Spinal decompression (traditionally called laminectomy or laminotomy) is a procedure undertaken to open up the space in the middle of the spine where the nerves run through to the legs. In most cases narrowing is caused by degeneration or arthritis in the spine. Occasionally it can be because the size of the canal has just developed smaller than usual.
Characteristic symptoms of spinal stenosis are called spinal claudication. Usually you are comfortable at rest but when you walk you develop pain in your buttock, hamstrings and/ or lower legs. After you walk a distance, if you stop, sit and rest the pain will settle, usually quickly and you are able to walk a distance again. Many people describe the relief leaning forward such as using a walker or a shopping trolley. Some people do not have classic symptoms and will present with pain in one or either leg which is not necessarily activity related.
The condition is a wear and tear condition in the spine. In itself it is not dangerous but can be painful and cause limitation on activity and quality of life.
The surgery involves a general anaesthetic. Once you are asleep, a catheter is placed in the bladder and you are then rolled onto your stomach on a special operating table for the surgery. An incision is made in the middle of the spine over the involved level. The muscles are taken off the side of the spine showing the bones at the back of the spine (spinous process, lamina) and a ligament between them (ligamentum flavum). Traditional operation involves removing all of these bones at the involved level. When this occurs in some cases one vertebra can shift forward on the other which can again put pressure on the nerve. To reduce the chance of this my preference is to leave some bone in the middle and the ligament between them intact. To do this I use a burr (like a dental burr) to remove two slots of bone from either side of the middle of the spine. This removes the pressure from the spinal canal to relieve the symptoms but by preserving some of the bone and ligament will keep some of the natural history of the spine. The procedure is usually performed at one or two spinal levels. Some patients will have the stenosis at more levels and will have a more extensive procedure. One or two level decompression will take between 45mins and 1 1⁄4hours. Following the surgery the wound is sutured and you are placed back on your bed. The anaesthetic is then reversed and you are taken to recovery.
Following the surgery, you will have a drip in your arm. This will be connected to a pump which you will be able to control to give you some pain relief. You will also have a urinary catheter.
The morning following surgery, the drip and urinary catheter are usually removed. In most cases you will receive an injection with anti inflammatory drug for the post surgical pain and then additionally some tablets for pain relief. The nurses and physiotherapists will then get you out of bed and start getting you mobile. When you are independently mobile you will be able to go home. Small numbers of patients are able to go home at day one. The majority of patients will go home in two or three days.