Spinal decompression surgery is carried out to relieve pressure on a nerve, or a group of nerves, in the spine. This kind of surgery is most common in the lumbar region, but can be performed on any part of the spine. There are many types of decompressive surgery, but the most common is a discectomy/microdiscetomy, carried out to reduce nerve root compression caused by a spinal disc.
A laminectomy is a type of spinal surgery where the bones at the back of the spinal column are removed to gives the nerves more space to function, or prevent worsening of compression and associated pain.
One of the most common causes for back and leg pain is a ‘slipped’, or herniated or bulging, disc. Disc problems are actually very common and the vast majority of the time, will not require any surgical intervention – however in some cases, surgery is considered in order to remove the part of the disc causing pressure on a nerve or group of nerves. Often, the healthy portion of the disc is left in place, as it still serves an important function within the spine.
Depending on the type of decompression surgery performed, recovery can be as little as 10 days to as much as three months. Following a microdiscectomy, most people are back to office-based jobs within two to four weeks (or once the wound has healed). Following a decompression and a fusion, it may take up to three months to return to work, although most people take approximately six weeks off. The benefits of the surgery, however, do not necessarily become evident immediately, and it may take up to a year for a patient to experience the maximal benefits from surgery. Surgery is more often than not successful in relieving leg pain (known as radiation/sciatica).
With any type of invasive intervention or procedure, there are risks, including infection, bleeding, scarring, nerve damage and blood vessel damage and deep vein thrombosis. While generally speaking, these risks are rare, it’s important to discuss them fully with your consultant. With spinal surgery, there is also the risk of ongoing symptoms such as leg pain, pins and needles, weakness in the legs or arms, altered sensation or numbness, and headaches. Sometimes, a dural tear (a tear in the watertight sac that surrounds the spinal cord and nerves) can occur, causing the cerebrospinal fluid within the sac to leak. Surgeries may also fail, and further surgical procedures may be required. With some types of surgery, depending on the location, there may also be additional risks, including stroke, blindness and death, particularly in the cervical spine.
Decompression surgery is extremely effective when performed in the right circumstances. It is not a one-size-fits-all treatment however, and the surgery is only performed on individuals where it’s deemed suitable and likely to help. On average, decompression surgery has an 85% success rate at alleviating leg pain.
At Complex Spine London, we are experts in minimally invasive surgery and aim to always explore minimally invasive techniques where possible.These can often bring about excellent results for our patients.
Decompression surgery is usually considered for patients experiencing significant sciatic/radicular leg pain, where the symptoms correspond with root causes detected in an MRI scan, and when more simple and conservative measures alone have not been effective.
While this type of surgery can be very good at alleviating this type of leg pain, surgical decompression is not considered an effective solution for back pain (in fact there is no surgical procedure which offers a high degree of back pain relief with any degree of certainty). Therefore, those who benefit the most from decompression surgery are individuals who experience leg pain as the main symptom, in a pattern which fits with findings from their scans. Often, we will first undertake diagnostic injections which may temporarily mimic the effects of a surgical decompression; this can give us a good guide as to how likely it is that surgery will work.
Most people will require at least one MRI scan before a decision to perform surgery is made. There are other tests which may also be necessary, and a decision is made on a case by case basis. More often than not however, a diagnostic injection, as described above, is most useful.