What is Lumbar Decompression Surgery?
Lumbar decompression surgery, also known as decompressive lumbar laminectomy, is a procedure to relieve spinal stenosis, which is compression of the nerves in the lumbar spine (lower back).
Spinal stenosis can cause shooting pain down the legs (also known as sciatica or radiculopathy), or can also cause a sensation of fatigue, weakness and cramping in the legs with walking (also known as neurogenic claudication).
These symptoms can be present in isolation or they can both be present simultaneously. Patients often find that they have to walk bent forward or leaning on a shopping cart to relieve their leg pain. In many cases the symptoms of spinal stenosis can be treated without decompressive lumbar laminectomy surgery, but when non-surgical methods have failed, lumbar decompression surgery can be very successful to relieve the leg pain and difficulty walking caused by spinal stenosis.
Depending on the location of the spinal stenosis and the presence of any spinal instability, the nerves usually can be decompressed without having to perform a lumbar decompression and fusion. Lumbar decompression surgery can be performed using minimally invasive techniques.
Lumbar Decompression Procedure
During lumbar decompression surgery, the patient is positioned prone (face and belly down).
After cleaning the skin and placing sterile drapes, a small incision is made over the affected level or levels that have spinal stenosis.
A high speed burr and cutting instruments are used to remove a part of the lamina (laminectomy) above and below the affected level. For example if spinal stenosis is present at L4-5, then a portion of the L4 lamina and a portion of the L5 lamina are removed.
A structure called the ligamentum flavum that connects the two lamina and typically is the main cause of spinal stenosis is then carefully removed to increase the space for the nerves.
A small amount of the medial part (inside) of the facets joints on both side are also removed to further enlarge the spinal canal and space for the nerves.
The canal for the nerves is then carefully probed to make sure that sufficient space has been created for the nerves. Then the incision is closed in layers.
What To Expect After Lumbar Decompression Surgery?
Spinal decompression surgery is typically highly successful at relieving leg pain symptoms. Most patients wake up from anesthesia and realize immediately that the leg pain they had been having before surgery is gone or significantly improved.
Patients are usually up walking within a couple of hours after the operation is complete, and notice that they can walk farther and also stand up straighter than they did before surgery.
Occasionally a drain is placed after spinal decompression surgery, which is typically removed on the same day or the following morning after surgery.
Decompressive Lumbar Laminectomy Recovery Time
The recovery from spinal decompression surgery is typically fairly rapid. Patients usually can go home after surgery either on the same day or the following day after lumbar decompression surgery.
Strong narcotic pain medications are usually only required for 3-5 days after surgery, and many patients don’t require these types of medications at all.
Leg pain after decompressive lumbar laminectomy is typically markedly improved immediately after surgery, but complete resolution can take weeks to months, and in rare cases does not resolve completely.
If numbness or weakness was present before surgery, this can take weeks to months to recover, and sometimes this component of the symptoms won’t fully resolve if there is pre-existing damage to the nerves.
Post-operative visits are recommended at 2 weeks, 6 weeks, and 3 months after surgery for monitoring the recovery process.
For the first 4-6 weeks patients are restricted from heavy lifting, bending, or twisting. After that patients can slowly return to activities as tolerated. If a lumbar decompression and fusion was performed, activities are typically restricted for at least 3 months post-surgery to allow the fusion to begin to heal.
Walking or low-impact exercise such as riding a stationary bike or elliptical trainer are recommended and can begin within a day or two after spinal decompression surgery. Tylenol or NSAIDS (non-steroidal anti-inflammatory medications such as naproxen or ibuprofen) can be used for pain as needed during the recovery period but many patients find that after the first week they no longer need pain medication. If a lumbar decompression and fusion was performed NSAIDS should be avoided for 3 months post-surgery as they can delay the healing of the fusion.
Lumbar Decompression Surgery Risks
While all spinal operations carry some risks, the risks of lumbar decompression surgery are generally low. The risks of decompressive lumbar laminectomy include:
Risk of infection - This is quite low and estimated to be less than 1%
Risk of bleeding requiring transfusion - This is very low and is less than 1%
Risk of a dural tear which can result in a spinal fluid leak - This is the most common complication in lumbar decompression surgery and can occur in 5-7% of cases. If this occurs the tear is repaired using stitches, a patch, and often a combination of both. Patients are then placed on bedrest for 1-3 days to allow the tear to heal and then mobilized. This very rarely causes a long-term problem.
Risk of spinal instability - If no fusion is performed after a lumbar decompression, rarely the patient’s spine can become unstable causing recurrent leg pain and back pain symptoms. If this occurs sometimes a spinal fusion is recommended for pain relief.
Risk of nerve injury - This is very rare and occurs in less than 0.5% of cases
If you have more questions or would like to schedule an appointment with Dr. Nemani to see if you are a candidate for lumbar decompression surgery, please call 919-781-5600 or book an appointment online.