Lumbar decompression surgery is usually only considered if non-surgical treatments for your lower spine haven't worked and symptoms are affecting your quality of life.
Non-surgical treatments include painkillers, physiotherapy and spinal injection therapy. Spinal injection therapy is a course of spinal injections that can be used in combination with other therapies, such as physiotherapy. Local anaesthetic and steroids are injected to help reduce swelling and inflammation.
Lumbar decompression surgery may also be considered if you experience serious side effects when taking medications that affect your ability to work.
Surgery may become likely if difficult symptoms last up to 2 months. Surgery around 4 months after symptoms start is seen by some as the right time for the best results and recovery.
Surgery will only be recommended if you're healthy enough to withstand the effects of the anaesthetic and the surgery.
Spinal stenosis is a condition where the space around the spinal cord (the spinal column) narrows, compressing a section of nerve tissue.
The main symptoms of spinal stenosis are pain, numbness, weakness and a tingling sensation in one or both legs. This can make walking difficult and painful.
Most cases of spinal stenosis occur in older people. As you get older, the bones and tissues that make up the spine can become worn down, which can lead to a narrowing of the spinal column.
Cauda equina syndrome
Cauda equina syndrome is a rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed.
- sciatica on both sides
- weakness or numbness in both legs that is severe or getting worse
- numbness around or under your genitals, or around your anus
- finding it hard to start peeing, can't pee or can't control when you pee – and this isn't normal for you
- you don't notice when you need to poo or can't control when you poo – and this isn't normal for you
Cauda equina syndrome requires emergency hospital admission and may require emergency surgery, because the longer it goes untreated, the greater the chance it will lead to permanent paralysis and incontinence.
Slipped disc and sciatica
A slipped or herniated disc is where the tough coating of a disc in your spine tears, causing the jelly-like filling in the centre to spill out. The torn disc can press on a surrounding nerve or nerves, causing pain in parts of your legs.
This pain may be accompanied by tingling, pins and needles, numbness or weakness in certain areas of your legs. The pain is often referred to as sciatica and is sometimes worse when straining, coughing or sneezing.
The most common characteristic of sciatica is pain that radiates out from the lower back, down the buttocks and into 1 or both legs, right down to the calf. The pain can range from mild to severe. Sciatica on both sides can be a sign of cauda equina syndrome, which is a medical emergency.
A slipped disc can occur at any age. If a disc becomes damaged, it sometimes only takes an awkward twist or turn, a minor injury or even a sneeze to cause the filling in the centre of the disc to spill out.
However, the exact cause of a slipped disc is often unknown.
Metastatic spinal cord compression
Cancer in 1 part of the body, such as the lungs, sometimes spreads into the spine and presses on the spinal cord. This is known as metastatic spinal cord compression.
Initial symptoms can include:
- back pain, which may be mild at first, but usually gets worse over time; the pain is constant and often worse at night
- numbness in your fingers and toes
- problems urinating
Without treatment, metastatic spinal cord compression is potentially very serious and can result in permanent paralysis in the legs.
For people in good enough health to withstand surgery, metastatic spinal cord compression may be treated with surgery. However, if the problems only become apparent late on, many people are too ill to withstand or benefit from surgery.
Injury to your spine (such as dislocation or fracture) or the swelling of tissue can put pressure on your spinal cord or nerves.
Abnormal growths and tumours can form along the spine. Growing tumours may compress your spinal cord and nerve roots, causing pain.
Page last reviewed: 28 April 2022
Next review due: 28 April 2025