Lumbar decompressive surgery 

Introduction 

Lumbar surgery

Around half of us have back pain at some time in our lives. It often heals in time, but for some people the pain doesn't go away and surgery is the only answer. Watch this video to see how lumbar surgery can relieve pressure on the spinal nerves in the lower back.

How the spine works

  • Your spine extends from your skull to your pelvis. It is made up of 24 individual bones called vertebrae, which are stacked on top of each other.
  • The front of each vertebra is solid and is called the vertebral body. Behind the body of each vertebra is an arch of bone called the lamina. The arches form a hollow channel known as the spinal canal or vertebral canal, which protects the spinal cord and nerves.
  • A pair of spinal nerves branch out (one to the left and one to the right) from each vertebra. These nerves are called nerve roots and pass through gaps in the arches where they join up to provide sensation and movement to parts of the body. The gaps are called foramens.
  • The vertebrae are separated by soft pads or discs that act as shock absorbers.
  • Each vertebra also has two sets of joints called facet joints which, with the discs, allow the spine to bend.
  • The nerve root foramens are covered by the discs at the front and the facet joints at the back.
  • The vertebrae are also held together by tough bands called ligaments. Together with the spinal muscles, these give the back its strength.

Lumbar decompressive surgery is an operation to relieve pressure on the spinal nerves in the lower back. It is often used to treat a condition called spinal stenosis.

Spinal stenosis is the narrowing of areas of the spine. It occurs when the bones, ligaments or discs of the spine squash the nerves of the spine causing pain, usually in the lower back and legs.

Causes of spinal stenosis include:

  • age-related degeneration of the spine,
  • changes in the ligaments of the spine, and
  • diseases of the bone, such as Paget’s disease.

Other conditions that may require lumbar decompressive surgery include:

  • a slipped (herniated) disc,
  • spinal tumours, and
  • spinal injury.

Lumbar decompressive surgery is recommended when the pain in your back and legs is affecting your quality of life and alternative treatments, such as pain relief and physiotherapy, have not worked.

Types of surgery

There are two types of lumbar decompressive surgery:

  • A laminectomy or partial laminectomy removes or trims the bony arch of a vertebra (bone) or ligaments of the spine to relieve the pressure on the spinal cord.
  • A discectomy removes the damaged or bulging part of a slipped disc to relieve pressure on the spinal cord.

Outlook

70% and 75% of patients experience a significant improvement in leg pain after lumbar decompressive surgery. 20-25% of patients experience an improvement, but still have some pain.

The success rate for microdiscectomy (keyhole surgery) is slightly better, with 80-85% of patients experiencing an improvement in their leg pain.

Last reviewed: 21/01/2010

Next review due: 21/01/2012

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