Lumbar decompression surgery - When lumbar surgery may be recommended

Lumbar decompression surgery is usually only considered for problems affecting the lower (lumbar) spine if non-surgical treatments have not helped.

These may include painkillers, antidepressants, physiotherapy, or corticosteroid injections.

If these treatments have not been effective and your symptoms have a significant impact on your quality of life, lumbar decompression surgery may be recommended if you are thought to be healthy enough to withstand the effects of the anesthesia and surgery.

Some of the conditions that may require surgery are described below.

Spinal stenosis

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 include pain, numbness, weakness and a tingling sensation in one or both legs. This can make walking difficult and painful, although sitting down or leaning forward can offer relief in some cases.

Most cases of spinal stenosis are age related and usually occur in people over 60. As a person gets 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

A rare and severe type of spinal stenosis is cauda equina syndrome.

In cauda equina syndrome, all the nerves in the lower back suddenly become severely compressed, causing a range of problems including numbness in the skin around the back passage, inability to urinate or not being able to control your bladder (urinary incontinence) and loss of bowel control (bowel incontinence).

Cauda equine syndrome requires emergency hospital admission and emergency surgery, as the longer the condition goes untreated, the greater the chance that a person will be left permanently paralysed and incontinent.

Slipped disc and sciatica

A slipped or herniated disc is when the tough coating of a disc in your spine tears, causing the jelly-like filling in the centre to squeeze out. The torn disc can press on a surrounding nerve or nerves and cause pain in parts of your legs.

This pain may be accompanied by tingling, pins and needles, numbness or even weakness in certain areas of your legs. The pain is often referred to as sciatica. The pain is sometimes worse on straining, coughing or sneezing. 

The most common symptom of sciatica is pain radiating out from the lower back, down the buttocks and into one or both legs, right down to the calf. The pain can range from mild to severe.

A slipped disc can happen at any age, but is more common in people between 20 and 40 years of age. Initially minor degeneration may occur and then in some cases an awkward twist, turn or minor trauma, or even a cough or sneeze, can cause the filling in the centre of the affected disc to squeeze out.

In many people with a slipped disc, however, the exact cause is unknown.

Metastatic spinal cord compression

Cancer in one 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 then usually gets worse over time; the pain is constant and is often worse at night
• numbness in your toes and fingers
• problems passing urine

If it's not treated, metastatic spinal cord compression is potentially very serious and can result in permanent paralysis (inability to move parts of your body, which in this case would be your legs).

For people in good enough health to withstand surgery and with a good enough outlook, metastatic spinal cord compression is best treated with surgery. However, in cases where the problems become apparent late on, many people are too ill to withstand or benefit from surgery.

Spinal injury

Injury to your spine, such as dislocation and fractures, or the swelling of tissue can put pressure on your spinal cord or nerves.

Spinal tumours

Abnormal growths and tumours can form along your spine. These are usually not cancerous (benign), but growing tumours may compress your spinal cord and nerve roots, causing pain.