Lumbar decompression surgery - What happens during lumbar decompression surgery

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. Read more about NHS waiting times.

Before the operation

To help you recover from your operation and reduce your risk of complications, it helps if you are as fit as possible before surgery.

As soon as you know you are going to have lumbar decompression surgery, it is advisable to stop smoking if you smoke, eat a healthy diet and take regular exercise.

Pre-operative assessment

You will be asked to attend a pre-operative assessment appointment a few days or weeks before your operation. 

During this appointment, you may have some blood tests and a general health check to make sure that you are fit for surgery, as well as an X-ray or magnetic resonance imaging (MRI) scan of your spine.

The pre-operative assessment is a good opportunity to discuss any concerns you may have or ask any questions about your operation.

You should be told at your pre-operative assessment who will be doing your operation and you may be introduced to them. Lumbar decompression surgery is performed either by a neurosurgeon or an orthopaedic surgeon with experience in spinal surgery.

Read more about having an operation and general advice about going into hospital.

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 having the operation, you will be asked to sign a consent form to confirm that you know what the operation involves and what the potential risks are.

You will not usually be allowed to eat or drink for about six hours before your operation.

During lumbar decompression surgery, you will usually lie face down on a special curved mattress to allow the surgeon better access to the affected part of your spine and reduce the pressure on your chest, abdomen and pelvis.

The operation is normally carried out under general anaesthetic, which means you will be asleep during the procedure and won't feel any pain. The whole operation usually takes at least an hour, but may take much longer, depending on the complexity of the procedure.

Surgical procedures

The aim of lumbar decompression surgery is to relieve pressure on your spinal cord or nerves while maintaining as much of the strength and flexibility of your spine as possible.

Depending on the specific reason you are having surgery, a number of different procedures may need to be carried out during your operation to achieve this.

Three of the main procedures used are:

• laminectomy – where an arch of bone, known as the lamina, is removed from one of your vertebrae
• discectomy – where a section of a damaged disc is removed
• spinal fusion – where two or more vertebrae are joined together with a bone graft

Your surgeon will be able to provide more information on what procedures are going to be performed during your surgery.

The main procedures are described in more detail below.

Laminectomy

A laminectomy is done to remove areas of bone or ligament that are putting pressure on your spinal cord. Ligaments are tough bands of tissue that connect one bone to another. They can put pressure on the spinal cord if they deteriorate over time.

During a laminectomy, 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 so the surgeon has access to the affected compressed nerve roots. The nerve roots originate from the spinal cord and travel to the legs to supply your legs with sensation and ability to move.

The surgeon will then pull the nerve root back towards the centre of your spinal column and remove part of the bone or ligament putting pressure on your spinal nerves.

The surgeon will finish the operation by closing the incision with stitches or surgical staples. 

Discectomy

A discectomy is performed to release the pressure on your spinal nerves caused by a bulging or slipped disc.

As with a laminectomy, the surgeon makes an incision over the affected area of your spine down to the lamina and the ligament connecting the lamina and small area of adjoining lamina are removed so the surgeon has access to the affected nerve root.

The surgeon will then gently retract the nerve away to expose the prolapsed or bulging disc, which he or she will remove just enough of to stop pressure on the nerves. Most of the disc will be left behind to keep working as a shock absorber.

The surgeon will finish the operation by closing the incision with stitches or surgical staples. 

Spinal fusion

Spinal fusion is used to join two or more vertebrae together by placing an additional section of bone in the space between the vertebrae.

This helps prevent excessive movements between two adjacent vertebrae, lowering the risk of further irritation or compression of the nearby nerves and reducing pain and related symptoms.

The additional section of bone can be taken from somewhere else in your body (usually the hip) or from a donated bone and more recently, synthetic bone substitutes.

To improve the chance of fusion being successful, some surgeons may choose to use screws put into an area of the vertebrae called pedicles, which are joined together using connecting rods.

Afterwards, the surgeon will close the incision with stitches or surgical staples.

Keyhole surgery

Spinal compression surgery is usually performed through a large incision in the back. This is known as 'open' surgery.

In some cases, it may be possible for it to be performed using a microscope (such as a microdiscectomy) or a 'keyhole' technique known as microendoscopic surgery.

In this case, the operation is done using a tiny camera and surgical instruments inserted through a small incision in your back. The surgeon is guided by viewing the operation on a video monitor.

Microendoscopic surgery is complicated and is not suitable for everyone. Whether it is suitable depends on the exact problem in your lower back. There is also a slightly higher risk of accidental injury during this operation than with an open operation.

Some of the techniques used during microendoscopic surgery, such as using a laser or a heated probe to burn away a section of damaged disc, are relatively new. Therefore, it is still uncertain how effective or safe they maybe in the long term.

An advantage of microendoscopic surgery is that it usually has a much shorter recovery time. In many cases, people can leave hospital the day after surgery has been completed.