Lumbar Decompression Spine Surgery
Lumbar decompression surgery is used to treat compressed nerves in the lower (lumbar) spine. The surgery aims to treat symptoms caused by pressure on the nerves in the spine and is only recommended when non-surgical treatments fail to help.
Lumbar decompression surgery is often used to treat:-
- Spinal Stenosis (shrinking of the spinal column resulting in pressure on the nerves in spine)
- Slipped disc and Sciatica (an underlying nerve under pressure due to damaged spinal disc)
- Spinal injuries (severe injuries causing fracture or swelling of tissue)
- Metastatic spinal cord compression (cancer in one part of the body when spreads into the spine causing pressure on the spinal cord)
What happens during surgery?
Lumbar decompression surgery may involve one or more of the following procedures:-
- A bone section may be removed from the spinal bones to relieve pressure on the affected nerve. This is termed as laminectomy.
- The damaged disc may be removed to relieve pressure on a nerve. This is termed as discectomy.
- Two or more vertebrae may be joined together with a bone section to stabilise the spine. This is termed as spinal fusion.
There are many different treatments to relieve pressure on the spine. These are as follows:-
1) Pedicle Screw Fixation
- It provides stability and support to the spine after surgery and keep bone grafts intact during the healing period.
- Metal rods are used to connect the spinal segments and pedicle screws provide anchor points on it.
- Once the bone graft grows and fuses to the surrounding bones, the rods and screws may be removed by the doctor.
2) PLIF, ALIF and TLIF Procedures
These are three common fusion surgeries in which two or more vertebrae are joined or fused together.
PLIF: (Posterior Lumbar Interbody Fusion)
This is a fusion technique in which the vertebrae are reached through an incision in the patient's back (posterior). It involves three basic steps:-
- Pre-operative planning and templating is done using MRI and CAT scans to determine the size of implant(s) needed.
- Disc space is prepared depending on the number of levels to be fused. A 3-6 inch incision is made in the patient’s back and the spinal muscles are separated to access vertebral disc.
- Finally, implants such as; bone graft, allograft or BMP with a cage are inserted to promote fusion between the vertebrae. Rods or screws may also be used during this step to further stabilize the spine.
ALIF: (Anterior Lumbar Interbody Fusion)
This procedure for ALIF surgery is similar to PLIF, however it is done from the front (anterior) of the body. It involves the following steps:-
- A 3-5 inch incision is made on the lower abdominal area or on the side.
- A mini open ALIF approach could be performed to access the front of the spine through a very small incision while preserving the muscle strength and function. It is used to fuse the L5-S1 disc space.
- Disc material is removed after the abdominal muscles and blood vessels are retracted after the procedure.
- Bone graft, anterior interbody cages, rods, or screws, if necessary are inserted to stabilized the spine and facilitate fusion.
TLIF: In the TLIF technique, the spine is approached from the side of the spinal canal through a midline incision in the patient's back.
- This approach minimizes the nerve manipulation required to access the vertebrae, discs and nerves.
- It is less traumatic to the spine, safer for the nerves, and allows for minimal access and endoscopic techniques to be used for spinal fusion.
- Similar to PLIF and ALIF, disc material is replaced with bone graft (along with cages, screws, or rods if necessary) in the disc space. Instrumentation facilitates fusion and also adds strength and stability to the spine.
It aims to remove the disc material placing pressure on the spinal nerve column. It involves minimal incision and is used to eliminate sciatica pain caused by disc herniation. So the spinal nerve has the needed space inside the spinal column, stopping the pain caused by pinching on the nerve.
4) MISS (Minimally invasive spine surgery)
This surgery is used to treat back pain and neck pain caused by a variety of spinal disorders using advanced technology.
Spinal conditions treated with MISS are:-
- Degenerative disc disease
- Herniated discs
- Spinal stenosis
MISS minimizes soft tissue damage, is less risky, less invasive as compared to traditional open spine surgery. Decompression and stabilization are two main goals of minimally invasive spine surgery.
5) Foraminotomy Procedure
Nerves pass from the Neural foramina of spinal column to the rest of our body. These nerve bundles can become compressed causing intense pain. Any time the nerves coming through the foramen (opening in spine) become squeezed or pinched, a foraminotomy procedure can help.
This is a procedure for stabilizing compression fractures in the spine. In case of cracked or broken bones, often due to osteoporosis, bone cement is injected into the back bone(vertebrae). The bone cement helps in stabilizing the fractures and supports the spine. It helps relieve pain, increase mobility and reduce the use of painkillers.
Kyphoplasty is similar to vertebroplasty, however, it uses special balloons to create spaces within the vertebrae to fill bone cement. This procedure can correct spinal deformity and restore lost height.
Recovery of a patient depends on the complexity of the surgery and level of mobility of a patient before the surgery. Usually, a patient is discharged in about 1 to 4 days after the surgery.
On an average, a person can walk unassisted within a day of having the operation. However, strenuous activities are advised to be avoided for about 4-6 weeks.
Lumbar decompression surgery is an effective treatment and is often successful. But, surgeries are complicated procedures and have certain risks involved.
- Chances of developing an infection, csf leak, Implant Failure.
- A blood clot may develop in one of the leg veins, known as deep vein thrombosis (DVT)
- Heart related complications like myocardial infarction
- Damage to the spinal nerves or cord resulting in numbness or weakness in one or both legs, or some degree of paralysis which is a rare case.