Spinal Stenosis

Lumbar decompression is an operation to relieve a condition called lumbar stenosis- a narrowing of the spinal canal that leads to compression of the nerve roots travelling to the lower limbs. Generally it gives rise to a reduction in mobility due to back and leg pain with heaviness and numbness in the lower limbs that comes on with activity. People can also get symptoms if they sit or stand for any length of time. In approximately 10% of people with lumbar canal stenosis, they will also have a condition called Spondylolisthesis, where the alignment of two adjacent spinal vertebrae is abnormal (please see the other section about this condition).

 In the past, surgery for this lumbar canal stenosis was called a laminectomy, because part of the spine called the lamina was removed in order to achieve decompression. More recently, it has been recognized that the whole lamina does not need to be removed in order to treat this condition adequately. As long as the wear and tear tissue between two adjacent lamina was removed, then in most people adequate decompression could be achieved. Hence, the operation became known as interlaminar decompression.

 At CNS, the vast majority (>90%) of our interlaminar decompressions are performed using keyhole surgery. This allows the same decompression to be done as with open surgery, but through a much small incision, with preservation of many of the structures of the spine, including, bone, muscle and ligament that would otherwise be removed using open surgical techniques. As well as preserving important spinal structures, this technique reduces post-operative pain, blood loss and time to recovery.

 Lumbar decompression improves mobility and leg symptoms in 80-90% of people. Most people will also see an improvement in back pain though back pain alone is not typically an indication for surgery as in a small number of people, back pain can be made worse. On the whole, studies have shown that this surgery, in carefully selected people is as successful as a hip replacement in people crippled by hip arthritis.

 Overall lumbar decompression is a very safe and effective operation but as with all operations there are small risks. The risk of a superficial infection or a spinal fluid leak is in the region of 1-2%, both of which can be treated straightforwardly. The risk of serious complications such as nerve root damage or a serious infection in our hands is less than 1%. In the worst-case scenario, nerve root damage can result in difficulties with continence or weakness in the ankles and feet. While these risks are extremely rare, we feel that this emphasizes the fact that surgery is a last resort for people with spinal problems.

 A very small number of people (<5%) can go on to develop recurrent lumbar canal stenosis despite adequate surgery. Some of these people will require further surgery and occasionally this may require spinal fixation with pedicle screws and rods (please see section on spinal fixation).

  A very small percentage of people (<2%) will develop persistent leg pain secondary to fbrosis / scar tissue formation. This condition cannot be treated with surgery and requires specialist input from pain doctors. 

 

The surgery:

 Most people are admitted on the day of surgery will be home within 24 hours, often on the day of surgery. The operation usually takes less than an hour. The surgery is not particularly painful but you will be given effective pain killers during and shortly after surgery so that we can have you walking within a couple of hours of surgery and in the majority of cases, home the same day. 

 The recuperation period varies between people but on average is 2-4 weeks. During this time we encourage people to walk as much as possible but to only sit for limited periods (20-30 minutes). You will be advised to refrain from driving for at least 1-2 weeks, longer if you are still in pain. We do not routinely recommend any formal physiotherapy at this early stage but we will provide you with a graduated program of exercise to suit you level of activity and interest.  At the 4-6 week stage you should be thinking about taking some more vigorous exercise, building up to 2-3, 20-30 minute sessions per week. Any aerobic exercise (swimming, cycling, walking) is suitable but we recommend that you avoid contact sports, rowing machines and lifting weights. Physiotherapy can help if you are having difficulties at this stage.

 It is important to remember that wear and tear conditions such as disc prolapse actually affect the whole spine. Surgery deals with a particular part of the problem but it does not reverse the whole wear and tear condition. It is important that people follow our advise on looking after the spine to reduce the likelihood of back pain in the future. We will advise you about some important factors including posture, weight control and lifting techniques. 

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