Lumbar Decompression Back Surgery

Decompression surgery is a surgical / operational procedure that is done specificly to provide pain relief that is caused by pinched nerves (neural impingement).

During the lumbar decompression back surgery, what happens is that a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to give the nerve root more physical “breathing” space. This also allows an irritated or impinged nerve to have a better healing environment.

There are two common types of spine surgery decompression procedures:

Microdiscectomy

A microdiscectomy (also known as microdecompression) is generally done for pain relief that’s caused by a lumbar herniated disc.

This surgery is considered reliable for leg pain caused by the herniated disc. Patients know this pain as sciatica but the doctors and medical call it radiculopathy.

Lumbar Laminectomy

A lumbar laminectomy is known as an open decompression and it is usually done for pain from lumbar spinal stenosis.

The primary goal of lumbar laminectory surgery is to create/allow more room for the nerve root, which will reduce nerve pain (and potentially any leg weakness or neurological symptoms) and restoring the patient’s ability to participate in everyday activities.

In addition to the above conditions, a variety of lumbar spine problems can cause nerve pinching that can be treated by a lumbar decompression surgery.

These include conditions such as:

  • Isthmic or degenerative spondylolisthesis
  • A synovial cyst or a fracture with bone filling the spinal canal
  • A spinal tumor (rarely)

Alternatives to Microdiscectomy and Laminectomy

While the above 2 procedures are considered the gold standard for surgical decompression of the spine, there are a few variations and/or alternatives available to decompress the spine. For example:

  • Corpectomy – The vertebral body can be removed through an frontal incision to decompress the spinal canal. This type of surgery involves removing part of the vertebra in order to decompress (relieve pressure) from the spinal cord and/or spinal nerves. This surgery is used most commonly in cervical surgery, although occasionally it is useful in the thoracic spine. It is almost never necessary for in the lumbar spine, except in cases of tumors or fractures.
  • Laminotomy – this surgery is essentially the same as a laminectomy, with the difference being that instead of removing the entire lamina, a hole is made in the lamina
  • Interspinous process spacer – this is considered a possible alternative to a laminectomy. The goal of the interspinous process spacer surgery is to relieve spinal stenosis symptoms with a less invasive surgery.

How decompression surgery is done

With modern spine surgery techniques, both a microdiscectomy and laminectomy can usually be done with a minimum amount of side-effects such as post-surgery-related pains or discomfort PLUS a high degree of success in improving lower back pain and/or leg pain.

Lumbar microdiscectomy

A lumbar laminectomy is most commonly done to treat lumbar spinal stenosis symptoms.

During this procedure, the lamina (the bone in the back of the vertebra) at one or more of the spinal segments is removed with the main goal of relieving pressure on the spinal cord or nerves.

Sometimes in addition to the laminectomy, a spine fusion surgery is also necessary in order to achieve adequate decompression of a nerve root. This is especially true if the nerve root is compressed as it leaves the spine (in the foramen), known as foraminal stenosis.

Foraminal stenosis is difficult to decompress simply by removing bone because if the bone is fully removed in the location of the foramen it is generally necessary to also remove the facet joint. But if the facet joint is removed, it can lead or cause instability which can lead to other problems and pains down the road. That’s why spinal fusion can be clinically (and mechanically) necessary for stability.

A lumbar laminectomy is most commonly done to treat lumbar spinal stenosis symptoms.

During this procedure, the lamina (the bone in the back of the vertebra) at one or more of the spinal segments is removed with the main goal of relieving pressure on the spinal cord or nerves.

Sometimes in addition to the laminectomy, a spine fusion surgery is also necessary in order to achieve adequate decompression of a nerve root. This is especially true if the nerve root is compressed as it leaves the spine (in the foramen), known as foraminal stenosis.

Foraminal stenosis is difficult to decompress simply by removing bone because if the bone is fully removed in the location of the foramen it is generally necessary to also remove the facet joint. But if the facet joint is removed, it can lead or cause instability which can lead to other problems and pains down the road. That’s why spinal fusion can be clinically (and mechanically) necessary for stability.

A microdiscectomy is one of the most minimally invasive procedures that can be done to provide pain relief that’s associated with nerve root irritation.

In these types of surgery, it typically involves a fairly small incision (e.g. 1 – 1 ½ inches) in the lower back, and the portion of the herniation that is in contact with the nerve root is removed surgically.

The goal is to relieve symptoms associated with pressure on the nerve root. Good news is that lumbar microdiscectomies has a fairly high success rate – about 90-95% – in providing relief of leg pain and/or buttock pain. Even better is that often the pain relief can be experienced as early as waking up post surgery with a sense of obvious relief from their back or leg pains. 

If there were any neurological symptoms that patients had before the surgery, these tends to take longer for the nerves to heal and improve; this means that even though pain relief is experienced, their weakness or numbness (or any other neurological symptoms) can take months or up to 1+ year to improve.

For some, these neurological symptoms may improve but not fully recovered…and yes, physiotherapy will be helpful in recovering to the maximum possible.

Lumbar laminectomy

A lumbar laminectomy is most commonly done to treat lumbar spinal stenosis symptoms.

During this procedure, the lamina (the bone in the back of the vertebra) at one or more of the spinal segments is removed with the main goal of relieving pressure on the spinal cord or nerves.

Sometimes in addition to the laminectomy, a spine fusion surgery is also necessary in order to achieve adequate decompression of a nerve root. This is especially true if the nerve root is compressed as it leaves the spine (in the foramen), known as foraminal stenosis.

Foraminal stenosis is difficult to decompress simply by removing bone because if the bone is fully removed in the location of the foramen it is generally necessary to also remove the facet joint. But if the facet joint is removed, it can lead or cause instability which can lead to other problems and pains down the road. That’s why spinal fusion can be clinically (and mechanically) necessary for stability.

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