“All you need to know about Spine Decompression Surgery”
— Get Well in India
Spine decompression (lumbar decompression) is a surgical procedure which is used to treat compressed nerves in the lower (lumbar) spine. The surgery aims to improve persistent pain and numbness in the legs caused by pressure on the nerves in the spine.
In today’s world, a lot of people suffer from spine pain due to sedentary lifestyle and lack of exercise. The human body can only withstand a certain amount of pressure on its joints and ligaments before getting injured. A healthy body puts less amount of load on the joints and ligaments helping it maintain its flexibility. When a lot of pressure is put on the lower back, it causes the disc to rupture causing acute back pain and ultimately, nerve compression.
During spine decompression surgery, a small portion of the bone over the nerve root or disc is removed to give more space to the nerve and alleviate pain caused by pinched nerves.
This surgery is only recommended when non-surgical treatments have not worked out. Lets dig deeper and understand what happens in a non- surgical spinal decompression. It is a type of motorized traction that may help relieve back pain. It involves stretching of the spine which changes the position of the spine and relieves the pressure from the spinal disc. The spinal disc is a gel like cushion between the bones in the spine. By doing this, movement of water, oxygen, and nutrient-rich fluids are released into the discs allowing it to heal. When it fails, then spine decompression surgery is generally recommended.
Dr. Vikas Gupte
Dr. Hitesh Garg
The lumbar spine, or lower back, consists of five vertebrae numbered L1 through L5. These vertebrae are the largest in the spine and support the head and trunk. L5 vertebra transfers upper body weight through the sacrum and pelvis into the legs. The sacrum consists of five naturally fused vertebrae and provides stability to spinal column. Although the bones of sacrum are fused, they are numbered S1 through S5. The pelvis is often referred to as the hip.
Each lumbar vertebra shares a basic structure:
- Vertebral body: It looks like a large kidney-shaped bone from the top view.
- Pedicles: They are horizontal cylinders of bone that project outward off the back of a vertebral body.
- Lamina: It is a thin plate of bone that forms an arch behind a vertebral body.
- Articular processes: These are upward and downward bony projections from the lamina.
- Facet joints: Smooth cartilage-lined structures at the ends of the articular processes.
- Transverse processes: Long, thin bony sideway projections at the junction of the pedicle and lamina
In between each vertebral body there exists a disc which are numbered according to their spinal position. For example, the L4-L5 disc is found between the 4th and 5th lumbar vertebrae.
The lower back discs are the largest in the spine. The discs match the kidney-shape of the vertebrae. There are two parts to each disc. The outer layer and the inner layer. The outer layer consists of rings of cartilage called the annulus fibrosus which are flexible in nature. The inner layer consists of annulus, which is a jelly-like substance called the nucleus pulposus. The nucleus contains mostly water to help maintain hydrostatic disc pressure (which maintains balance of the body).
Discs perform two important functions:
- Act as spinal shock absorbers between the vertebral bodies.
- Function as flexible pivots to help provide motion between the vertebrae.
The spinal cord is a firm, yet delicate structure of nerve tissue. It cannot be displaced, only a serious neurological injury can displace or move the spinal cord. The spinal cord ends at L1 and below L1, there is a thick sack of fluid in a case like structure, which are nerves that make up the cauda equina. Spinal nerves exit the cauda equina through small holes called lateral foramina and control leg functions and sensations.
There are many reasons for back pain. A problem in any part of your spine can cause pain, but lumbar problems typically also create radiating pain and a tingling sensation in the legs and buttocks. Here are the probable causes listed below;
- Spinal stenosis where sections of spinal columns are narrowed putting pressure on the nerves.
- Slipped Disc and Sciatica where a damaged spinal disc presses down on an underlying nerve.
- Spinal injuries such as a fracture or the swelling of tissue
- Metastatic spinal cord compression where cancer in one part of the body, such as the lungs, spreads into the spine and presses on the spinal cord or nerves.
You may be a candidate for decompression if you have:
- Significant pain, weakness, or numbness in your leg or foot
- Aching pain spreading to the legs
- No effect of physical therapy or medication
- Difficulty walking or standing that affects your quality of life
- Weakness or loss of balance
Your orthopedic surgeon will suggest some diagnostic tests like MRI, CT scan, myelogram that will confirm whether a surgery is required or not.
Surgical Procedure Details
There are two types of spine decompression surgeries which have a success result and also help in alleviating lower back pain.
- Microdiscectomy: It is one of the most minimally invasive procedures to alleviate pain associated with nerve root irritation. In this surgery, a relatively small incision of 1 – 1 ½ inches is made in the lower back, and the portion of the herniation that is in contact with the nerve root is pulled out. The success rate of this surgery is very high about 90-95%. The main goal of microdiscectomy is to take pressure off your nerves to relieve your back pain. Most microdiscectomies take about an hour to complete.
- Lumbar laminectomy: It is also one of the common surgeries performed to treat lumbar pain. In this surgery, the lamina (the bone in the back of the vertebra) at one or more segments is removed. The main aim of this surgery is reducing pressure on the nerves caused by mainly age related changes in the spine. It is also done to treat other conditions, such as injuries to the spine, herniated discs or tumors.
Post surgery, typically you will stay in the hospital for a week, but your stay might be prolonged, depending on your progress. You will be given medication to reduce your pain and to make you feel as comfortable as possible. You need to take utmost care of your back and you need to make sure of the following things;
- General Activities:
- While sitting, use only a straight back chair to ensure proper posture. Do not sit for more than half an hour at a stretch. You may increase y=the duration gradually.
- Sleep only on a firm mattress. Avoid sleeping on couches or recliner chairs.
- Do not sleep on your abdomen. Always lie on back or side.
- Don’t bend, stoop or lift weight. Avoid jerks.
- Avoid house work like sweeping or washing clothes.
- Do not engage in strenuous activity for at least 10 weeks after surgery.
- 1st Week Post-Operative care:
- Avoid Driving. Do not sit in car as a passenger for more than 20 minutes.
- Walk around in your home on a smooth, flat surface.
- Do not climb stairs, especially alone.
- Do not lift anything heavier than 10 pounds.
- Take pain medication as directed.
- 2nd Week Post-Operative care:
- Start exercising as directed by physiotherapist.
- Increase your walking to 1 mile per day, if tolerated well.
- Light housework but still no vacuuming or sweeping.
- Refrain from sexual activity.
- 3rd Week Post-Operative care:
- You may resume sexual activity, if there is no pain at all.
- Increase walking time and housework as tolerated.
- If you need to lift anything, do not exceed 25 pounds. Take care while bending.
- You may start driving, to start with not more than 20 minutes.
- 4th Week Post-Operative:
- Gradually increase walking to 2 miles daily or as tolerated.
- Increase housework as tolerated.
- If you are a working professional, you may resume going to work.
The benefits of surgery appear to last for 8 to 10 years. Here are some benefits of spine decompression surgery:
- Relief from acute back and leg pain.
- Promotes healing of spinal disc tissues.
- Restore normal spinal disc and joint alignment.
- Maintaining balance and posture.
- Relieves pressure on spinal nerves.