Spinal decompression surgery is performed to relieve symptoms related to compression of the spinal cord or its roots, which may include back or neck pain and radiating limb pain (radiculopathy).
Spinal nerve compression symptoms include pain, altered sensations, muscle weakness or dysfunction, and even gait abnormalities. These symptoms can be caused by a wide variety of conditions. In some of these, such as in cervical spinal stenosis that leads to cervical myelopathy, you may feel symptoms in the arms, hands, legs or feet, and/or have balance problems, or even incontinence issues (bowel dysfunction, unexpected need to urinate, etc.). A rapid onset of these symptoms can indicate a condition known as cauda equina syndrome, which can cause paralysis and other serious problems if not addressed in a timely manner.
Pain and other symptoms treated by these surgeries are most common in the lower back (lumbar spine), followed by the neck (cervical spine). Symptoms in the upper back (thoracic spine) are possible but less common because it is the most stable part of the spine, due in part to its being connected to the rib cage. Neuropathies may involve feelings of numbness or a "pins and needles" tingling sensation and cause weakness or instability, primarily in lower the back.
Every type of spinal decompression modifies or removes bone, spinal disc or soft tissues that are causing compression of a nerve. The techniques vary according to which tissues are causing the compression. For example, laminoplasty involves the reshaping of part of a vertebral lamina, a laminotomy the making of a small hole the lamina, and a laminectomy the complete removal of a lamina, all to relieve pressure on the nerves.
Types of spine decompression surgery performed at HSS include laminectomy, laminotomy, laminoplasty, discectomy and microdiscectomy, among others. Lumbar decompression surgery may be used to address problems in the lower back, such as lumbar laminectomy, laminotomy, or microdiscectomy.
Some decompression surgeries may require the addition of a fusion procedure simultaneously. This depends on the type of disease being treated and the technique being used to address the disease. This includes lumbar decompressions, such as lumbar interbody fusion (LIF) techniques, which may indirectly decompress the spine, or cervical decompressions, such as anterior cervical discectomy and fusion (ACDF surgery), which are dependent on the differential anatomy of the spine.
Decompression surgery can be a good option for people who have back or neck pain and/or neuropathies due to nerve compression caused by a herniated disc, spinal stenosis, spondylolisthesis, and for whom nonsurgical methods such as physical therapy, epidural steroid injections or pain management regimens have failed to provide relief.
Most spinal decompression surgeries will be performed under general anesthesia, with the patient completely unconscious. Some modern techniques allow for spinal surgery under regional anesthesia (either spinal or epidural anesthesia). These techniques allow patients to breathe on their own without the need for mechanical assistance. These techniques may reduce complications associated with general anesthesia but are not widely available and may be performed on a case-by-case basis.
In many cases, patients undergoing decompressions such as a laminectomy, discectomy, or microdiscectomy can go home the same day. This is often the case with a laminectomy, microdiscectomy, and there is research to suggest that even multilevel ACDF surgeries may be safely done on an outpatient basis. Some patients having spinal decompression may need to stay one or more nights including those who have chronic diseases or sleep. Some patients require a spinal fusion may stay overnight and return home one or two days after surgery. Rarely, a patient may need to stay as many longer.
In addition, some decompression spine surgeries may be planned as an ambulatory (outpatient) procedure, but then converted to an overnight stay to monitor the patient. In one study of more than 1,000 patients who underwent an ambulatory one- or two-level lumbar decompression, 58% ended up staying over at least one night.
At HSS patients are encouraged to walk the same day of most decompression surgeries.
Depending on the specific procedure and other factors, patients generally are able to return to work between two and four weeks after surgery. Some patients who have a microdiscectomy decompression may be able to return to work after less than two weeks.
The recovery time for decompression surgery alone is generally faster compared to procedures that include a fusion. Owing to the wide range of decompression surgery types and the number of spinal levels addressed with surgery there is likewise some variability in recovery duration. There is recent evidence that microdiscectomy patients can return to physical therapy and low impact aerobic exercise within four weeks of surgery. Patients undergoing laminectomy procedure can expect surgery pain to ease within two to four weeks of surgery and starting physical therapy and other activities by about six weeks. Fusion procedures are likewise highly variable and recovery times prolonged, approaching three to six months before patients can return to exercise or sports activities. Please confer with your surgeon regarding your procedure and expected recovery.
Precise success rates of spinal decompression surgery can be difficult to calculate due to the wide variety of procedures, severity of spinal conditions, and the age and health of individual patients. Patients can expect a significant decrease in their pain and an improvement in their overall function.
HSS Spine clinical studies examine patient demographics, spine imaging, type of surgery, and patient-reported outcome measures (PROMs), which are questionnaires we give our patients. In a clinical study based on HSS lumbar spine surgery PROMs, about 60% of decompression and microdiscectomy patients reported back improvement at or after six months. Of those who had been experiencing leg pain prior to surgery, 67% of decompression and 70% of microdiscectomy patients reported improvement at or after six months. PROMs are useful to help measure success but are subjective. The data collected is based how individual patients feel at the moment they are asked about their symptoms or complete a survey. However, HSS is working to make use of wearable technologies and other methods to gather more objective data to measure surgical success, such as tabulating patients’ daily step counts before and after surgery.
Below, find deep-dive articles and animations on different types of spine decompression surgery and related topics.
These articles and videos explain how the different types of spinal decompression surgeries are performed.
Watch these animations to learn about spinal surgeries for tumors and fractures.