Before the operation
If you and your consultant decide that you could benefit from lumbar decompression surgery, you will be put on a waiting list. Your doctor or surgeon should be able to tell you how long you are likely to have to wait in your area.
To help you recover from your operation and reduce your risk of complications, it helps if you are as fit as possible beforehand. As soon as you know you are going to have lumbar decompressive surgery, try to:
- stop smoking,
- eat a healthy diet,
- do regular exercise, and
- lose weight if you are overweight.
You will be given a pre-assessment appointment a few days before your operation. Your surgeon will do an X-ray and MRI (magnetic resonance imaging) scan of your spine. The appointment may also involve having some blood tests and a general health check to make sure that you are fit for surgery.
You can also use your pre-assessment appointment as an opportunity to discuss any concerns or ask any questions about your operation.
The operation
You will be admitted to hospital on the day of your operation or the day before. Your surgeon and anaesthetist will explain what will happen during your operation. This will give you the opportunity to ask any questions you may have.
Before going for your operation, you will be asked to sign a consent form for the operation and the anaesthetic. This confirms that you know what the operation involves and the risks.
You will not be allowed to eat or drink for six to eight hours before your operation.
During lumbar decompressive surgery, you will usually be lying face down on a special curved mattress. This reduces the pressure on your chest, abdomen and pelvis. Your spine will be flexed to help expose the compressed nerve. Surgery usually takes between one and two hours.
The goal of lumbar decompressive surgery is to relieve pressure on your spinal cord or nerves and to maintain the strength and flexibility of your spine.
Laminectomy or partial laminectomy
A laminectomy is done to remove areas of bone or ligament that are putting pressure on your spinal cord.
- The surgeon makes a straight incision over the affected section of the spine and down to the lamina, the bony arch of your vertebra.
- The ligament joining the lamina is removed to view the affected nerve root.
- The surgeon will then pull the nerve root back towards the centre of your spinal column and remove part of the bone or ligament causing you pain. This will relieve the pressure on your spinal nerves.
- The incision is then closed and stitched.
Discectomy
A discectomy is done to release the pressure on your spinal nerves caused by a bulging or slipped disc.
- The surgeon makes an incision over the affected area of your spine down to the lamina, the bony arch of your vertebra.
- The ligament joining the lamina is removed to view the affected nerve root.
- The surgeon will then pull the nerve root back towards the centre of your spinal column and will remove just enough of the disc to stop pressure on the nerves. Part of the disc needs to stay to keep working as a shock absorber.
- The incision is then closed and stitched.
Keyhole Surgery
Discectomies and laminectomies are usually performed through a large incision in the back, known as open surgery. In some cases, they may be performed using a microscope (microdiscectomy) or a keyhole technique known as microendoscopic surgery. In this case, the operation is done using a tiny camera and surgical instruments that are inserted through a small incision in your back. The surgeon is guided by viewing the operation on a video monitor.
Microendoscopic back surgery is complicated and is not suitable for all patients (this depends on the exact problem causing your back and leg pain). There is a slightly higher risk of injury than with an open operation. However, this technique may allow your procedure to be carried out as a day case, with a quicker recovery time.
