Spinal Decompression
The spinal cord passes through the vertebral column, which forms a bony protective cover. However, many conditions can cause parts of the vertebrae to compress the spinal cord or the nerves that branch out through them, leading to pain, loss of sensation and/or motor function in the part of the body supplied by the compressed nerve.
Spinal decompression is treatment to relieve pressure on one or many “pinched nerves” of the spinal column. It can be achieved either surgically or by non-surgical methods. It is used to treat conditions which cause chronic backache such as herniated disc, disc bulge, sciatica and spinal stenosis.
Surgical Method
Surgical spinal decompression is performed by two procedures:
1) Microdiscectomy/micro decompression
2) Laminectomy/open decompression
Microdiscectomy: This is a minimally invasive procedure which involves removal of a portion of a herniated nucleus pulposus by a surgical instrument or LASER.
Laminectomy: This is a procedure in which a small portion of the arch of the vertebrae is removed to relieve pressure on the pinched nerve. This is performed as a last resort, when conservative treatment fails to provide relief from back pain.
Discectomy and decompression surgery is considered when conservative treatment fails to relieve symptoms, you are healthy enough to undergo the surgery, and your surgeon can exactly locate the cause for pain. It is indicated for:
- Herniated disc: bulging of the soft intervertebral disc
- Spinal stenosis: narrowing of the space around the spinal cord
- Sciatica: pain in certain regions of the leg
- Metastatic spinal cord compression: secondary cancer in the spine
- Spinal tumor: primary tumor in the spine
- Spinal injury: swelling of tissue, bone dislocation or fracture
Minimally invasive discectomy and decompression surgery is usually performed under general anesthesia. You will lie face-down on the operating table and your surgeon makes a small incision over the vertebra causing the compression. A tubular retractor is then inserted to hold back the surrounding muscles and form a narrow tunnel through which the surgery can be performed. Small surgical instruments are then inserted through the retractor to remove a portion of the lamina (bony arch of the vertebra that covers the spinal cord) to allow a clear view of the spinal cord and the damaged area. The nerve is retracted, and the herniated disc is removed (discectomy) and replaced with bone graft. Decompression may also involve the removal of extra bone, tissue or tumor, to release the pressure off the spinal cord and nerves. Once the surgery is complete, the retractor is removed and the incision is closed with sutures or staples.
Depending on the extent of the surgery, you will be able to go home one or two days after the surgery. From the day of surgery, you are encouraged to move around and will be gradually taught certain exercises to improve strength and mobility. You will be able to resume work four to six weeks after the procedure.
As with all surgical procedures, minimally invasive discectomy and decompression may be associated with certain complications such as bleeding, infection, blood clots, nerve damage and recurring symptoms.
When compared to the open approach, minimally invasive discectomy and decompression involves fewer complications, faster recovery, reduced post-operative pain, minimal damage to surrounding muscle and soft tissues, and less bleeding.