Spinal decompression surgery is a procedure that relieves pressure on compressed nerves in the spine. It is used to treat conditions like spinal stenosis, herniated discs, degenerative disc disease, and pinched nerves. While spinal decompression can significantly improve symptoms like pain, numbness, and weakness, it is still major surgery and does carry risks. Understanding the details of the procedure and potential complications can help patients weigh the risks and benefits.
What is spinal decompression surgery?
Spinal decompression surgery, also called neurodecompression or laminectomy, removes tissue pressing on the spinal cord or nerves. This relieves pressure and creates more space in the spinal canal.
The surgery most often focuses on the lumbar or cervical spine. During a lumbar decompression, the surgeon accesses the low back and removes a portion of bone and ligaments over the nerve root. Cervical decompression is performed in the neck area.
Depending on the patient’s specific condition, the surgeon may remove:
- Herniated disc material pressing on a nerve
- Enlarged facet joints contributing to foraminal stenosis
- Hypertrophic ligamentum flavum
- Bone spurs
This decompresses the nerve roots and takes pressure off the spinal cord. Decompression surgery can be done alone or along with spinal fusion or discectomy.
Why is spinal decompression performed?
There are several spinal conditions that may call for decompression surgery when non-surgical treatment options have failed to provide relief:
- Spinal stenosis: Narrowing of the spinal canal that compresses nerves. This is often caused by arthritis, bone spurs, disc bulging, or thickened ligaments.
- Herniated disc: Ruptured disc allowing disc material to press on spinal nerves.
- Degenerative disc disease: Discs wear down and lose cushioning ability, allowing nerve compression.
- Pinched nerve: Nerves become compressed, usually by bulging discs, enlarged joints, or bone spurs.
Symptoms that may be treated with decompression include:
- Leg or arm pain, numbness, or weakness
- Persistent or sudden low back or neck pain
- Pain, tingling, or numbness that radiates down an arm or leg
- Muscle spasms
- Reduced mobility or flexibility
- Muscle weakness
Conservative treatments like medication, steroid injections, chiropractic care, or physical therapy are tried first. But if symptoms do not improve and greatly impact quality of life, doctors may recommend decompression surgery.
How is the surgery performed?
Spinal decompression surgery is done under general anesthesia. The steps generally include:
- Patient is positioned face down on the operating table (prone position).
- Incision is made along midline of the back and muscle is retracted.
- Portion of lamina bone is removed to expose spinal canal and nerves.
- Thickened tissue pressing on nerves is removed.
- Spinal instrumentation like rods or screws may be implanted for stabilization.
- Incision is closed with sutures or staples.
The specifics depend on location in spine, underlying condition, and surgeon’s technique. With a lumbar decompression, the surgeon accesses the low back. A cervical decompression is performed through the neck. Minimally invasive keyhole surgery uses a smaller incision and microscope or endoscope. The surgery typically lasts 1-3 hours.
How long is the recovery time?
The hospital stay after spinal decompression is usually 1-3 days. Recovery time depends on age, health status, and procedure specifics. Most people can return to light activity in 4-6 weeks. By 12 weeks, moderate activity is permitted. Heavy lifting and strenuous work may need to wait 3-6 months.
Immediately after surgery, patients need help standing, walking, and changing positions. Walking short distances is encouraged to prevent blood clots. Pain medications are prescribed to manage post-surgical pain. A back brace may be recommended.
Follow-up appointments monitor healing. Physical therapy helps restore strength and mobility. Some post-operative discomfort is normal for a few weeks. Numbness or tingling may linger for months as nerves heal.
What are the risks and complications?
As with any major surgery, spinal decompression carries some risks:
- Infection: Occurs in about 1-2% of surgeries. Signs include fever, chills, and wound drainage.
- Bleeding: Excessive blood loss rarely occurs but may require transfusion.
- Nerve injury: Temporary or permanent nerve damage can happen with traction on nerves.
- Spinal instability: Bones may become less stable after tissue removal.
- Dural tear: Leakage of spinal fluid from dural membrane tear.
- Paralysis: Extremely rare major neurological complication.
- Chronic pain: Failed back surgery syndrome causes ongoing pain.
- Bone regrowth: Spurs may recur, compressing nerves again.
There are also anesthesia risks and risks from blood clots, heart attack, stroke, and reactions to implants. Smoking, obesity, diabetes, and age over 60 increase surgical risks and complications.
What is recovery like?
The hospital stay is typically 1-3 days after decompression surgery. Patients can usually sit up and take gentle short walks as soon as the first day. Walking prevents blood clots but may require some assistance at first.
Oral pain medication helps manage post-surgical pain. Muscle relaxants and stool softeners are also commonly prescribed. Wound care and monitoring for signs of infection are important.
Sitting for long periods is limited to avoid tailbone soreness. A back brace adds support while healing. Physical therapy starts gentle exercises to improve mobility and strength.
Some pain, swelling, and bruising are normal initially. Numbness, tingling, and burning may linger for weeks or months. Symptoms like leg pain and numbness should gradually subside.
When can I return to normal activity?
Recovery happens in phases of increasing activity:
- 0-2 weeks: Rest and gentle movement. Can start basic self-care.
- 2-6 weeks: Light activity around the house permitted. Begin PT.
- 6-12 weeks: Drive short distances. PT focuses on core strength.
- 3-6 months: Exercise restrictions lift. Strenuous activity usually permitted.
It takes about 3 months for the fusion to become solid. Full recovery takes around 6 months for most patients. Exact timelines depend on factors like age, complexity of surgery, physical health, and response to physical therapy. Patience is needed to allow the body to heal.
Can spinal decompression be done more than once?
In some cases, a repeat decompression surgery may be necessary if symptoms return. Reasons include:
- Scar tissue putting pressure on nerves
- Progression of spinal arthritis
- Adjacent segment disease
- Facet joint degeneration
- Recurrence of disc herniation
- Bone regrowth causing recurrent stenosis
Repeat surgery has a higher complication rate. Non-surgical treatments are tried first when possible. Factors considered before reoperation include level of pain, disability, age, and overall health.
What is recovery like long-term?
It can take around a year to reach maximum improvement. Long-term outcomes depend on the reason for surgery and patient factors.
Spinal stenosis decompression often successfully relieves leg pain and improves mobility. One study found 76% of patients had good leg pain relief 5 years later. However, recurrent stenosis may happen.
Outcomes are also generally good with cervical decompression. One study found 60% of patients remained pain-free 5 years after surgery.
Results with herniated discs are mixed. One study found about 80% had good results after 2 years. But, 20-30% may have recurrent disc herniation later.
Smoking, diabetes, and spinal instability increase risk of poorer long-term outcomes. Older age also lowers success rates somewhat.
Conclusion
Spinal decompression surgery can significantly improve quality of life when nonsurgical options fail. However, recovery takes months and carries significant risks. Candidates should be in good general health without major complicating factors. Outcomes are often good for stenosis and cervical procedures. Disc herniation reoccurs more often. Patients considering decompression need to weigh expected benefits against the risks and recovery time.
| Risks of Spinal Decompression Surgery | Approximate Rates |
|---|---|
| Infection | 1-2% |
| Bleeding/transfusion | <5% |
| Nerve injury | 1-3% |
| Dural tear | 3% |
| Graft/implant complication | 8-10% |
| Reoperation | 5-15% |
| Paralysis | <1% |
| Timeline of Recovery after Spinal Decompression Surgery | |
|---|---|
| 1-2 weeks | Rest, light mobility, self-care |
| 2-6 weeks | Light household activities |
| 6-12 weeks | Begin driving short distances |
| 3-6 months | Resume moderate exercise |
| 6-12 months | Gradually resume normal activity |
| 1+ years | Achieve maximum improvement |
When to See a Doctor
Contact your surgeon if you experience:
- Fever over 101°F
- Redness, swelling, or drainage at incision site
- Sudden or severe pain at surgery location
- Numbness/weakness in legs
- Difficulty with urination or bowel movements
- Heavy bleeding or calf swelling
These may indicate complications requiring medical care. Routine follow-up care helps monitor the recovery process. Report any new numbness, weakness, or setbacks in mobility. Working closely with your healthcare team gives you the best chance of optimal spinal decompression surgery outcomes.
