Overview
Definition
Lumbar Decompression Surgery is a treatment for spinal stenosis (narrowing of the spinal canal). The surgical procedure that alleviates pain caused by pinched nerves is decompression. Lumbar decompression is the removal of material (bone or disc) that is taking up space resulting in pressure on the nerve root in the lumbar region.
Degenerative spinal stenosis develops with aging. Everyone begins with a different spinal canal size and shape. With aging, the spinal canal volume decreases. If the original size is large, the aging process may not cause symptoms, but if the original size is small, pressure on the neural elements over time may cause clinical symptoms. Initial variations in size and shape of the canal can be quite marked. The configuration of the spinal canal is just as important as the diameter, and there are anatomic characteristics associated with constriction.
What Does Lumbar Decompressive Surgery Involve?
There are two types of lumbar decompressive surgery:
- A laminectomy involves removing or trimming most of the bony arch, or lamina, of a vertebra in order to decompress the nerves that supply the legs.
- A discectomy involves removing the damaged or bulging part of a slipped disc to relieve pressure on the nerve.
Candidates For Lumbar Decompression
For those who suffer from back or spine conditions, this form of surgery may be recommended. Common conditions that may target you as a candidate for lumbar decompression may be spinal stenosis or disc herniation. While there are other conditions that may prompt lumbar decompression, they are not as common.
Diagnosis
How Do Doctors Diagnose The Problem?
Diagnosis begins with a complete history and physical exam. Your doctor will ask questions about your symptoms and how your problem is affecting your daily activities. Your doctor will also want to know what positions or activities make your symptoms worse or better.
Next the doctor examines you by checking your posture and the amount of movement in your low back. Your doctor checks to see which back movements cause pain or other symptoms. Your skin sensation, muscle strength, and reflexes are also tested.
Doctors will usually order X-rays of the low back. The X-rays are taken with your spine in various positions. They can be used to see which vertebra is slipping and how far it has slipped. If more information is needed, your doctor may order computed tomography (a CT scan). This is a detailed X-ray that lets the doctor see slices of the body's tissue. If you have nerve problems, the doctor may combine the CT scan with myelography. To do this, a special dye is injected into the space around the spinal canal, the subarachnoid space. During the CT scan, the dye highlights the spinal nerves. The dye can improve the accuracy of a standard CT scan for diagnosing the health of the nerves.
Your doctor may also order a magnetic resonance imaging (MRI) scan. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. It can help in the diagnosis of spondylolisthesis. It can also provide information about the health of nerves and other soft tissues.
Lumbar Decompression Procedures
The most common types of spine surgery procedures for decompression are a microdisectomy and a laminectomy. Both have a high success ratio that result in pain relief in both the lower back and leg(s).
Depending on the degree of pain from the compressed nerve root, some patients may also require a spinal fusion for optimal decompression most especially if the affected nerve root is compressed in the foramen.
For patients who opt to have the lumbar decompression surgery, it can take quite some time for the healing of the nerve root. Typically, if the patient shows signs of healing within 60-90 days, the healing of the nerve root continues. If however, there are no signs of healing within the first 60-90 days after the lumbar decompression has been performed, the procedure is deemed to be unsuccessful and further treatment will be considered.
For those who experienced pain in their leg(s), the lumbar decompression most often relieves this pain once the surgery has been performed. There is a very small percentage of patients who may still suffer from leg pain until the nerve heals. This is especially true if there is an increase in swelling around the nerve and nerve root.
Surgery
Surgery is used when the slip is severe and when symptoms are not relieved with nonsurgical treatments. Symptoms that cause an abnormal walking pattern, changes in bowel or bladder function, or steady worsening in nerve function require surgery. Deterioration of symptoms is common in patients with a history of significant neurologic symptoms who don't have surgery to correct the problem.
If a reasonable trial of conservative care (three months or more) does not improve things and/or your quality of life is significantly reduced, then surgery may be the next best solution.
The main types of surgery for spondylolisthesis include:
- laminectomy (decompression)
- posterior fusion with or without instrumentation
- posterior lumbar interbody fusion
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