What is a Lumbar Decompression?
This is an operation which involves decompression of the nerves of the lower spine in patients with lumbar spinal stenosis or nerve root foraminal compression. There are various methods of performing this operation.
The traditional operation is a laminectomy procedure, which involves a relatively large wound and removal of a considerable amount of bone to provide access to the spinal canal. However, advances in spinal surgery over the last two decades and the introduction of operating microscopes has led to development of less invasive surgical techniques with excellent results. These micro-surgical techniques involve decompression of the nerves through small windows (fenestrations) in the bone using the strong magnification and light of a surgical microscope. These techniques involve less muscle and soft tissue disturbance, reduced blood loss and wound pain. Patients recover quickly and are usually able to mobilise and return home on the day after the operation.
More recent technological advances include the development of Interspace Distraction Devices (e.g Wallis Ligament, X-Stop etc), which have allowed surgeons to offer more minimally invasive procedures thus avoiding direct surgery near the nerves. However, this procedure is only suitable in a few select patients with specific types of lumbar nerve root compression.
What is the success rate?
The overall success rate of lumbar decompression in relieving leg symptoms varies from 85 - 95%. It will not improve back pain and the operation is therefore not recommended for back pain alone. Most patients experience relief of symptoms within a few days or weeks after the operation. Over time, patients are gradually able to walk in a more upright position and their walking distance improves.
About 5% of patients do not improve or experience worsening symptoms after surgery. In these cases, a repeat MRI scan is usually necessary to check that the nerves are free of compression.
Complications can occur with any operation and this is why the option of surgery needs careful consideration and is generally undertaken when the other treatment measures have failed. The overall complication rate for this operation is relatively low and varies between 2 and 5 % of patients. Most complications are treatable problems such as wound pain, infection, haemorrhage or CSF fluid leak. Other complications such as nerve damage leading to limb muscle weakness are fortunately very rare.
As part of the consultation and consent for the operation, your surgeon should be able to provide you with details of his/her success and complication rate for the procedure that is being advised.
What is the recovery time?
Patients are usually able to get out of bed for a short walk within 6 - 12 hours of the operation. Most patients are ready to go home 1 to 2 days after the operation. The wound may be a little sore for 2 - 3 days but this is usually simple to manage with regular mild pain medication.
Most patients are able to gradually return to normal non-strenuous activities within 2- 3 weeks and drive their car within 7 - 10 days. Patients with desk-based or non-physical jobs can usually return to work within 2 to 3 weeks. A longer period off work is usually necessary if the occupation involves heavy physical work.