Performed by – Sri Chatakondu, Sarmad Kazzaz, Mark Thomas, Adam Way

Reason for decompression surgery
The nerves within the spinal canal can become compressed over time due to thickening of ligament and overgrowth of bone. This compression within the spine is called stenosis. It will lead to back and leg pain and often pins/needles symptoms. These symptoms can be constant but are often associated with walking. Painkillers and epidural injections can be considered but the success rate is not always guaranteed and thus surgery becomes necessary.

Types of decompression surgery
The main types of decompression are:

• Microdiscectomy surgery
• One or multiple level decompression
• Decompression surgery that requires stabilisation or fusion surgery as well

Procedure
You will discuss the surgery with your surgeon both in clinic but also on the day of the procedure. The anaesthetist will also discuss the procedure with you. X-rays will be taken during surgery to ensure the correct nerves are being thoroughly decompressed. Afterwards you will start the recovery and rehabilitation phase with the nurses and physiotherapists on the ward. You should generally expect to leave hospital 1-3 days after the surgery.

Risks of surgery
The role of surgery is to take pressure off the nerves, giving them the best chance of recovery. Sometimes the benefit is immediate but also they can remain permanently damaged from the pre surgery pressure. The full outcome of relieving nerve pressure can take 12-18 months. There are some risks with this type of surgery.

Infection – The risk is less than 1% and you will be given antibiotics during and after surgery to reduce the chance.

Bleeding – There is always a small amount of blood lost during any surgery but the risk of requiring a blood transfusion is very small. At times we can collect your own blood and then give it back to you in theatre.

Recurrence – Thickened bone and ligaments are removed to take pressure off the nerves, but these can regrow over time. At times revision surgery is required and the chance is about 2-5%.

Dural Tear – The brain, spinal cord and nerves are bathed in cerebrospinal fluid (CSF), which is housed in a sheath called the dura, which is as thin as tissue paper. There is a risk of puncturing this membrane which can lead to headache symptoms. These symptoms last for a few days and then settle, but very rarely further surgery to close the leak may be discussed.

Nerve Injury – During surgery the nerves are decompressed and manipulated and the implants are inserted very close to the nerves. This can result in damage, which is often temporary but can be permanent. This can lead to symptoms of ongoing pain, numbness or weakness in the leg. The chance of paralysis is possible but very rare with fusion surgery.

Cauda Equina syndrome – Both during and after surgery, a blood clot can put pressure on the nerves passing the operation area. These nerves pass the area to supply the bladder, bowel and sexual function nerves. If pressure is significant, this can lead to a loss of bladder/bowel and sexual function permanently but the risk of this approximately 1 in 5000.

Review / Follow-up from surgery
It is important patients follow the guidance of their surgeon and physiotherapist for the best rehabilitation following decompression surgery. It is vital patients perform regular exercises to prevent the back going into spasm. Patients will generally be discharged a few days after surgery and then see their GP or GP Practice nurse at 2 weeks for a review of the wound. They will then be followed up by their surgeon at 6-8 weeks post operatively.