Decompression surgery (laminectomy) removes the bony roof covering the spinal cord and nerves to create more space for them to move freely. Narrowing / stenosis of the spinal canal can cause chronic pain, numbness, and muscle weakness in your arms or legs. Stenosis is often caused by age-related osteoarthritis, enlarged joints, and thickened ligaments. Decompression may be recommended if your symptoms have not improved with physical therapy or medications. The surgery requires a hospital stay from 1 to 3 days and recovery takes between 4 to 6 weeks.
What is spinal decompression?
Spinal decompression can be performed anywhere along the spine from the neck (cervical) to the lower back (lumbar). The procedure is performed through a surgical incision in the back (posterior). The lamina is the bone that forms the backside of the spinal canal and makes a roof over the spinal cord. Removing the lamina and other soft tissues gives more room for the nerves and allows for removal of bone spurs. Depending on the extent of stenosis, one vertebra (single-level) or more (multi-level) may be involved. There are several types of decompression surgery:
- Laminectomy is the removal of the entire bony lamina, a portion of the enlarged facet joints, and the thickened ligaments overlying the spinal cord and nerves.
- Laminotomy is the removal of a small portion of the lamina and ligaments, usually on one side. Using this method the natural support of the lamina is left in place, decreasing the chance of postoperative spinal instability. Sometimes an endoscope may be used, allowing for a smaller, less invasive incision.
- Foraminotomy is the removal of bone around the neural foramen - the space between vertebrae where the nerve root exits the spinal canal. This method is used when disc degeneration has caused the height of the foramen to collapse, resulting in a pinched nerve. It can be performed with a laminectomy or laminotomy.
- Laminaplasty is the expansion of the spinal canal by cutting the laminae on one side and swinging them open like a door. It is used only in the cervical area.
In some cases, spinal fusion may be done at the same time to help stabilize sections of the spine treated with laminectomy. Fusion uses a combination of bone graft, screws, and rods to connect two separate vertebrae together into one new piece of bone. Fusing the joint prevents the spinal stenosis from recurring and can help eliminate pain from an unstable spine.
Who is a candidate?
You may be a candidate for decompression if you have:
- Significant pain, weakness, or numbness in your leg or foot
- Leg pain worse than back pain
- Not improved with physical therapy or medication
- Difficulty walking or standing that affects your quality of life
- Diagnostic tests (MRI, CT, myelogram) that show stenosis in the central canal or lateral recess.
The surgical decision
Decompression surgery for spinal stenosis is elective, except in the rare instance of cauda equina syndrome or rapidly progressing neurologic deficits.Your doctor may recommend treatment options, but only you can decide whether surgery is right for you. Be sure to look at all the risks and benefits before making a decision. Decompression does not cure spinal stenosis nor eliminate arthritis; it only relieves some of the symptoms. Unfortunately, the symptoms may recur as the degenerative process that produces stenosis continues.
Who performs the procedure?
A neurosurgeon or an orthopedic surgeon can perform spine surgery. Many spine surgeons have specialized training in complex spine surgery. Ask your surgeon about their training, especially if your case is complex or you’ve had more than one spinal surgery.
What happens before surgery?
You may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. In the doctors office you will sign consent forms and fill out paperwork so that the surgeon knows your medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, previous surgeries). You may wish to donate blood several weeks before surgery. You should stop taking all non-steroidal anti-inflammatory medicines (Naprosyn, Advil, Motrin, Nuprin, Aleve, etc.) and blood thinners (coumadin, aspirin, etc.) one week before surgery. Additionally, stop smoking, chewing tobacco, and drinking alcohol one week before and 2 weeks after surgery as these activities can cause bleeding problems.
Patients are admitted to the hospital the morning of the procedure. No food or drink is permitted past midnight the night before surgery. An intravenous (IV) line is placed in your arm. An anesthesiologist will explain the effects of anesthesia and its risks.