Lumbar Decompression

Everything You Should Know About Lumbar Decompression Surgery

Lumbar decompression surgery is used to treat compressed nerves in the lumbar spine (a condition known as “lumbar spinal stenosis” or “lumbar canal stenosis”). It is typically recommended only after other, non-surgical treatments have failed to produce relief from the significant and persistent leg pain experienced when standing or walking that is the result of compression of spinal nerves caused by inward buckling of the thickened ligament (AKA ligamentum flavum) within the lumbar part of spinal column.

What is Spinal Decompression Surgery?

Lumbar spine decompression surgery is carried out while the patient is under general anaesthesia so there is no pain during the procedure. It is a patient-friendly, minimally invasive operation that can take anywhere from one and a half hours to several hours depending on the particulars of the patient’s physiology as well as the complexity of the surgery itself. During the procedure a small incision (usually no longer than 1 inch) will be made in the middle of the patient’s back along the vertical axis of the spine over the affected vertebrae (usually L4/5, but other locations or more than one location are also possible). The attached muscles will be lifted away exposing the spine itself. The surgeon will then, under magnification of a surgical microscope, remove those parts of thickened ligament (flavectomy/ligamentectomy) and/or the surrounding tissue that has been bringing pressure on the spinal nerves. In short, the goal is to relieve pressure on the nerves of the spinal cord and to do so in such a minimally invasive way that the patient is able to regain full flexibility and strength.

Techniques

Several surgical techniques have proven effective at achieving lumbar decompression. Exactly which is used will depend on the specifics of the patient’s case.

Interlaminar decompression (AKA flavectomy/ligamentectomy) – This is the most commonly used technique. It is a patient-friendly, minimally invasive and an individually tailored technique where only thickened ligament is gently removed through a small “keyhole” incision. As a result, pressure on the spinal nerves is released. No compromise to the stability of the spine is caused by using this technique. One of the benefits of this procedure is that the patient will have a shorter recovery time and can typically leave hospital the day after the surgery is performed.

Interspinous distraction procedures (interspinous spacer implantation) – Interspinous distraction procedure is a relatively easy, minimally-invasive technique involving placement of an implant between the spinous processes (posterior part of the vertebrae) at the affected level thereby enlarging the space for compressed spinal nerves.

Spinal fusion – With a spinal fusion, two or more vertebrae are fused into a single unit. This technique is used in cases of “instability” – a combination of spinal lumbar stenosis with abnormal movement between two or more nearby vertebral bodies – or in case of “spondylolisthesis” – a forward shift of one vertebral body onto another.

Discectomy (microdiscectomy) – in some cases bulging (herniation) of the intervertebral disc contributes to the compression of the spinal nerves. Therefore, sometimes removal of this bulging part of intervertebral disc is necessary as a part of decompression procedure.

Some patients may need a specifically tailored combination of above-mentioned techniques to be performed in order to achieve relief, although with the majority of patients only one will be required. Your surgeon will be able to tell you which of the above procedures you will need to undergo prior to your surgery.

When is Lumbar Decompression Indicated?

There are in fact a number of back conditions that may be helped by lumbar spinal decompression surgery, but the most common is known as lumbar spinal stenosis.

Lumbar spinal stenosis – This condition is most commonly caused by a degenerative disease of the lumbar vertebrae. The main symptom is leg pain when walking or standing (known as neurogenic claudication) which is relieved by sitting or bending forward. Pain when walking can be significant, severely restricting mobility. This type of leg pain is caused by compression of spinal nerves by a thickened (hypertophic), inward-buckling ligament known as ligamentum flavum.

There are also less common symptoms associated with lumbar spinal stenosis including sharp, telescoping pain down through the leg. You may also experience pins and needles, a tingling sensation, weakness in parts of your legs and/or numbness. This pain is most often referred to as “sciatica” and may be made worse by walking, coughing or sneezing.

As mentioned, with spinal stenosis even a simple act like walking is often painful and difficult. Spinal stenosis usually occurs in people over 60 years of age whose spinal columns have become worn down over time. Although it’s not unheard of for younger people to need spinal stenosis treatment as well.

Lumbar decompression surgery is indicated for those who do not improve with conservative treatments.

Contraindications and precautions for surgery

There are no absolute contraindications for the spinal decompression surgery procedure although there are some relative factors you may want to consider before undergoing this type of operation.

Back pain only – Patients who are experiencing only or mostly back pain are not likely to be good candidates for this type of surgery. Decompression of the lumbar spine is intended for and will primarily benefit those experiencing significant leg pain (sciatica) when walking or standing.

Discrepancy between clinical and radiological findings – Patients whose clinical and radiological findings don’t correlate are unlikely to see any benefit from lumbar decompression.

Spinal Decompression Surgery Recovery

Your experience regarding lumbar decompression surgery recovery will depend in large part on your level of physical fitness prior to the procedure. In the days immediately following surgery you’ll be encouraged to begin moving about and walking if the medical team deem it appropriate. Most patients are discharged from Neuro Spine Riga one to three days after the surgery.

In most cases it will take approximately four to six weeks for you to completely regain normal mobility and function. Although the length of your spinal decompression surgery recovery time may differ, depending as we said on your overall level of fitness as well as whether there are complications to deal with. But whether or not you experience complications recovery will encompass a range of issues and considerations. These include:

Getting home – When you get back to the UK it will be important to follow the guidance provided by the medical and support staff carefully. This will affect your recovery time from spinal decompression surgery. You’ll be advised to gradually increase your level of physical activity although you should expect to need some assistance with household chores, food prep and the like for at least a week following surgery. So you should have some form of post-surgical assistance lined up before you undergo the procedure.

Dealing with pain – There is no way to avoid the fact that having your back opened up will result in some pain afterward. However, thanks to the minimally invasive techniques employed by Neuro Spine Riga, pain after surgery is minor,  can be effectively managed by using painkillers and is not an issue. In most cases the surgery-related pain will dissipate in anywhere from a few days to a few weeks. You should inform the medical staff if yours does not.

Stitches – Any stitches deep within the skin are designed to dissolve over time and will not need to be removed. In the case of non-dissolvable stitches or staples these will typically be removed 10 days after the operation. Keep in mind also that the surgical wound will be covered by a dressing for 10 days after surgery.

Driving – Many patients are eager to get back behind the wheel after this type of surgery but it’s important not to drive if you are still on painkillers, regardless of how long it has been since your surgery. In the absence of painkillers however, most people are able to resume driving anywhere from two to six weeks after surgery.

Returning to work – In most case people who undergo this type of surgery return to regular work anywhere from one to six weeks after the procedure. If, however, your job requires a lot of physical activity you may be advised to wait at least 6 to 8 weeks before returning to work and even then you may have to work your way gradually back to normal pre-surgery work levels.