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Lumbar Decompression Surgery |
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Definition
Lumbar Decompression Surgery is a treatment for spinal stenosis (narrowing of the spinal canal).
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Description
Spinal stenosis is narrowing of the spinal canal, which may result in pressure on the internal structures. Vague leg pain, numbness, and tingling distributed over the anterior and posterior thighs and calves are brought on, classically, by spinal postures that mechanically compromise the neural canal and foramina (openings for nerves). Less often, this syndrome is precipitated by the increased metabolic and vascular demands of the lower extremities, causing a compromise of neural blood flow. Both these mechanisms can occur at the same time.
Degenerative spinal stenosis develops with aging. Everyone begins with a different spinal canal size and shape. With aging, the spinal canal volume decreases. If the original size is large, the aging process may not cause symptoms, but if the original size is small, pressure on the neural elements over time may cause clinical symptoms. Initial variations in size and shape of the canal can be quite marked. The configuration of the spinal canal is just as important as the diameter, and there are anatomic characteristics associated with constriction.
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Nonsurgical Management
The majority of patients with spinal stenosis can be successfully managed without surgery. Rest, especially bed rest with the spine flexed, and non-steroidal anti-inflammatory drugs (NSAIDs) are the most useful modes of treatment for an acute attack. If rest and non-steroidal anti-inflammatory drugs do not provide relief in the acute stages, oral steroids or, if those fail, epidural injections may give symptomatic relief.
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Indications for Surgery
The goals of surgical treatment in lumbar spinal stenosis are relief of pain and preservation or return of neurologic function. Surgery is indicated for the patient whose leg pain prevents him or her from walking or performing activities of daily living (despite medical treatment) and for the patient who demonstrates profound neural deficits or advancing neural changes. The goal of surgery in spinal stenosis is to remove completely all pressure from the neural elements. The type of pathology present will dictate the extent and type of decompression surgery required.
In anatomical terms, if midline ridging is the only abnormality present and the nerve roots are free in the foramen, complete laminectomy of the affected levels, with preservation of the facet joints, will suffice.
In certain individuals, even after foraminotomy and unroofing of the lateral recesses, the nerve root will still be tightly tethered around a pedicle that has undergone a relative descent during disc degeneration. In these cases, the pedicle should be excised (cut out).
In most patients with degenerative spinal stenosis, decompression at a minimum of two levels is done (i.e., at L5 and L4 ['L' stands for Lumbar, or lower back, the number refers to the specific spinal bone]), in developmental spinal stenosis, at least three levels, extending up to L3, are decompressed.
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Recovery
After discharge form the hospital, the patient is encouraged to increase the level of activity gradually. Back pain should be the guideline to the level of activity. Automobile riding is prohibited for the first several weeks; heavy lifting is also discouraged.
After 4 to 6 weeks patients may return to light work, at least part-time.
After 3 months, most patients are able to return full-time to sedentary or moderately active employment. Heavy physical labor and vigorous athletics are generally prohibited for six months.
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Questions to Ask Your Doctor
Is the pain due to spinal stenosis?
To what extent is the spinal canal compromised?
Would anti-inflammatory drugs help?
Is surgery indicated?
What would be the goal of the surgery?
How long will recovery take?
What is expected after full recovery?
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