Introduction
Lumbar decompression surgery is a pain-relieving operation for severe lower back pain. This technique is usually recommended when all other non-surgical treatment modalities have failed to alleviate the pain.
What Is Lumbar Decompression?
The lower back or the spine, referred to as the lumbar region, consists of five bones. The nerves in this region may get compressed, causing pain in the lumbar region. This nerve compression causes intense pain and numbness, which the patient cannot tolerate. Hence, surgery is done to decompress the impinging nerves by removing a portion of the lamina (a bony roof for the spinal canal that contains the nerves) on one side, helping reduce the symptoms of nerve impingement.
What Are the Symptoms of Nerve Compression in the Spinal Region?
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Pain in the lower back (lumbar) region or sometimes in the neck and upper back area.
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Numbness or tingling sensation in the lower back. It can also cause numbness in the arms and legs.
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Weakness in the lumbar region.
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Difficulty in maintaining the balance.
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Rarely, problems in bowel functioning and loss of bladder control.
Who Needs Lumbar Decompression Surgery?
The conditions that require lumbar decompression surgery are:
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Spinal Stenosis - Spinal stenosis is caused due to narrowing of a part of the spine that puts pressure on the nerve inside.
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Spinal Injuries - In spinal injuries leading to fracture or swelling of the tissues.
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Sciatica - A condition where the spinal disc is damaged and impinges the nerve.
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Cauda Equina Syndrome - A condition where multiple nerves in the lumbar region are affected.
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Cancer Involving the Spine - Cancer in one organ, such as the lung, can spread to the spine and causes pressure on the spinal cord and nerves. This condition is called metastatic spinal cord compression.
What Are the Types of Lumbar Decompression Surgeries?
Decompression surgery is recommended only when other non-surgical treatment options do not work. Some of them are painless surgery, while others are not. The various surgery for decompression include:
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Laminectomy - Removal of the entire lamina and the ligaments covering the spinal cord and the nerves. This decompresses the nerve on both sides of the spinal cord.
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Laminotomy - Removal of a small portion of the lamina and ligaments to relieve the nerve compression on one side of the spinal cord.
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Foraminotomy - This technique is used when a damaged disc is impinging the nerve in the foramen (a hole or passage for the spinal nerves to pass through). The procedure removes the bone around the foramen.
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Laminoplasty - This procedure is usually performed in the neck region. Here, a portion of the lamina is cut only on one side to expand and increase the space within the spinal canal.
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Discectomy - Removal of the disc that is impinging the nerves.
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Spinal fusion - A procedure to fuse two vertebrae (bones that form the spinal cord) when there is excessive movement. The fusion is done by adding another bone taken from another part of the body or a synthetic bone. This bone fuses the two vertebrae and reduces the pressure on the nerves.
The doctor recommends the right surgical option depending on the patient's condition. The decompression surgery only relieves the symptoms but does not provide a permanent cure. The symptoms may recur when the situation deteriorates, putting pressure on the nerves.
What Investigations Are Carried Out Before the Surgery?
The doctor may run a few tests to find the cause of the pain and choose the appropriate treatment option suitable for an individual. The investigations include:
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Bone Scan - This test detects any infection, fracture, or cancer in the bone.
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Electromyography - A test to check the functioning of the nerves and muscles.
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Discography - An imaging test is done by injecting a contrast dye into the lumbar region, and a CT (computed tomography) scan is taken to visualize any damage to the disc.
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MRI (Magnetic Resonance Imaging) Scan - It uses a magnetic field to visualize the muscle and other soft tissues to find the cause of the pain.
How to Prepare a Patient for the Surgery?
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The doctor will provide all the information regarding the purpose, benefits, and possible risks involved with the procedure. Finally, the patient signs a consent form to approve the surgery.
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Patients are advised to avoid having solid foods about eight hours before the surgery and to have some water before initiating surgical procedures.
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Patients under anticoagulant therapy or taking blood thinners (Aspirin) are advised to discontinue their medications a week before surgery to avoid bleeding complications.
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Any known allergic reactions to anesthetic agents and other medications are reported to the doctor to reduce the potential risk of complications.
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High-risk habits such as smoking and consumption of alcohol should be avoided.
How Is Lumbar Decompression Surgery Performed?
An experienced neurosurgeon or orthopedic surgeon performs the surgery. The whole surgery lasts for three to four hours.
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Anesthesia is given to sedate the patient, and the operation site is prepared with povidone-iodine (skin disinfectant).
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A cut (incision) is made on the lower back region, and the lamina is located.
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After exposing the lamina, a laminectomy or laminotomy is done by removing all or only a section of the bony lamina and the ligament, depending on the extent of nerve impingement.
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Once the lamina is removed, the dura mater (the protective covering of the spinal cord) is located and slightly retracted to remove the ligament and any bony overgrowths.
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Next, foraminotomy is carried out to create space within the nerve foramen.
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If disc damage is the cause of pain, then a discectomy is also done.
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Lastly, if multiple vertebrae are damaged and removed during this procedure, a spinal fusion is done with the help of a bone graft (synthetic or bone from another part of the body, such as hip bone). The bone graft is stabilized in place using screws and plates.
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Sutures are placed to close the operation site.
Sometimes, a keyhole of surgery is carried out using a laparoscope (a fiber-optic instrument with a camera attached at one end that helps visualize the operation site from the outside). This procedure is slightly more challenging than the standard operation using large incisions. But, it is painless and has a faster recovery time after the surgery. Then, the doctor decides the appropriate procedure for a successful treatment.
What Are the Associated Surgical Risks?
General complications include allergic reactions to anesthesia, blood clot formation, bleeding, and infection.
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Persistent Pain - The pain may still be present after the surgery due to permanent nerve damage. Hence, in this case, a spinal cord stimulation or any other treatment plan is opted to provide relief.
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Failure in the Fusion of Vertebrae - In patients with the habit of smoking, the bone fails to fuse as smoking inhibits the growth of bone-forming cells. Other reasons include osteoporosis, obesity, and malnutrition.
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Bone Graft Migration - If the screws and plates are not used to stabilize the bone graft, it might move to another place. In this case, another operation is required.
What Are the After-Care Instructions to Be Followed?
After discharge from the hospital, the patient must follow instructions for at least two weeks.
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Avoid any activity that may be physically straining.
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Driving must be avoided if the patient is under painkillers.
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Keep the incision area clean and dry.
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Avoid smoking and alcohol consumption.
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Start walking gradually.
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Stay hydrated by drinking lots of water.
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All the medications prescribed should be consumed regularly.
The surgeon must be informed of any symptoms of pain, swelling, bleeding, or any other difficulty to be managed immediately.
Conclusion
Lumbar decompression is a minimally invasive surgical procedure to alleviate pain in the lower back region. It significantly improves the patient's comfort and ability to walk. However, the symptoms might recur if the area is under strain or the patient puts on weight. Hence, proper health maintenance is also crucial.
