A spinal decompression is an operation carried out on patients with spinal stenosis. Spinal stenosis is a narrowing of the space available for the nerves in the spinal canal and it is caused by age related wear and tear in your lower back. The spinal canal can become so tight (stenotic) that the nerves become compressed. This nerve compression can cause pain and other symtpoms in your legs, particularly on walking. The aim of a spinal decompression is to make more space for the nerves in your lower back to prevent your symptoms from getting any worse. Following surgery, most patients get complete relieve of their leg pain. A spinal decompression is not generally an operation for back pain.

How do we do it?

A spinal decompression is carried out under a general anaesthetic. You will meet the anaesthetist on the ward prior to your surgery who will explain the anaesthetic to you. The operation takes about 75-90 minutes. Once asleep the patient is placed on their front on the operating table. X-ray is used to identify the correct area of the lower back. A longitudinal incision is made, and the muscle is separated off the spine. The decompression itself involves removing the tissues that are compressing the nerves. This necessitates the removal of a small amount of bone, thickened ligament, and sometimes a disc prolapse. At the end of the operation the wound is closed with dissolvable stitches and covered with a dressing.

If you are on any medication that has the potential to thin your blood such as aspirin, clopidogrel, warfarin or any other blood thinning medication then we do need to know about this prior to the date of your injection as this will usually need to be stopped prior to your operation.

If you take anti-inflammatory tablets then you must stop taking them 7 days before your surgery.

What are the Risks?

Infection

The risk of infection is less than 1%. If you develop an infection it is likely to be a superficial wound infection that will resolve with a short course of oral antibiotics. Occasionally patients get a deep infection at the site of surgery. This is more serious. If this occurs you may require a prolonged course of intravenous antibiotics or additional surgery.

Bleeding

You will lose some blood during the operation. We would normally expect that your body to deal with this blood loss without needing a blood transfusion.

DVT

Developing blood clots in the legs (deep vein thrombosis – DVT) is a risk of any surgery. We worry about DVTs as bits can break off a travel around your body. This is called an embolus. An embolus can affect your breathing, cause you to have a stroke, and could potentially be fatal. DVTs occur in approximately 1 in 200 patients having back surgery. An embolus is a much less common occurrence. We minimize the risk of DVT by asking patients to wear hospital stockings following their surgery (TEDS), and mechanical pumps during and immediately after surgery. These pumps squeeze your lower legs, helping the blood to circulate. They are put on when you go to sleep and stay on until you start to mobilize. We encourage early mobilization as this also helps to prevent DVTs. If a patient is considered to be high risk for a DVT then we will prescribe blood thinning medication for a couple of weeks after your surgery.

Nerve Injury

In carrying out your decompression there is a very small risk of nerve injury. This can lead to loss of nerve function, with persisting leg pain, weakness, and numbness. It is possible that a nerve injury could affect your bladder and bowel function, as well as erectile function in men. Nerve injuries are usually temporary, but may be permanent. The risk of nerve injury is slightly increased if your stenosis is very severe.

Dural Tear

Occasionally the lining to the nerve (the dura) can be damaged causing the leakage of the fluid that surrounds the nerves (the cerebro-spinal fluid). Some tears are managed conservatively, whilst others require surgical repair. Patients who have had a dural tear may be asked to stay in bed for a short period of time following their operation on flat bed rest. This would normally be for between 24 hours and 5-days. Occasionally a persistent leakage of spinal fluid occurs which may require further surgery.

Recurrent Stenosis/Symptoms

Spinal stenosis is a degenerative condition, and there is risk that it can recur with time causing your symptoms to return. This may require further surgery.

Back Pain

A spinal decompression is an operation to address your leg pain. In most cases it is unlikely to help your back pain, and your back pain may be worse following surgery.

Risks Associated with Having an Operation Lying on your Front

when getting you ready for surgery, care is taken to ensure that everything is protected. The does however remain a small risk of pressure damage. This can cause some temporary skin damage to the tip of your nose and your chin. This would normally completely recover over 2-3 weeks. There is a very small risk of some damage to your vision. Visual damage is reported as occurring in 1 in 10 000 cases.

Medical Complications

Following any operation there is a small risk of post-operative medical complications, such as chest infections or urine infections.

What Can I Expect Following my Surgery?

Following surgery most patients notice an immediate improvement in their symptoms. Unfortunately, this is not always the case. When the nerves have been very badly damaged by the compression recovery can be much slower, and occasionally they do not recover at all. Many patients are left with residual, patchy numbness. This should not interfere with your function. If this numbness does recover it may take up to 18-months to do so.

When you wake up following your surgery you will feel bruised in your lower back at the site of the operation. We try and minimize this by injecting local anaesthetic around the wound. This post-operative discomfort in your back will take a couple of weeks to settle down. The wound will be closed with a dissolvable suture, so there will be no stitches that need to be taken out. Your wound will require minimal attention after discharge. You will be in hospital for 2-4 nights. Before you go home the nurses will explain how you need to look after your wound. A physiotherapist will see you before you are discharged.

Following your operation there are no formal restrictions. For the first couple of weeks your back will feel quite sore, and this will limit your activity level. This will gradually settle down. To begin with you should limit activity to gentle walking and stretches. You can increase your activity as comfort allows. You should be back to your normal level of activity by 6-8 weeks.

What Next?

Returning to Work

People with non-manual jobs will normally be able to return to work after 2-4 weeks. It will be 2-3 months before you can return to manual work.

Driving

There is no restriction with the DVLA, though there will be with your insurance company. You will need to be able to undertake an emergency stop, and be in complete control of your car at all times without being distracted by pain. If this is not the case then your insurance will NOT be valid. Most patients are back to driving within 3-4 weeks of their surgery.

Flying

– You should not fly for 2-weeks following your surgery. You should not undertake any long haul flights for 6-weeks. If traveling on a long haul flight within 6-months of your operation then you should wear your hospital stockings when flying.

Exercise

Undertaking an exercise programme that aims to improve and maintain aerobic fitness is important. This may include regular brisk walking, swimming or cycling. Specific exercises to maintain flexibility and strengthen the abdominal and spinal muscles are important.

Follow-Up

You will be seen back in the clinic a few weeks after your surgery to see how you are getting on, and to answer any further queries that you may have. An appointment will be made for you before you leave the ward.