Spinal Decompression Surgery

Your doctor may recommend spinal decompression surgery to treat severe symptoms of spinal nerve compression or symptoms that don’t improve well enough with more conservative treatments, such as physical therapy.

A variety of diseases, disorders and conditions of the spine can lead to pressure on the spinal cord or nerve roots including:

• Bone spurs, which are abnormal growths of bone on a vertebra

• Degenerative disc disease, which is a breakdown of the intervertebral discs—made of a cartilage-like substance, collagen, and other connective tissues—that provide cushioning for the vertebrae above and below them.

• Herniated disc, which is a displacement of an intervertebral disc. Other names for this condition include bulged disc, slipped disc, and ruptured disc.

• Scoliosis, which is an abnormal spinal alignment causing an s-shaped curvature

• Spinal stenosis, which is a narrowing of the spinal column, usually due to arthritis. Foraminotomy and laminectomy are common spinal decompression surgeries for spinal stenosis.

Other possible causes of spinal nerve compression include infections, injuries and tumors.

Depending on the cause of the compression, symptoms may take years to develop or they may come on very suddenly. Symptoms also vary depending on the location of the disease or injury in the spine, such as the neck or lower back. Common symptoms include pain that may radiate or spread to other areas, burning, tingling, numbness, weakness, and problems with balance or coordination.

In general, doctors recommend more conservative treatments before considering surgery. For spinal compression, the two main nonsurgical treatments are medications and physical therapy. If you have tried these without relief, spinal decompression surgery may be right for you. You may also be a candidate if you are having disabling pain, weakness leading to difficulty walking or standing, or rapidly worsening symptoms.

Talk with your doctor about your quality of life with spinal compression symptoms. See if the risks and benefits of spinal decompression surgery make it an option for you.

An orthopedic surgeon or a neurosurgeon may perform spinal decompression surgery. Orthopedic surgeons specialize in the medical and surgical treatment of musculoskeletal problems. This includes conditions affecting the muscles, bones, and connective tissue of the spine. Some orthopedic surgeons specialize in the spine. Neurosurgeons focus on the surgical treatment of diseases, disorders and conditions of the nervous system. This includes the nerves of the spine.

When choosing a surgeon, look for one with plenty of experience treating people with your type of spinal nerve compression. You will likely receive a referral to an ‘orthopedic spine surgeon’ or ‘neurological spine surgeon’ (or simply ‘spine surgeon’). Board-certified and trained spine surgeons are equally qualified; however, there may be differences. They may further specialize in certain spine surgeries and procedures. They may also specialize in minimally invasive surgery or in certain parts of the spine, such as the cervical spine of the neck or the lumbar spine of the low back.

Spinal decompression surgeries take place in a hospital or surgical center. The specific details of the procedure will vary depending on which kind of surgery you need. Most spinal decompression surgeries are major surgeries. In most cases, you will receive general anesthesia so you will not feel pain. This combination of gases and IV (intravenous) medications will put you in a deep sleep. You may also have a peripheral nerve block infusion to control pain during and after surgery.

Many spinal decompression surgeries are minimally invasive procedures. This includes spinal stenosis back surgery, such as laminectomy and spinal fusion. There are several ways to perform minimally invasive spinal decompression surgery. The most common approach uses a tubular retractor. The surgeon makes a small incision over the spine and inserts the retractor. The retractor pushes muscles and tissue out of the way instead of cutting them. It remains in place during the procedure, creating a tunnel to the spine through which the surgeon works. The surgeon may need to use more than one retractor to complete the surgery.

Minimally invasive surgeries have advantages over traditional open surgeries. The risk of complications is generally lower and they usually involve a faster recovery with less pain. Still, in some cases, open surgery with a larger incision may be the best or safest option depending on your circumstances. Talk with your doctor and ask if minimally invasive surgery is an option for you. If so, make sure the surgeon you choose has weekly or semi-weekly expertise performing the minimally invasive approach of the surgery you need.

In general, this is what happens the day of your surgery:

• You change into a hospital gown in your preoperative room or area. It is best to leave jewelry and valuables at home or with the person who came with you to the surgery. You will have blankets to stay warm.

• You talk with a preoperative nurse, who may perform a brief exam.

• You talk with an anesthesiologist or nurse anesthetist about your medical history and the anesthesia you will have.

• You get a sedative to help you relax before the team takes you the OR (operating room).

• Your team will start general anesthesia in the OR. You will not remember anything else until you wake up in the recovery room.

All surgeries, even minimally invasive ones, involve risks. Some of these problems can be serious and may develop during the surgery itself or afterwards during recovery. Most spinal decompression surgeries go smoothly, but it is important to be aware of possible complications.

The general risks of surgery include:

• Anesthesia reaction, such as an allergic reaction and problems with breathing

• Bleeding, which can lead to shock

• Blood clot, in particular a deep vein thrombosis (DVT) that develops in the leg or pelvis

• Infection

Spinal decompression surgery risks will vary somewhat with the specific procedure. In general, these risks include:

• Delayed healing, incomplete healing, or problems during the healing process, which is more common in people who smoke. Sometimes, a second surgery is necessary.

• Nerve, muscle, or blood vessel damage

• Pain, disability, or other symptoms that persists after surgery

• Spinal headache due to leaking cerebrospinal fluid

• Worsening back or neck symptoms

You can reduce your risk of certain complications by:

• Following activity, dietary and lifestyle restrictions and recommendations before your surgery and during recovery

• Informing your doctor if you are nursing or if there is any possibility of pregnancy

• Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

• Taking your medications exactly as directed

• Telling all members of your care team if you have allergies

You can take steps before surgery that can help improve comfort and outcome during recovery. You can prepare for spinal decompression surgery by:

• Arranging for someone to accompany you and drive you home. You also need someone to stay with you for at least the first 24 hours.

• Getting preoperative testing if your doctor orders it. This will depend on your medical history and the specific procedure you need.

• Losing excess weight before surgery

• Not eating or drinking before surgery as directed. Having food or drink too close to the start of your surgery may require postponement and rescheduling. It is a matter of safety with general anesthesia to prevent choking on stomach contents.

• Sharing your complete medical history with your surgical team. This includes chronic conditions, allergies, and medications. When listing medications, include prescriptions, over-the-counter drugs, herbal treatments, and vitamin supplements.

• Stopping smoking as soon as possible to help the healing process

• Taking or stopping medications as directed

In preparing for surgery, you may have several questions. It is helpful to write them down so you can remember everything you want to know. Contact the doctor by phone or email if available. A video conference may be another option for your appointment.

Questions you may want to ask include:

• Why are you recommending spinal decompression surgery? Are there any other options left to try?

• How long will the surgery take? When can I go home?

• What restrictions will I have after surgery? What kind of assistance will I need at home? For how long?

• When can I return to work and other activities?

• Will I need physical therapy? When will therapy start and how many sessions will I need?

• How will you manage my pain?

• What changes, if any, do we need to make to my medication plan?

• When should I follow up with you?

• How should I contact you after hours if I have a problem?

Knowing what to expect after surgery may make it easier for you to plan and prepare for spine surgery recovery.

Some spinal decompression surgeries are outpatient procedures. If this is the case, you will go home the same day. However, it is common to stay in the hospital after many of these surgeries. The length of your stay will depend on the specific procedure and whether or not it is minimally invasive. It may be as short as a day or two or as long as a week. Regardless, your team will give you detailed instructions about your recovery before you leave. This includes information about activity level, pain management, medications, and follow-up appointments.

After some spinal decompression surgeries, you may need a back brace or other support to stabilize your spine while it heals. Either way, your doctor will likely encourage you to walk frequently.

You will also start physical therapy soon after your surgery. A physical therapist will show you how to move properly to protect and support your back and spine during recovery and afterwards. The therapist will also teach you about activities to avoid, such as twisting your spine. Full recovery from spinal decompression surgery can take several weeks or months.

Most people have some degree of pain and discomfort after spinal decompression surgery. Controlling pain is important for healing and a smooth recovery. It makes it easier to walk and complete rehabilitation exercises and activities that are vital for your recovery. Tell your doctor if your pain gets worse or changes in any way. This could be a sign of a complication.

If you have questions between follow-up appointments, contact your doctor during normal hours. However, call the doctor right away or seek immediate medical care if you have:

• Breathing problems or shortness of breath

• Confusion or changes in level of alertness

• Chest pain, pressure or tightness

• Drainage of pus, redness, or swelling around your incision

• Fever. It is common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.

• Inability to urinate or move your bowels

• Leg pain, redness or swelling, which could mean you have a blood clot

• Unexpected bleeding

Spinal nerve decompression surgeries successfully relieve pain in 80 to 90% of patients. But it is important to have realistic expectations. If a degenerative process like arthritis caused the nerve compression, it may continue to affect other portions of your spine. It is possible that pain and other symptoms will return. Staying physically active and maintaining a healthy weight can help keep your spine healthy and avoid future problems.