Lumbar Decompressive Surgery - Who Needs It?

1. Healthy disc
2. Nerve root
3. Extruded disc protrusion
4. Disc bulge
5. Spinal nerves (cauda equina)

Conditions that may require lumbar decompressive surgery include:

Spinal Stenosis:

Spinal stenosis is the narrowing of the central spinal canal or side root canals of the spine. This narrowing causes pressure on the nerves in the canal, leading to pain, usually in the lower back and legs.

Causes Of Spinal Stenosis Include:

Age-related degeneration of the spine. The main cause of spinal stenosis is natural age-related degeneration. This is often linked to osteoarthritis. As the vertebrae (bones) of the spine begin to weaken and deteriorate, they rub against each other. This causes bony growths called bone spurs, which can cause the spinal canal to narrow.

Changes in the ligaments of the spine. Like the bones of your spine, the ligaments in your back degenerate over time and can become stiff and thick. This loss of elasticity can have the effect of narrowing your spinal canal.
Diseases of the bone. Diseases that affect bone growth, such as Paget’s disease and achondroplasia, can cause malformation of the bones of the spine and a narrowing of the spinal canal.

Slipped (herniated) Disc

A slipped or herniated disc is when the tough coating of a disc in your spine tears, causing the jelly-like filling to seep out. The torn disc can press on the surrounding nerves causing pain in your back and legs.
A slipped disc can happen at any age, but is more common in people between 20 and 40 years of age. It is usually caused by a combination of minor degeneration in the disc combined with trauma. The trauma can be minor, such as a cough or sneeze.
A slipped disc can press on the nerve sac in the spinal canal causing back pain, or on the surrounding nerves causing pain in the back and legs.

Spinal Tumours

Abnormal growths and tumours can form along your spine. These are usually benign (not cancerous), but growing tumours may compress your spinal cord and nerve roots causing pain.
Injury

Injury to your spine, such as dislocation and fractures, or the swelling of tissue after spinal surgery, can put pressure on your spinal cord or nerves.

When To Consider Surgery

Lumbar decompressive surgery is considered as a treatment for spinal stenosis when:
pain relief medication and other treatments have failed to help your symptoms,
the pain is so severe it is interfering with your quality of life, including work and sleep,
you have had an MRI scan that shows you have a disc, bony spur or thickened ligament pressing on a nerve, or
you have cauda equina syndrome, a rare and severe form of spinal stenosis. Pressure on the nerves in the lower back causes numbness in the buttocks and prevents you from urinating. In this case, emergency surgery is needed.

Lumbar Decompression Surgery

Lumbar decompressive surgery is an operation to relieve pressure on the spinal nerves in the lower back. It is often used to treat a condition called spinal stenosis.
Spinal stenosis is the narrowing of areas of the spine. It occurs when the bones, ligaments or discs of the spine squash the nerves of the spine causing pain, usually in the lower back and legs.

Causes Of Spinal Stenosis Include:

• Age-related degeneration of the spine,
• Changes in the ligaments of the spine, and
• Diseases of the bone, such as Paget’s disease.
• Other conditions that may require lumbar decompressive surgery include:
• A slipped (herniated) disc,
• Spinal tumours, and
• Spinal injury.

Lumbar decompressive surgery is recommended when the pain in your back and legs is affecting your quality of life and alternative treatments, such as pain relief and physiotherapy, have not worked.
Types of surgery

There Are Two Types Of Lumbar Decompressive Surgery:

A laminectomy or partial laminectomy removes or trims the bony arch of a vertebra (bone) or ligaments of the spine to relieve the pressure on the spinal cord.
A discectomy removes the damaged or bulging part of a slipped disc to relieve pressure on the spinal cord.

Outlook

70% and 75% of patients experience a significant improvement in leg pain after lumbar decompressive surgery. 20-25% of patients experience an improvement, but still have some pain.
The success rate for microdiscectomy (keyhole surgery) is slightly better, with 80-85% of patients experiencing an improvement in their leg pain.

Slipped Disc

1. Healthy Disc
2. Nerve
3. Slipped Disc
4. Damaged Disc
5. Spinal Cord

A slipped disc, also called a prolapsed or herniated disc, occurs when one of the discs of the spine is ruptured (splits) and the gel inside leaks out. This causes back pain and can also cause pain in other areas of the body.

The spine 

The spine is made up of 24 individual bones called vertebrae, which are stacked on top of each other. Discs are the protective, circular pads of cartilage (connective tissue) that lie in between the vertebrae. The discs are responsible for cushioning the vertebrae when jumping or running.

The spinal cord is a collection of nerve fibres that are attached to the brain and are protected by the spine. Nerve fibres from the spinal cord pass between the vertebrae as they take and receive messages to and from different parts of the body.

A slipped disc

The discs are made from a tough, fibrous case, which contains a softer, gel-like substance. A slipped disc occurs when the outer part of the disc ruptures (splits), allowing the gel inside to bulge and protrude outwards between the vertebrae.

The damaged disc can put pressure on the whole spinal cord or on a single nerve fibre. This means that a slipped disc can cause pain both in the area of the protruding disc and in any part of the body that is controlled by the nerve that the disc is pressing on.

How common is a slipped disc?

Slipped discs are most common in people between the ages of 30 and 50. The condition affects twice as many men as women.

A slipped disc occurs most frequently in the lower back, but any disc can rupture, including those in the upper back and neck. Around one-third of adults in the UK have lower back pain, and a slipped disc is responsible in less than 1 in 20 cases.

Outlook

It can take around four to six weeks to recover from a slipped disc. In most cases, treatment involves a combination of physical therapy, such as exercise and massage, and medication to relieve the pain.

In severe cases, or if the pain continues for longer than six weeks, surgery may be considered. A number of different procedures can release the compressed nerve and remove part of the disc. The success rate for surgery on the lumber (lower) spine is around 60-90%.