Decompression (or Laminectomy)
The term 'decompression' is used to describe the surgical treatment of spinal stenosis. This is caused by the narrowing of the spaces through which nerves leave the spinal canal and travel to other parts of the body. The space is bordered by the vertebral body, the lamina and intervertebral disc. It is not the same as discectomy but the symtoms it is designed to alleviate are very similar. The aging process contributes to the narrowing of these spaces and the discs themselves can collapse and add to the problem. Surgical decompression is often accompanied by discectomy.
The common symptoms are pain (which can vary from a mild ache to excruciating discomfort), numbness, muscle weakness and a tingling ('pins and needles') sensation. As the spaces in the spine narrow the room available for the nerves and the blood supply to them worsens. Pain can be relieved temporarily by leaning forward or sitting down as it stretches the back of the spine and opens up the spaces between the vertebrae.
Patients suffering from back pain and showing symptoms such as these will be referred by their doctor to a consultant spinal surgeon. The consultant will be able to determine the cause of the symptoms by careful examination. An MRI scan is undertaken to verify the extent of the spinal stenosis and the level in the spinal column at which it is located.
Since this type of condition is progressive it will worsen if left untreated and surgical intervention is almost always the most effective treatment. The operation will improve the availability of space in the spinal column for the nerves and blood vessels and relieve associated pain. If left too long before the problem is addressed permanent nerve damage may be unreversible.
Before a patient is admitted to hospital for spinal surgery they will be asked to make a visit for a pre-operative assessment. This is a thorough examination and education process during which routine tests are carried out. It is also a very good opportunity for patients and their relatives to ask any questions they may have about the operation or preparing for it. The operation itself can take between one and two hours, depending on the severity of the stenosis and the number of levels in the spine that are affected.
This type of operation is always carried out under general anaesthetic. During the procedure the spinal surgeon will access the affected area through a small incision in the midline of the back. The muscles are moved to the side and as much bone will be removed from the lamina (hence the alternative name 'laminectomy'), disc and surrounding tissues as necessary for decompress the nerves and create some space to allow for future degeneration. An x-ray will be taken using a portable machine during surgery to confirm the operation is at the right level.
Once the operation is complete patients will be moved to the recovery ward until the nurses and anaesthetist determine the patient is stable enough to return to the ward where most patients will spend one or two nights following surgery. Often much of the pain and symtoms are noticeably relieved immediately after surgery, however it can take several months for nerves to recover. It is also not uncommon for patients to notice unexpected pain or symptoms and but this is caused by temporary localised swelling from the operation itself.
Rehabilitation and prevention
It is important to follow the exercises set out by the physiotherapists (it more common for a physiotherapist to prescribe an exercise regime than the consultant spinal surgeon) on an ongoing basis in order to maximise recovery after surgery and reduce the risk of symptoms recurring as much as possible. It is also important that patients are familiar with the do's and don'ts as to avoid overdoing themselves in the immediate post-operative period up to the time of the follow up appointment with the consultant spinal surgeon. Exercise programmes are best tailored to individual patient's needs.
For any enquiries please contact Mrs Mandy O'Sullivan who will endeavour to help you in any way possible.