What happens during lumbar decompression surgery

If you and your consultant decide you could benefit from lumbar decompression surgery, you'll be put on a waiting list.

Your doctor or surgeon should be able to tell you how long you're likely to have to wait.

As soon as you know you're going to have lumbar decompression surgery, it's advisable to stop smoking (if you smoke), eat a healthy, balanced diet and take regular exercise .

Pre-operative assessment

You'll be asked to attend a pre-operative assessment appointment a few days or weeks before your operation.

During this appointment, you may have some Blood tests and a general health check to make sure you're fit for surgery, as well as an X-ray or magnetic resonance imaging (MRI) scan of your spine.

Thisassessment is a good opportunity to discuss any concerns you may have or ask questions about your operation.

You should be told who will be doing your operation and you may be introduced to them. Lumbar decompression surgery is carried out either by a neurosurgeon or an orthopaedic surgeon with experience in spinal surgery.

The operation

You'll be admitted to hospital either on the day of your operation or the day before. Your surgeon and anaesthetist will explain what will happen during the operation. This will give you the opportunity to ask any questions.

Before the operation, you'll be asked to sign a consent form to confirm that you know what's involved and the potential risks.

You'll usually be asked not to eat or drink for about six hours before the operation.

During lumbar decompression surgery, you'll usually lie face down on a special curved mattress to allow the surgeon better access to the affected part of your spine and reduce the pressure on your chest, abdomen and pelvis.

The operation is carried out under general anaesthetic , which means you'll be asleep during the procedure and won't feel any pain. The wholeoperation takes at least an hour, but it may take much longer, depending on its complexity.

The exact level of decompression required will be determined using an X-ray. An incision will be made in the middle of your back, running vertically along your spine. The length of the incision will depend on:

• how many vertebrae and/or discs need to be treated
• the complexity of the surgery
• whether fusion has been considered

The muscles in your back will be lifted from the back bone, to expose the back of the spine. The affected tissues or nerves will be removed little by little, taking the pressure off the spinal cord or nerves. Once adequate decompression has been achieved, the muscles will be stitched back together and the incision will be closed and stitched up.

Surgical procedures

The aim of lumbar decompression surgery is to relieve the pressure on your spinal cord or nerves, while maintaining as much of the strength and flexibility of your spine as possible.

Depending on the specific reason you're having surgery, a number of different procedures may need to be carried out during your operation to achieve this.

Three of the main procedures used are:

• laminectomy where a section of bone is removed from one of your vertebrae (spinal bones) to relieve pressure on the affected nerve
• discectomy where a section of a damaged disc is removed
• spinal fusion where two or more vertebrae are joined together with a bone graft

Your surgeon can give you more information about which procedures are going to be performed during your surgery.

The three mainprocedures are described in more detail below.

Laminectomy

A laminectomy removes areas of bone or tissue that are putting pressure on your spinal cord.

The surgeon makes an incision (cut) over the affected section of spine down to the lamina (bony arch of your vertebra), to accessthe compressed nerve. The nerve will be pulledback towards the centre of the spinal column and part of the bone or ligament pressing on the nerve will be removed.

To complete the operation,the surgeon will close the incision using stitches or surgical staples.

Discectomy

A discectomy is carried out to release the pressure on your spinal nerves caused by a bulging or slipped disc.

As with a laminectomy, the surgeon will make an incision over the affected area of your spine down to the lamina.

The surgeon will gently pull the nerve away to expose the prolapsed or bulging disc,which they'll remove just enough of to prevent pressure on the nerves. Most of the disc will be left behind to keep working as a shock absorber.

To completethe operation, the surgeon will close the incision with stitches or surgical staples.

Spinal fusion

Spinal fusion is used to join two or more vertebrae together by placing an additional section of bone in the space between them.

This helps to prevent excessive movements between two adjacent vertebrae, lowering the risk of further irritation or compression of the nearby nerves and reducing pain and related symptoms.

The additional section of bone can be taken from somewhere else in your body (usually the hip) or from a donated bone. More recently, synthetic (man-made) bone substitutes have been used.

To improve the chance of fusion being successful, some surgeons may use screws and connecting rods to secure the bones.

Afterwards, the surgeon will close the incision with stitches or surgical staples.

Keyhole surgery

Spinal decompression surgery is usually performed through a large incision in the back. This is known as "open" surgery.

In some cases, it may be possible for spinal fusion to be carried out using a "keyhole" technique known as microendoscopic surgery.This is performed using a tiny camera and surgical instruments inserted through a small incision in your back. The surgeon is guided by viewing the operation on a video monitor.

Microendoscopic surgery is complicated and isn't suitable for everyone. Whether it's suitable for you depends on the exact problem in your lower back. There's also a slightly higher risk of accidental injury during this operation than with an open operation.

Some of the techniques used during microendoscopic surgery, such as using a laser or a heated probe to burn away a section of damaged disc, are relatively new. Therefore, it's still uncertain how effective or safe they may be in the long term.

An advantage of microendoscopic surgery is that it usually has a much shorter recovery time. In many cases, people can leave hospital the day after surgery has been completed.