Lumbar decompression surgery

The lumbar spine is the lower back region of your spinal column (also referred to as the backbone) and it comprises five bones (vertebrae) known as L1 to L5. There are five spongy cushions called intervertebral discs between these vertebrae, providing shock absorption and helping keep the spine stable.

There are five pairs of nerves in the lumbar region. A pair branches off from the right and left sides of the L1 to L5 vertebrae. The nerves run from this area of your lower back and merge with others to control the pain and movement signals of the lower body. Therefore, any damage to this area can result in significant lower back or leg pain.

Lumbar decompression is a procedure used to treat compressed nerves in the lower spine. It will only be recommended by your consultant when other treatments haven't helped. In some cases, spinal fusion may be done at the same time. This fuses two or more vertebrae to add stability to the spine.

There are many types of spinal decompression procedures, the most common including:

Laminotomy and laminectomy

This is when a section or the entire lamina – the bony arch of the back part of the spinal bone or the posterior aspect of a vertebra – is removed to widen the spinal canal and relieve pressure on the affected nerve. A laminotomy is when only part of the lamina is removed. A laminectomy is when the entire lamina – or multiple laminae – are removed.

To do this, your surgeon makes a cut over the affected area to access the spine. Small instruments are used to remove the smallest amount of lamina necessary. If required, bone spurs may also be removed during the procedure.

Discectomy

During this procedure, a section of the slipped disc is removed to relieve pressure on a nerve. The surgeon reaches the damaged disc from the back of the spine by making an incision over the affected area. 

The back muscles are moved to one side to expose the vertebra and an X-ray is taken to confirm accuracy.

The surgeon creates an opening in the lamina and gently pulls back the protective sac of the spinal nerve root. A surgical microscope is sometimes used to find the affected disc and only the ruptured portion is removed. If there are any bone spurs or a synovial cyst (fluid filled sac), these are removed too.

Foraminotomy or foraminectomy

Both foraminotomy and foraminectomy are procedures that enlarge the openings in the spinal column where nerve roots exit the spinal cord by removing excess bone or a bulging disc. This releases any compressed nerves in that area.

Your surgeon will make an incision on your back and expose the affected vertebra. The intervertebral foramen is then widened and any blockages are removed.

The process is the same for a foraminectomy but a larger amount of bone is removed.

Corpectomy

During a corpectomy, your surgeon removes the large front portion of the vertebra. They may also remove the damaged disc. This relieves the pressure on your spinal cord and nerves. It's followed by replacement of the vertebra with a spacer such as a cage, then fusion of the vertebrae above and below the removed portion to provide stability.

A corpectomy is a much bigger procedure than a discectomy, and a larger and more vertical incision will often be used to allow your surgeon better access to the vertebra.

Minimally invasive lumbar decompression surgery

It's possible to have minimally invasive lumbar decompression surgery. Your surgeon makes one or more small incisions in your skin and a small metal tube or endoscope is placed through the cut. Carrying out your operation through additional smaller incisions causes much less damage to muscles and soft tissues. 

In many cases involving the lumbar spine, surgeons will opt to access the spine from the side of the body. 

What diagnostic tests are carried out? 

If your consultant is considering a spinal decompression operation, they might conduct several tests to better understand your injury. These may include imaging tests such as an X-ray and an MRI scan. This will confirm the level of damage to the lumbar spine.

A specialist musculoskeletal radiologist will report on the results, providing your consultant with the full picture before discussing treatment options with you.  

How do I prepare for lumbar decompression surgery?

Your consultant will explain how spinal decompression surgery works. In the days before your operation, it's worth taking the time to plan for your return home post-surgery. You’ll need to arrange for someone to pick you up from the hospital, as you won't be able to drive. It's worth seeing if someone can assist you with your day-to-day activities too. 

As you'll be given a general anaesthetic, your consultant will tell you how long to avoid eating and drinking before your procedure.

What's the recovery from lumbar spine decompression surgery like?

The average stay post-treatment is one to two nights in hospital. The day after your operation, a physiotherapist or a nurse will help get you moving. The amount of movement is then increased daily. 

Before leaving hospital, you'll be advised to continue to slowly build up activity levels, but activities that are more strenuous than walking will need to be avoided for about six weeks. You may be able to return to work after about four to six weeks, but you may need more time off if your job involves lifting heavy objects or driving for long periods.

Full recovery times vary. This will depend on whether you had one or more procedures during your operation and how well your body responds. There is good evidence that when appropriate, lumbar decompression surgery is effective for pain relief and improved function.