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.
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Does every instance of nerve pressure require 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).1 2 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.
Types of Decompression Surgery
To relieve pressure on the spinal cord and/or nerve roots, different approaches may be required depending on the location of the problem. The types of decompression surgeries that address lumbar nerve issues include:
- Discectomy—A discectomy refers to the partial or complete removal of a disc. The most common reason for a discectomy is a herniated disc, which, as noted above, sometimes presses on a nearby nerve and causes pain. In most cases, simply removing a small portion of the disc (the part that is bulging) solves the problem.
- Laminotomy—The lamina is the bony “roof” covering the spinal canal, which runs down the length of your spine. The lamina itself isn’t often the problem, but a surgeon may need to remove a portion of the lamina to gain access to the problem area—the spinal canal or the nerve root. It’s like lifting the hood of your car to change the spark plugs in order to make the car run smoothly again.
- Laminectomy—While a laminotomy is the removal of part of the lamina, a laminectomy is the total removal of the lamina. Typically, the most common reason for a lumbar laminectomy is lumbar spinal stenosis.
- Keyhole Laminotomy—“Keyhole” accurately describes this surgery, which uses a smaller incision than a laminotomy and removes even less of the lamina. In some cases, this smaller procedure is all that’s needed to gain entry into the canal and successfully address the nerve issue.
- Partial Foraminotomy—The foramen is the exit passageway for nerves leaving the spinal canal. If that passageway becomes smaller it will pinch the nerves, causing pain. In a foraminotomy, a surgeon tries to open the space up again by removing small portions of material on the inside of the passageway—the pedicle on top, facet joints on the sides, and the disc.
- Partial Facetectomy—A degenerating facet joint may become enlarged or develop bone spurs (an outgrowth of bone), causing compression of a nearby nerve. Or, a small portion of a facet joint may need to be removed in order to gain access to a troublesome disc. In either case, a facetectomy is performed. (Note that the facet joints are vital to overall stability of the spine, so depending on how much of the joint is removed it may be necessary to do additional surgery for stabilization purposes.)
What To Expect During Decompression Surgery & The Recovery Period
In general, decompression surgeries are very safe procedures. They may be done in a hospital or an outpatient surgery center, and most patients go home the same day. A discectomy, for example, only takes about 45 minutes.
Whether you’re having one of the nerve decompression procedures listed above or disc decompression surgery, recovery is usually fairly smooth. Most patients are up and walking the same day of surgery, and driving comfortably two to three days later. Many surgeons advise caution in the first few weeks after surgery—no heavy lifting, for example—to avoid putting extra stress on your spine and reduce the chances of a recurrent herniated disc. (Though some studies say there isn’t much you can do to prevent it.) It may be necessary to take a pain reliever (like Tylenol or Advil) for mild back pain for a period of days to a couple of weeks after surgery.
One difference in recovery is in the case of dorsal root ganglion (DRG) compression, where the central nervous system hooks into the peripheral nervous system. The DRG is located in the foramen, and the nerves can be more painful and sensitive there; this may result in a potentially longer recovery time.
Things To Be Aware Of After Disc Decompression Surgery
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.3 That means they may need additional 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. Instability of the spine must be addressed.
For many years the only solution for restabilization was lumbar fusion. The problem with fusion is that it removes a joint from your spine, which limits your mobility. On top of that, taking away even a single joint means the remaining joints have to handle a greater mechanical load associated with your daily movements. The stress this creates on the levels above and below the fusion usually results in a more rapid degeneration of those levels—which usually means another fusion somewhere down the line.
Today, patients also have the option of choosing a BalancedBack Total Joint Replacement. Rather than removing a joint, the BalancedBack procedure replaces the function of the disc and facet joint with a motion device. So where fusion sacrifices motion for stability, BalancedBack retains motion and stability. The new, productive joint allows the levels above and below it to move naturally, and adapts to any posture. Motion minimizes additional stress on adjacent vertebral levels, protecting them and even slowing down their degeneration.
1 Postacchini, F. (1996). Results of surgery compared with conservative management for lumbar disc herniations. Spine, 21(11), 1383-1387.
2 Dinning, T. A., & Schaeffer, H. R. (1993). Discogenic compression of the cauda equina: a surgical emergency. Australian and New Zealand Journal of Surgery, 63(12), 927-934.
3 Ambrossi, G. L. G., McGirt, M. J., Sciubba, D. M., Witham, T. F., Wolinsky, J. P., Gokaslan, Z. L., & Long, D. M. (2009). Recurrent lumbar disc herniation after single-level lumbar discectomy: incidence and health care cost analysis. Neurosurgery, 65(3), 574-578.