Lumbar Decompression Surgery
Information about your procedure:
The normal spinal column has a central canal through which the spinal cord passes down. To each side of the canal, spinal nerve roots branch out at every level. The spinal cord stops at the top of the lumbar spine (low back) and below that tiny nerve rootlets splay out like a horse’s tail (cauda equina). The spinal cord, nerve roots and cauda equina are protected by a tough outer membrane, called the dura mater.
Following your recent MRI scan and consultation with your spinal surgeon you have been diagnosed with a narrowing of your lumbar spinal canal (stenosis). This is usually related to the wear and tear of the spine.
When nerves are compressed they can produce symptoms of pain, numbness and tingling in the legs. In rare cases they can produce severe pain and even weakness. Most cases will produce pain in the legs when walking but the pain will be relieved by sitting.
The objective of surgery is to remove the enlarged bone and ‘thickened’ ligament from the back of the spinal canal to give the spinal nerves more room.
About the procedure
The operation is carried out under general anaesthetic, through an incision in the lower back. After the muscles have been moved aside, bone and ligament are removed. After surgery, most patients can expect to regain significant improvement in their ability to perform normal daily activities and markedly reduced levels of leg pain and discomfort. The results are not nearly as reliable for the relief of lower back pain which usually has several causes.
Risks and complications
Risks include the following:
Damage to the nerve root and the outer lining which surrounds the nerve roots (dura). This is reported in < 5% of cases. It may occur as a result of the bone being very stuck to the lining and tearing it as the bone is lifted off. This could result in back or leg pain, weakness or numbness, leaking from the wound, headaches or, very rarely, meningitis.
Deep wound infections may occur in < 1% of cases. These can be more difficult to treat with antibiotics alone and sometimes patients require more surgery.
Ongoing back pain and recurrent leg pain
Bleeding. You must inform your consultant if you are taking tablets used to thin the blood, such as warfarin, aspirin or clopidogrel.
Rarely, surgery may make your symptoms worse than before.
There are also very rare but serious complications that in extreme circumstances might include damage to the cauda equina with paralysis and loss of control of the bladder and bowel. This can occur through bleeding into the spinal canal after surgery (a haematoma). If this was to occur, every effort would be made to reverse the situation by returning to theatre to wash out the haematoma. Sometimes, however, paralysis can occur as a result of damage or reduction of the blood supply of the nerves or spinal cord and this is unfortunately not reversible.
What to expect in hospital
Immediately after the procedure you will be taken on your bed to the recovery ward where nurses will monitor your blood pressure and pulse. Once back on the ward and when you are fully awake you will be allowed to get out of bed. You may have a plastic tube (drain) coming from the wound, that will prevent any blood collection in the wound. This will be removed on the ward the next day and removal is not painful.
You will normally be discharged home with simple analgesia the day after your operation. Please arrange for either a friend or relative to collect you from the hospital, as driving yourself or taking public transport is not advised for 48 hours after the anaesthetic. A responsible adult should remain with you overnight. You will walk as comfort allows from the day after the surgery.
In general, you may return to work in 3-4 weeks provided that you are comfortable. We will provide a sick note at your request on the day of the procedure, if necessary.
Follow up to check your wound and trim sutures in 2 weeks.