Spine : Lumbar decompression

Overview

Decompression is a surgical procedure that is performed to alleviate pain caused by pinched nerves (neural impingement).

In this type of back surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to give the nerve root more space and provide a better healing environment.

Several conditions may cause neural impingement, including spinal stenosis, a disc herniation, isthmic spondylolisthesis, degenerative spondylolisthesis, or (rarely) a spinal tumour.

There are two common types of spine surgery decompression procedures:
1. Microdiscectomy (or microdecompression)
2. Laminectomy (or open decompression)

Procedure

With modern spine surgery techniques, both a microdiscectomy and laminectomy can usually be done with a minimum amount of morbidity (e.g. post-operative discomfort) and a high degree of success in alleviating low back pain and/or leg pain.

Sometimes in addition to the decompression procedure a spine fusion surgery is also necessary in order to achieve adequate decompression of a nerve root. This is especially true if the nerve root is compressed as it leaves the spine (in the foramen), known as foraminal stenosis.

Foraminal stenosis is difficult to decompress simply by removing bone because if the bone is fully removed in the location of the foramen it is generally necessary to also remove the facet joint. Doing so leads to instability; so a spinal fusion is necessary to restore stability.

The foramen can be opened either through an anterior approach (by "jacking" open the disc space in the front of the spine) or by distracting between two pedicle screws inserted posteriorly (through the back of the spine). After the foramen is opened up a spine fusion is also done to keep it open so the instrumentation does not fail and the foraminal stenosis does not return later.

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