight as your body goes through various movements. Stress fractures in these areas are more likely to become displaced or progress to a complete fracture. One of these locations is the outer side of your femur, or thigh bone.
Finally, bones in areas without much muscle or other soft tissue coverage—such as your tibia, or shin bone—are also prone to high-risk stress fractures. If your stress fracture is in one of these areas, your orthopedic surgeon may recommend surgery. While some high-risk stress fractures heal on their own, surgical intervention is often needed to ensure complete healing.
If your stress fracture does not heal with rest, you may need surgery. There are several different surgical techniques for stress fracture treatment, including screws, wires, rods, and plates designed to help your bone progress to full union.
Displaced Stress Fractures
Displacement is the term used to describe bone edges that have moved out of alignment, which makes it harder for your stress fracture to heal.
Displacement has several risks. For example, displaced stress fractures in your femur can lead to avascular necrosis—the death of bone tissue caused by lack of blood supply—in the ball of your joint, which can cause arthritis or even collapse of the bone.
If your stress fracture is displaced, your treatment will need to be more aggressive. Your bone will need to be immobilized, usually using a cast or splint, and you will need to rest it completely (i.e., no weight-bearing or unnecessary activity) for several weeks. If that does not help, internal fixation using screws or rods is the next step to ensure healing of your stress fracture.
Delayed Union and Non-Union of Stress Fractures
There are several factors that can slow down or even prevent the healing of your stress fracture, including diabetes, hormone imbalance, and unhealthy habits.
In order to ensure complete healing of your stress fracture, you will need to follow your orthopedic surgeon’s instructions on what to do—and what not to do—before, during, and after your treatment. Examples include:
- Stop smoking. Nicotine delays healing and tobacco weakens your bones.
- Improve your diet. Insufficient calcium and vitamin D can make it more difficult for your stress fracture to heal.
- Do not return to activity before your orthopedic surgeon approves it. This could delay healing and may even result in a complete fracture.
Diagnosed with a Stress Fracture?
If you are suffering from a stress fracture, contact Arkansas Surgical Hospital at (877) 918-7020 for help setting up an appointment with one of our specialists.
NORTH LITTLE ROCK – Arkansas Surgical Hospital has been named a 2019 Guardian of Excellence Award® winner by Press Ganey and is the only hospital in Arkansas to receive this recognition.
The nationally-recognized award honors top-performing health care organizations that have achieved the 95th percentile or above in Patient Experience. Presented annually, the award names clients who consistently sustained performance in the top 5% of all Press Ganey clients for each reporting period during the course of one year.
The 2019 award recipients were honored at the Press Ganey National Client Conference in Orlando, Florida on November 18.
According to Helm, the award represents an important recognition from the industry’s leader in measuring, understanding, and improving the delivery of care.
“It is an honor for our hospital to be named a Guardian of Excellence for Patient Experience,” said Helm. “This prestigious award is further proof that our commitment to exceptional care is being recognized by those to whom it matters most: our patients.”
“Congratulations to Arkansas Surgical Hospital for receiving the Guardian of Excellence Award,” said Patrick T. Ryan, Executive Chairman of Press Ganey. “This honor reflects their unwavering commitment to improving the safety, quality, and experience of care. Their hard work and dedication are inspiring, and we are proud to partner with them on our shared mission to reduce patient suffering.”
About Arkansas Surgical Hospital: Arkansas Surgical Hospital, the leader in orthopedic and spine surgery in Arkansas, is located in North Little Rock. The physician owners at Arkansas Surgical Hospital are focused on exceptional outcomes for their patients. This includes a commitment to patient safety, care, and comfort for patients and their families. To learn more about Arkansas Surgical Hospital, visit ArkSurgicalHospital.com.
About Press Ganey: Press Ganey pioneered the health care performance improvement movement more than 30 years ago. Today, Press Ganey offers an integrated suite of solutions that enables enterprise transformation across the patient journey. Delivered through a cutting-edge digital platform built on a foundation of data security, Press Ganey solutions address safety, clinical excellence, patient experience, and workforce engagement. The company works with more than 41,000 health care facilities in its mission to reduce patient suffering and enhance caregiver resilience to improve the overall safety, quality, and experience of care.
If you’re living with hip pain and have tried non-surgical treatments—like painkillers, physical therapy, and injections—without relief, it may be time to consider hip replacement surgery. But before you make that decision, there are many important factors to consider.
Is Hip Replacement Surgery Right for You?
A total hip replacement procedure isn’t the answer for everyone. Before deciding to undergo hip replacement surgery, you should consider several factors, including your age, the severity of your symptoms, your diagnosis, and your ability to complete the recovery process.
In general, hip prosthetics last around 15 to 20 years. Just as our natural hips can become worn down over time, so can your artificial hip: your implant can be weakened by friction during decades of everyday use. This weakening is often accelerated by obesity or being too active.
Orthopedic surgeons typically recommend waiting until you are older to receive a hip replacement. The younger you are when you receive your hip implant, the more likely it will be that you will have to get it repaired or replaced one day.
The Severity of Your Symptoms
If the problems caused by your hip pain symptoms are still bearable—meaning, if they don’t hinder your daily life—it may not necessarily be time for a hip replacement. You should only consider replacing your hip if all other non-surgical treatments have failed. While hip replacement surgery is proven to be safe and effective, all surgeries carry a risk of complications and infections. For this reason, hip replacement surgery should be considered a last resort.
An orthopedic surgeon will need to determine the underlying cause of your hip pain to see if a total hip replacement is the right answer for you.
Osteoarthritis and rheumatoid arthritis are some of the most common causes of hip pain and disability. Post-traumatic arthritis, which can develop as a result of an injury, fracture, or dislocation, can also create the need for a hip replacement.
Although hip replacement surgery is commonly utilized as a treatment for arthritis in the hip, it’s important to note that loosening of the implant is common in patients with inflammatory arthritis. Your orthopedic surgeon will need to perform imaging tests on the area to see if a hip replacement is right for you.
Osteonecrosis of the hip occurs when the head of your femur, or thigh bone, doesn’t receive enough of the blood supply that keeps it healthy and functioning. This loss can lead to damage, arthritis, and even collapse of the femoral head.
Fractures, dislocations, thrombosis, vasculitis, Crohn’s disease, and alcoholism can all lead to the development of osteonecrosis. Hip replacements relieve the pain caused by osteonecrosis because the femoral head and the damaged cartilage are replaced with artificial materials.
Other Medical Conditions
Your overall health will need to be assessed to determine whether or not you are a viable candidate for total hip replacement surgery. Your bone health and bone density, for example, can affect whether an artificial hip will be more likely to become loose or shift out of place. Your doctor will need to do a physical examination and go over your medical history.
Poor candidates for hip replacement surgery include those who smoke, those who have already undergone a hip replacement, those with high-risk health issues, and those who cannot commit to the rehabilitation process after the surgery. Talk to your doctor about managing any chronic conditions—such as heart disease, diabetes, obesity, or sleep apnea—throughout the stages of your joint replacement.
Recovery from hip replacement surgery is an extensive process. For this reason, there are things you need to take care of well before the scheduled date of your procedure. Being prepared ahead of time will help the recovery process go much more smoothly.
Physical therapy is necessary for success after any joint replacement procedure. Completing your prescribed physical therapy requirements helps you heal more quickly and with fewer complications.
Physical therapy often starts shortly after your surgery while you are still in the hospital. Your regimen will be customized to your needs as determined by a physical therapist and your surgeon. When you are discharged, you will be prescribed specific exercises to help your new hip.
If you are unsure if you will be able to complete a physical therapy regimen after you undergo surgery, a hip replacement may not be right for you at this time. Factors that could impact your ability to successfully perform physical therapy activities include:
- Your health. Your doctor will evaluate you before your joint replacement surgery to determine if you are healthy enough to participate in physical therapy. If the physical activities you can do are limited, you may need a specialized regimen.
- Your resources. Not every patient has a rehabilitation center they can access near their home. Your discharge planning team will help you find the best option for you, whether that means sending a physical therapist to your home or helping you find an inpatient facility that will better suit your needs.
- Your time. If you are unable to take time off of work or from other duties to commit to a physical therapy program, your body will not be able to effectively heal and strengthen. Schedule your hip replacement during a time when you won’t be too busy to commit to your recovery.
Preparing Your Home
Before your surgery, you will be given a list of changes to make to your home in order to make it easier for you to move around and function with your new hip as you recover. Examples include:
- Staying on the ground floor. Climbing stairs should be kept to a minimum, so you will need to make sure that all your essentials are on the ground floor with you. Do you have places to sleep, eat, and use the bathroom that don’t require you to climb stairs? If not, consider staying in a rehabilitation center or at a friend or family member’s house.
- Rearranging furniture. You will need a walker or cane to move around for a while after your surgery, so be sure to clear plenty of space in your living areas.
- Removing rugs. Rugs can slip or bunch up, impeding your mobility and increasing your risk of falling.
- Installing shower handles. These should be sturdy enough to prevent you from slipping and falling in the shower. A bench or chair for your shower may also be helpful.
- Preparing meals. Your ability to cook will be limited, so preparing and freezing meals ahead of time is important to ensure you will have convenient access to food.
- Getting firm pillows. If your pillows and chair cushions are soft, buy or borrow firm ones. These are needed to allow you to sit with proper support. They can also be used to prop up your leg while you sleep.
For a successful recovery from total hip replacement surgery, you will need plenty of time off of work. You will also need to arrange for help from family and friends for a few weeks once you are home, so be sure to coordinate schedules as required. If you don’t have nearby friends or family that can help, your discharge team can help you with caregiver arrangements.
You should stop smoking before your surgery as it leads to unnecessary risks and affects your healing. To reduce your risk of infection, schedule major dental procedures before your surgery. No other surgical procedures should be performed within the first 90 days after your surgery.
While your new hip will allow you to resume many of the activities you enjoyed before you developed chronic hip pain, it is important to note that you should keep high-impact movements like running and jumping to a minimum as they can accelerate the wear and tear of your implant. Walking, biking, and swimming are great low-impact exercises for hip replacement patients. Other activities you can safely and comfortably take part in with your new hip include golfing, driving, and dancing.
When traveling, keep in mind that the materials used in your artificial hip may set off metal detectors. Alert security officers at airports, museums, and other public places about your artificial hip before you are scanned.
Finally, you may need to limit, adjust, or change the way you currently bend at the hip when reaching and sitting. Your surgical team will advise you on the specific restrictions and benefits of your new hip.
Living with Hip Pain
If you’re living with hip pain and think it’s time for a hip replacement, contact Arkansas Surgical Hospital today at (877) 918-7200 for help making an appointment with one of our specialists.