Why is it done?
Pressure on a nerve root in the lower spine, often called nerve root compression, causes back and leg pain. In Lumbar Decompression the surgeon reaches the lumbar spine through a small incision in the lower back. After the muscles of the spine are spread, a portion of the lamina is removed to expose the compressed nerve root(s).
Pressure is relieved by removal of the source of compression part of the herniated disc, a disc fragment, a tumor, or a rough protrusion of bone, called a bone spur.
What happens afterwards?
Successful recovery from lumbar decompression requires that you approach the operation and recovery period with confidence based on a thorough understanding of the process. Your surgeon has the training and expertise to correct physical defects by performing the operation; he and the rest of the health care team will support your recovery. Your body is able to heal the involved muscle, nerve, and bone tissues. Full recovery, however, will also depend on your having a strong, positive attitude, setting small goals for improvement, and working steadily to accomplish each goal.
Surgery for lumbar decompression is performed with the patient lying on the abdomen. A small incision is made in the lower back. The size of the incision depends on the severity of the problem but the surgeon makes every effort to keep the incison as small as possible.
After a retractor is used to move aside fat and muscle, the lamina (bone covering the spinal canal) is exposed. Part of it is cut away to uncover the ligamentum flavum – a thick ligament that covers the spinal canal.
Entering the spinal canal
Next an opening is cut in the ligamentum flavum through which the spinal canal is reached. The compressed nerves are now seen, as is the cauda equina (bundle of nerve fibers). The cause of compression may now also be identified – a bulging, ruptured or herniated disc, a bone spur or, or perhaps only thickened ligamentum flavum.
Removal of a herniated disc
The compressed nerve is gently retracted to one side, and if a herniated disc is the cause of the compression then this is removed. As much of the disc is taken out as is necessary to take pressure off the nerve. The surgeon will remove all “safely available” disc material but not the entire disc. After the cause of compression is removed, the nerve can begin to heal. The space left after removal of the disc should gradually fill with connective tissue.
Lumbar Decompression is completed when the incision is closed in several layers. Absorbable suture material is used but we advise that the suture is removed at 2 weeks by attending your GP surgery. Occassionally the suture ends need to be clipped if it can not be removed in one piece.
Certain risks must be considered with any surgery. Although every precaution will be taken to avoid complications, among the most common risks possible with surgery are: infection, excessive bleeding (haemorrhage), and an adverse reaction to anaesthesia. Since lumbar laminectomy involves the nervous system, nerve damage is another possible risk.
Clinical experience and scientific calculation indicate that these risks are low; but surgery is a human effort. Unforeseen circumstances can complicate a normally no-risk procedure and lead to serious or even life-threatening situations. Although such complications are rare, you should feel free to discuss the question of risk with your doctor.
It is normal to have some pain after Lumbar Decompression, especially in the lower back. This does not mean that the procedure was unsuccessful or that your recovery will be slow. Leg aching is also not unusual, caused by inflammation of the previously compressed nerve. It will go away slowly as the nerve heals. You may experience muscle spasms across your back and even down your legs. Medication will be given to control pain and relieve spasm. Moist heat and frequent repositioning may also help.
You may move about in bed and rest in any comfortable position when you have recovered from anaesthesia. Walking may begin within several hours. The easiest way for you to get out of bed is to raise the head of the bed as far as it will go, and then swing your legs to the floor. You may change positions in bed. During the first few trips from bed, you will require help from a nurse to avoid falls or injury.
Usually, you may take a shower a couple of days after surgery. This will make you feel better and should be done with a waterproof dressing left in place to protect the incision. Your nurse will be able to change your dressing to a waterproof one. Lotion may be massaged into the lower back, including the area around the incision to eliminate dryness and help relieve muscle spasm.
Intravenous (I.V.) fluids will be discontinued when you can tolerate regular liquids without nausea or vomiting. Your diet will then be adjusted back to normal as your appetite returns. Constipation will be treated with laxatives and a diet of whole grain cereals, fruits, and fruit juices.
It is normal to feel discouraged and tired for several days after Lumbar Decompression surgery. These feelings may be your body’s natural reaction to the cutback of extra hormones it put out to handle the stress of surgery. Although emotional let-down is not uncommon, it must not be allowed to get in the way of the positive attitude essential to your recovery and return to normal activity.
Discharge from the Hospital
The hospital stay for lumbar decompression patients usually lasts from 3 to 5 days. For a single level discectomy the hospital stay may be shorter This will be determined by your progress and by the amount of comfort and help available to you at home.