Lumbar decompression is a surgery that creates extra space around the nerve by removing excess bone and ligament that accrue from degeneration (wear and tear from aging). The size of the incision depends on the number of vertebrae that are decompressed. In general, each level requires an additional inch of incision. Following general anesthesia, the skin is cut and the muscle moved off of the shielding bone called the lamina. In most instances, the lamina is removed to reveal the underlying nerves. The ligament is freed from the nerve and removed along with excess bone in order to open the tunnel that the nerve uses to travel to the legs. (See the drawing at top of page)
Unlike a disc herniation that can shrink over time, the buildup of excess bone and ligament in a lumbar decompression never goes away on its own. Studies indicate that although injections can reduce pain, sometimes for months, the pain often returns and ultimately surgery becomes necessary to open the tunnel.
Randomized-controlled trials have confirmed the usefulness of this surgery to alleviate pain from the compressed nerves in the lower back.
Most patients worry about the amount of bone that is removed. However, we do not remove any bone that is essential to the strength of the spine. There are no long term structural consequences to the removal of this material.
Following the surgery, you will be expected to be able to walk right away. While recovery varies considerably from one patient to another, most people resume activities of daily living within days. However, there will be a soreness at the site of surgery.
For single level surgeries (one affected disc), patients typically go home soon after the procedure. For multi-level surgeries, patients tend to remain in the hospital for a day or two. Most patients can resume sedentary jobs within 1-2 weeks, active jobs within 4-6 weeks and heavy activity in 3 months.
Although older patients worry about the risk of surgery, laminectomies for stenosis are almost uniformly performed in elderly patients without significant risk. Risks of bleeding, infection and neurologic injury generally occur in less than 5% of the procedures. Despite the natural fear of having surgery, death and paralysis are both extremely unusual with this procedure.