Lumbar Decompression Spine Surgery
A lumbar spinal decompression is spine surgery to relieve pressure on a pinched nerve root in the low back. A decompression typically is performed to relieve pain, numbness, tingling, or weakness in the legs caused by herniated discs, spinal stenosis (narrowing), spondylolisthesis, and other conditions that cause pressure on the nerves in the spine.
Stenosis, or narrowing of the spinal canals, often develops with age, as ligaments of the spine thicken and harden, discs bulge, bones and joints enlarge, and bone spurs form. Spondylolisthesis is the slipping of one vertebra over another, and also can lead to narrowing or compression.
What Conditions Can Lumbar Decompression Treat?
Lumbar decompression spine surgery is used to relieve symptoms caused by:
- Spinal stenosis
- Persistent pain in one leg or one side of the buttock, known as sciatica or radiculopathy
- Degenerative disc disease
- Herniated disc
- A progressive form of arthritis known as spondylitis
- A condition known as spondylolisthesis, in which one vertebra has slipped over another.
How Is Lumbar Decompression Performed?
During lumbar decompression surgery, one of our expert neurosurgeons will make an incision in the back. The muscles surrounding the spine will be moved to expose the spine. Then the surgeon will remove the parts of the spine that are compressing the nerves. This may include any of the following structures: disc, ligament, bone spurs, facet joint, tumor, blood clot, or abscess.
Spine decompression surgeries have differing names depending for the structures in the spine that are being removed or altered. Often more than one of these procedures will be used. Your Denver spine surgeon will decide which type of decompression is right for your specific condition. Lumbar spinal decompression spine surgery procedures include:
Laminectomy - The lamina, a portion of the spinal canal, is removed. This can be performed to allow more space for the nerves, without sacrificing any structural or protective function.
Laminotomy - A partial section of the lamina is removed.
Microdiscectomy - A small piece of disc that is compressing the nerve is removed. This procedure is performed for bulging or herniated discs. This procedure can be performed using minimally invasive techniques and is always considered a microsurgery. This procedure often also requires laminotomy or laminectomy to access the space where the disc is located.
Facetectomy - The facet joints are the joints that are found in between the vertebrae in the spine. As a result of arthritis, these joints can develop bone spurs that can compress spinal nerves. With a facetectomy, a portion of the arthritic facet joint is removed to take pressure off the nerve.
Foraminotomy - The spinal nerves travel through small canals as they exit the spine. These canals are called foramina. In a foraminotomy, the canals are cleaned out to allow the nerves to freely pass through.
Who is a Candidate for Lumbar Decompression?
The spine surgeons at Neurosurgery One, formerly South Denver Neurosurgery, believe surgery should be considered only when non-surgical therapies such as steroid injections and physical therapy fail to provide adequate relief.
Ideal candidates for lumbar decompression are those who experience:
- Pain, weakness or numbness in a leg or foot that has persisted for several months or more and does not respond to more conservative treatment
- Pain that radiates to legs
- Pain that is more severe in legs than in the back itself.
- Muscle weakness as a result of nerve compression
- Rare cases when loss of bladder and bowel control is due to severe nerve compression
- Difficulty performing daily activities or physical activity due to pain
- Difficulty standing or walking
In addition, at Neurosurgery One, our spine surgeons believe that surgery should be performed only when patients have a diagnosis of identifiable structural issue that is confirmed through imaging such as MRI.
Benefits of Lumbar Decompression Surgery
Studies show that approximately 80% to 90% of patients will experience significant improvement in their ability to perform normal daily activities following lumbar decompression surgery. Approximately the same number experience a significant reduction in pain.
Risks of Lumbar Decompression Surgery
The risk of complications associated with spine surgery for lumbar decompression are low but may include:
- Nerve root damage. Approximately 1 in 1,000 patients experience some nerve damage
- Bowel or bladder incontinence. This side effect is experienced by 1 in 10,000 patients.
- Cerebrospinal fluid leak. This occurs in about 1% to 3% of laminectomy surgery patients. If the membrane around the spinal nerves is breached, a cerebrospinal fluid link may occur. This is repaired in the operating room, but may require lying down for 24-48 hours after surgery to allow the repair to seal with no long-term symptoms.
- Infections. About 1% of patients will acquire an infection after surgery, which may require further surgery along with IV antibiotics.
Each person is unique, and you should discuss specific risks with your spine surgeon.
Recovery Following Lumbar Decompression Surgery
Every patient’s experience is unique. However, you may expect some or all of the following after your lumbar decompression spine surgery:
- Some decompressions are performed as an outpatient procedure, where patients go home the same day. Others require a stay in the hospital for one to three days following lumbar decompression surgery.
- Following lumbar decompression surgery, you will likely be encouraged to walk the same day. However, you’ll be advised to avoid excessive bending, lifting, or twisting foreight weeks after this surgery to allow for healing.
- You may need help with bathing, dressing, and other activities in the first few days after surgery.
- Your spine surgeon will encourage you to gradually return to normal activities, including walking. Walking short distances at first, gradually increasing to one to two miles daily will help speed your recovery.
- Your surgeon may encourage you to wear a brace for a short time after surgery.
Full recovery may take up to six-twelve weeks, but will depend on your overall health and fitness before the surgery.