One of the more common procedures is lumbar laminectomy spinal stenosis. This procedure involves removing the bones, ligaments, etc. that are compressing the nerves and it may be done with or without spinal fusion—a procedure to fuse the vertebrae together in an effort to improve stability of the spine. This decompression procedure can be done via an open procedure or a less invasive procedure that relies upon microscopes for “seeing” the area on which a surgeon is working. For an estimated 80% of patients this surgery results in a good to excellent lumbar spinal stenosis prognosis.
Interspinous process distraction: A spacer device is inserted between the spinous processes – the bony protrusions along the back of the lumbar spine. Once in place, the spacer lifts and opens the spinal canal as if one were in a seated position rather than a standing position, effectively relieving the pressure on the spinal nerves. The spacer device is not attached to bone or ligament and does not result in spinal fusion. The surgery is minimally invasive and can be done under local anesthetic. Because interspinous process distractors are relatively new compared to a laminectomy, the long-term effectiveness is not known. Also, not all insurance companies will pay for this technology and out-of-pocket expenses may be incurred.
Surgery appears to lead to better outcomes if there are ongoing symptoms after three to six months of conservative treatment.  Laminectomy is the most effective of the surgical treatments.  In those who worsen despite conservative treatments surgery leads to improvement in 60–70% of cases.  Another procedure using an interspinous distraction device known as X-STOP was less effective and more expensive when more than one spinal level is repaired.  Both surgical procedures are more expensive than medical management.