How Decompression Surgery Is Performed

With modern spine surgery techniques, both a microdiscectomy and laminectomy can usually be done with a minimum amount of morbidity (e.g. post-operative discomfort) and a high degree of success in alleviating lower back pain and/or leg pain.

Lumbar Microdiscectomy

A microdiscectomy is one of the most minimally invasive procedures that can be done to alleviate pain associated with nerve root irritation. In this surgery, a relatively small incision (e.g. 1 - 1 ½ inches) in the lower back, and the portion of the herniation that is in contact with the nerve root is pulled out.

The goal is to relieve symptoms associated with pressure on the nerve root. The surgery has a relatively high success rate - about 90-95% - in providing relief of leg pain and/or buttock pain. Often, the pain relief is instant and patients wake up after the surgery feeling marked relief of their leg pain. If neurological symptoms had also been experienced prior to surgery, it may take longer for the nerve to heal and the patient may continue to feel some weakness or numbness, or any of their prior symptoms, for several months or up to a year. For some, the symptoms may improve but never fully resolve.

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Lumbar Laminectomy

A lumbar laminectomy is the surgery most commonly performed to treat lumbar spinal stenosis symptoms. During this procedure, the lamina (the bone in the back of the vertebra) at one or more segments is removed with the goal of alleviated pressure on the spinal cord or nerves.

Sometimes in addition to the laminectomy, a spine fusion surgery is also necessary in order to achieve adequate decompression of a nerve root. This is especially true if the nerve root is compressed as it leaves the spine (in the foramen), known as foraminal stenosis.

Foraminal stenosis is difficult to decompress simply by removing bone because if the bone is fully removed in the location of the foramen it is generally necessary to also remove the facet joint. Removal of the facet joint leads to instability, so a spinal fusion is necessary to provide stability.

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The foramen can be opened either through an anterior approach (by "jacking" open the disc space in the front of the spine) or by distracting between two pedicle screws inserted posteriorly (through the back of the spine). After the foramen is opened up, a spine fusion is also done to keep it open so the instrumentation does not fail and the stenosis does not return later.

As an alternative to spinal fusion, interspinous process spacers may be implanted to open the central canal and foramen, and address motion restrictions and pain from spinal stenosis.