Lumbar Decompression Surgery

Lumbar decompression is a type of surgery used to treat compressed nerves in the lower (lumbar) spine. It’s only recommended when non-surgical treatments haven’t helped.

The surgery aims to improve symptoms such as persistent pain and numbness in the legs caused by pressure on the nerves in the spine.

Non-surgical Alternatives

Lumbar decompression surgery is usually only considered if non-surgical treatments for your lower spine haven’t worked and symptoms are affecting your quality of life.

• Non-surgical treatments include:
• Analgesia (painkillers)
• Physiotherapy
• Spinal injection therapy – course of spinal injections, which include a local anaesthetic and steroid, are injected to help reduce swelling and inflammation. It can be used along with physiotherapy

Indications For Lumbar Decompression Surgery

• Spinal stenosis
• Slipped disc and sciatica
• Spinal injuries
• Metastatic spinal cord compression
• Spinal tumours
• Lumbar decompression surgery may be considered if you experience serious side effects when taking medications that affect your ability to work.

Surgery may become likely if difficult symptoms last up to 2 months. Surgery around 4 months after symptoms start is seen by some as the right time for the best results and recovery.

Spinal Stenosis

Spinal stenosis is a condition where the space around the spinal cord (the spinal column) narrows, compressing a section of nerve tissue.

The main symptoms of spinal stenosis are pain, numbness, weakness and a tingling sensation in one or both legs. This can make walking difficult and painful.

Most cases of spinal stenosis occur in older people. As you get older, the bones and tissues that make up the spine can become worn down, which can lead to a narrowing of the spinal column.

Cauda Equina Syndrome

Cauda equina syndrome is a rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed.

Symptoms include:

• Sciatica – sudden pain radiating down the back of your legs
• Weakness or numbness in both legs that is severe or getting worse
• Numbness around or under your genitals, or around your anus
• Urinary retention – unable to empty bladder completely
• Urinary / faecal incontinence – unintentional passing of urine/faces
• Cauda equina syndrome requires emergency hospital admission and may require emergency surgery, because the longer it goes untreated, the greater the chance it will lead to permanent paralysis and incontinence.

Slipped Disc And Sciatica

A slipped or herniated disk is where the tough coating of a disc in your spine tears, causing the jelly-like filling in the centre to spill out. The torn disc can press on a surrounding nerve or nerves, causing pain in parts of your legs.

This pain may be accompanied by tingling, pins and needles, numbness or weakness in certain areas of your legs. The pain is often referred to as sciatica and is sometimes worse when straining, coughing or sneezing.

The most common characteristic of sciatica is pain that radiates out from the lower back, down the buttocks and into 1 or both legs, right down to the calf. The pain can range from mild to severe. Sciatica on both sides can be a sign of cauda equina syndrome, which is a medical emergency.

A slipped disc can occur at any age. If a disc becomes damaged, it sometimes only takes an awkward twist or turn, a minor injury or even a sneeze to cause the filling in the centre of the disc to spill out. However, the exact cause of a slipped disc is often unknown.

Metastatic Spinal Cord Compression

Cancer in one part of the body, such as the lungs, sometimes spreads into the spine and presses on the spinal cord. This is known as metastatic spinal cord compression.

Initial symptoms can include:

• back pain, which may be mild at first, but usually gets worse over time; the pain is constant and often worse at night
• numbness in your fingers and toes
• problems urinating

Without treatment, metastatic spinal cord compression is potentially very serious and can result in permanent paralysis in the legs.

For people in good enough health to withstand surgery, metastatic spinal cord compression may be treated with surgery. However, if the problems only become apparent late on, many people are too ill to withstand or benefit from surgery.

Spinal injury

Injury to your spine (such as dislocation or fracture) or the swelling of tissue can put pressure on your spinal cord or nerves.

Spinal tumours

Abnormal growths and tumours can form along the spine. Growing tumours may compress your spinal cord and nerve roots, causing pain.

What happens during lumbar decompression surgery?

The aim of lumbar decompression surgery is to relieve the pressure on your spinal cord or nerves, while maintaining as much of the strength and flexibility of your spine as possible.

If lumbar decompression surgery is recommended, you’ll usually have at least 1 of the following procedures:

• Laminectomy – where a section of bone is removed from 1 of your vertebrae to relieve pressure on the affected nerve
• Discectomy – where a section of a damaged disc is removed to relieve pressure on a nerve
• Spinal fusion – where 2 or more vertebrae are joined together with a section of bone to stabilise and strengthen the spine

In many cases, a combination of these techniques may be used.

You will be asked to attend a pre-operative assessment appointment a few days or weeks before your operation.

Lumbar decompression is usually carried out under general anaesthetic, which means you will be unconscious during the procedure. The surgery usually takes at least an hour, but may take much longer, depending on the complexity of the procedure.

Healthcare Abroad will require your medical images and report prior to your travel. We send this to the surgical team through Zed Technologies, which is a secure facility for transferring medical images. You can access your images though any of the following ways:

• CD – Contact the radiology department in the hospital where you got the scans.
• Affidea – You can access and share them via Affidea patient connect.

We will work with your GP to expedite new scans to send to the surgical team.

Effectiveness of lumbar decompression surgery

It can be an effective treatment for people with severe pain caused by compressed nerves. Many people who undergo the operation experience a significant improvement in pain and other associated symptoms.

What is keyhole surgery?

Spinal decompression surgery is usually performed through a large incision in the back. This is known as “open” surgery.

In some cases, it may be possible for spinal fusion to be carried out using a keyhole technique known as microendoscopic surgery. This is performed using a tiny camera and surgical instruments inserted through a small incision in your back. The surgeon is guided by viewing the operation on a video monitor.

Microendoscopic surgery is complicated and is not suitable for everyone. Whether it is suitable for you depends on the exact problem in your lower back. There is also a slightly higher risk of accidental injury during this operation than with an open operation.

Some of the techniques used during microendoscopic surgery, such as using a laser or a heated probe to burn away a section of damaged disc, are relatively new. Therefore, it is still uncertain how effective or safe they may be in the long term.

An advantage of microendoscopic surgery is that it usually has a much shorter recovery time. In many cases, people can leave the hospital the day after surgery has been completed.

Recovery

You will usually be well enough to leave hospital about 1-4 days after having surgery, depending on the complexity of the surgery and your level of mobility before the operation. You may be asked to return to hospital for one or more follow-up appointments in the weeks after your operation to check on your recovery

Most people are able to walk unassisted within a day of having the operation, although more strenuous activities will need to be avoided for about 6 weeks.

You may be able to return to work after about 4-6 weeks, although you may need more time off if your job involves driving for long periods or lifting heavy objects.

Pain

Immediately after surgery, you will have some pain in and around the area where the operation was carried out. You will be given pain relief to ensure you are comfortable and to help you move.

It can take up to 6 weeks for the general pain and tiredness after your operation to disappear completely.

Stitches

You will have stitches or staples to close any cuts or incisions made during your operation. If dissolvable stitches are used, they do not need to be removed. Non-dissolvable stitches or staples will be removed 5 to 10 days after your operation. Your stitches will be covered with an adhesive dressing.

Be careful not to get your dressing wet when you wash. After removal of the stitches, you won’t need to change your dressing, and will be able to bathe and shower as normal

Rehabilitation

Your medical team will want you to get up and moving about as soon as possible, usually from the day after the operation. This is because inactivity can increase your risk of developing a blood clot in the leg (DVT), and movement can speed up the recovery process.

After your operation, a physiotherapist will help you safely regain strength and movement. They will teach you some simple exercises you can do at home to help your recovery.

Driving

Before starting to drive again, you should be free from the effects of any painkillers that may make you drowsy.

You should be comfortable in the driving position and be able to do an emergency stop without experiencing any pain. Most people feel ready to drive after 2 to 6 weeks, depending on the size of the operation.

When to seek medical advice

Call the hospital where you had your operation, or your GP, for advice if:

• There is leaking fluid or redness at the site of your wound
• your stitches come out
• your dressing becomes soaked with blood
• you have a fever of 38oC
• you have increasing pain, numbness or weakness in your legs, back or buttocks
• you cannot move your legs
• you cannot urinate or control your bladder
• you have a severe headache
• you experience a sudden shortness of breath – this could be a sign of pulmonary embolism, pneumonia, or other heart and lung problems

Complications of lumbar decompression surgery

Like all types of surgery, lumbar decompression also has risks, which include:

• Recurring or continuing symptoms
• Infection
• Deep vein thrombosis (DVT) – a blood clot formed in a vein in the leg
• Pulmonary embolism (rare) due to DVT
• Dural tear – dura is the tissue around the spinal cord and nerves
• Leakage of cerebrospinal fluid (CSF)
• Nerve injury and paralysis