Have you been told you may need disc decompression surgery? If so, you’re in good company. Hundreds of thousands of disc decompressions are done every year, and it’s certainly one of the most common procedures spine surgeons do. This article will cover the basics of disc decompression surgery—what it is, why someone might need it, and things to be aware of after the procedure is done.
What is disc decompression surgery?
The word decompression is a general term used to describe the removal of material impinging on a nerve. This type of surgery is so common because nerve pressure is the number one cause of back and leg pain.
Sometimes the pressure is the result of a disc herniation, where the outer layer of a disc gets weak and the inner layer pushes out to create a bulge, which presses against a nerve. In that case, a surgeon would remove the bulging part of the disc, thereby removing the pressure on the nerve. This is a true “disc decompression.”
Spinal stenosis creates a condition that also causes nerve pressure but does not always involve a disc—these cases would be more accurately described as “nerve decompression.” Stenosis is when passages containing the spinal cord and nerves start to narrow, decreasing the space they have available and compressing them. Surgery involves removing small parts of an inflamed ligament or a bone spur, or sometimes a disc—whatever is causing the narrowing.
More than 90 percent of decompression surgeries are due to disc herniation or spinal stenosis. Another cause of nerve pressure, though rare, could be a tumor; if a tumor grows in the space where a nerve is traveling, part of the tumor will have to be removed to relieve the pain. Tumors constitute a very small number of decompression cases.
The symptoms associated with a pinched nerve are the same whether it’s caused by stenosis or disc herniation—it could be a sharp, stabbing, lancinating pain; sometimes numbness or tingling; or sometimes weakness in the extremity. Sometimes it’s a combination of them all.
Download this free brochure to find out the most common causes of back and leg pain and the treatments available.
Does every instance of nerve pressure require disc decompression surgery?
No. Treatment options depend on a patient’s symptoms as well as their general health and age. In most cases, doctors recommend conservative treatment options first (cauda equina syndrome being an exception to the rule, where urgent surgical decompression is needed). Those would include:
- Medication such as anti-inflammatories or muscle relaxers, which may be useful for reducing inflammation and can help reduce pain.
- Injection therapy, which can be helpful in the early stages of stenosis but become less effective over time.
- Physical therapy, which may provide only temporary relief, because stenosis is an anatomical problem.
After six to eight weeks of one or more of these treatments, your next step depends on whether you’ve achieved a “minimally important clinical difference” (MICD)—a concept that describes the smallest measurable change in symptoms (about 15 percent) that will be noticeable to a patient. Some patients may achieve a 40 percent change and feel that the pain has improved to the point where it’s no longer affecting them on a daily basis; for others, the pain may be completely gone. Still others may improve only about 10 percent, in which case surgery may be required. Keep in mind that how much people are willing to “live with” depends in part upon their age—a 30-year-old won’t be as willing to give up their favorite activities to accommodate back or leg pain, but an 80-year-old with the same symptoms might prefer to live with the condition and avoid surgery, for example.
Things To Be Aware Of After Disc Decompression
Disc decompressions usually work well, but it’s important to know that 10-15 percent of people who are treated for a disc herniation will have a recurrent herniation anywhere from a few weeks to years later. That means they may need additional disc decompression surgeries in the future.
For people who experience multiple recurrent disc herniations, this can pose a problem. Discs and facet joints are crucial components of the spine; removing too much of either element could cause the spine to become unstable. If a surgeon knows a decompression will cause instability, they will also have to perform an additional procedure to restabilize the spine. For many years the only solution for restabilization was lumbar fusion; today patients also have the option of choosing a BalancedBack® Total Lumbar Arthroplasty.
BalancedBack® is an attractive alternative to fusion for a number of reasons:
- It allows surgeons to address a broad range of decompression issues.
- It stabilizes the spine by replacing a damaged disc and facet joint with a completely new joint (as opposed to fusion, which removes a joint and restores stability by fusing two separate vertebrae together).
- It allows patients to retain full range of motion in the lumbar spine (whereas fusion restricts range of motion) and find their natural balance in any position.
If you’d like to know more about disc decompression surgery or BalancedBack®, ask us a question and we’ll do our best to help.