The surgery aims to improve symptoms such as persistent pain and numbness in the legs caused by pressure on the nerves in the spine.

• Spinal Stenosis – narrowing of a section of the spinal column and nerve compression due to spinal degeneration (ligament and facet hypertrophy and osteophyte formations)
• Lumbar disc herniation: where a migrated disc material causes compression on an underlying nerve.
• Spinal injuries – such as a fracture or the swelling of tissue
• Metastatic spinal cord compression where cancer in one part of the body, such as the lungs, spreads into the spine and presses on the spinal cord or nerves

Depending on the patient’s symptoms, radiological evidence of instability, the patient may need a spinal decompression, a spinal fusion, or a combination of the two. Refer also lumbar fusion

Anesthesia

• Surgery is performed in general anesthesia, the patient will be fully asleep.

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Patient position

• Patients are made to lay down on the stomach ( prone position), generally using a special operating table with special padding and supports.

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Procedure

• A 2-3 centimeter longitudinal incision is made in the midline of the low back, directly over the correct level of the herniated disc, confirmed with intraoperative fluoroscopy. Special retractors and an operating microscope or loops are used to visualize the region of the spine. A portion of the lamina (laminotomy) or the whole lamina (laminectomy) is removed along with the surrounding ligaments to expose the herniated disc. The nerve root and neurologic structures are protected, carefully retracted to remove the herniated disc. The resultant space eventually becomes filled with scar (fibrous) tissue. Dissolvable sutures are used to close the skin. The wound area is usually washed out with sterile water containing antibiotics. The deep fascial layer is closed with strong non-absorbable sutures, while is closed with subcuticular self-absorbable sutures leaving a minimal scar. The total surgery time is approximately 1 hour.

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Post-Operative Care

• After 1-2 hours of monitoring in the recovery room, patients are shifted to ward. Oral fluid intake started after 4 hours and gradually switched to a full diet. Most of the patients can stand and walk by the evening or the next morning with good pain tolerance and can be sent home accordingly in 1-2 days.

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Home Care

• To follow proper techniques of getting in and out of bed and walking independently. Should walk and stay active as much as possible. Can climb stairs if required. The patient should avoid prolong sitting (>45-60 min) and avoid bending at the waist, lifting (more than 2-3 kg)

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Brace

• Usually not required or recommended to wear a back brace after surgery.

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Wound Care and follow up

• Before leaving the hospital, a waterproof dressing is applied to the surgical wound, and the patient can take shower and will be called on the 5th post-op day for a dressing checkup and change of medication if needed.

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Return to work

• The patient can resume light work or driving once the pain is tolerable, usually in a week to 10 days. While heavy work and sports activity should be avoided for at least 6 weeks after the surgery.

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Complications

Lumbar decompression is generally considered a very safe procedure, however, like any other surgery, there can be several risks and complications:

• Operative wound infection
• Hoarseness of voice and difficulty in swallowing
• Dural tear and CSF leakage
• Bleeding
• Implant related complication- loose screw, broken implant
• Adjacent segment disease
• Pseudoarthrosis or non-union
• Nerve root damage
• Bowel/bladder incontinence
• Deep vein thrombosis, which occurs when blood clots form in the leg

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Result of surgery

• Posterior decompression (laminectomy) with or without fusion is the gold standard spinal stenosis treatment. Long-term followup studies have shown more than 90% of patients remained satisfied with the surgery especially with symptomatic relief in claudication leg pain.

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