What is spinal decompression surgery?

What decompression means

Decompression is a surgical procedure to relieve pressure caused by bone or disc material pressing on the spinal cord or nerves, according to the American Association of Neurological Surgeons (AANS). The spinal canal is the ring of bone that houses the spinal cord and nerve roots. Mayo Clinic explains that when this canal becomes too small, the condition is called spinal stenosis, and that extra bone, herniated discs, cysts and thickened ligaments are common causes. Background on the condition is in what spinal stenosis is.

Mayo Clinic says the operation called laminectomy is also called spinal decompression surgery. The terms below are the ones that public sources define most often.

Laminectomy, laminotomy and foraminotomy

Laminectomy. The lamina is the rear part of a vertebra that covers the spinal canal. Mayo Clinic describes laminectomy as removing some or all of it to make more room, and says the surgeon removes bone spurs, thickened tissue and the smallest amount of lamina needed to relieve pressure. MedlinePlus says part or all of the lamina may be removed on both sides of the spine, and that the surgery takes 1 to 3 hours under general anesthesia.

Laminotomy. AANS defines a laminotomy as an opening made in the lamina to relieve pressure on nerve roots. Unlike a laminectomy, where the whole lamina is removed, it typically involves removing just half of it, on the side where the person has symptoms.

Foraminotomy. The foramen is the opening in the spine where a nerve root leaves the canal. MedlinePlus describes foraminotomy as surgery that widens this opening. Some bone is cut or shaved away, and any disc fragments are removed. It can be done alone or along with a laminotomy or laminectomy.

These procedures are often combined with others. MedlinePlus says a laminectomy may be done along with a discectomy or spinal fusion, and Mayo Clinic says fusion may be added if a vertebra has slipped or the spine needs more stability.

Minimally invasive options and results

AANS says some decompression can be done through a minimally invasive approach, using tubes to hold muscle aside and a microscope or endoscope to see, and names laminectomy and foraminotomy as the more common decompressive procedures. Mayo Clinic adds that evidence comparing minimally invasive laminectomy with standard laminectomy is still evolving.

On results, Mayo Clinic says most people have less leg or arm pain after laminectomy and that walking and standing may become easier. It also says benefits may lessen over time if arthritis or other degenerative changes continue, and that the operation is less likely to improve pain felt only in the back or neck. MedlinePlus says laminectomy for spinal stenosis often provides full or some relief of symptoms. On recovery, MedlinePlus says most people go home the same day or 1 to 2 days later, with driving possible within a week or two and light work after 4 weeks, especially without a fusion. See how long recovery after spine surgery takes for more, and what the risks of spine surgery are for the downsides. The wider set of operations is gathered at surgery in outline.

When to get help

Mayo Clinic says laminectomy is typically done only after other treatments such as medicines, physical therapy or injections have not helped enough. Whether it suits a particular person is for a surgeon to judge, and practice varies by country and by clinician. The NHS lists symptoms in someone with back pain that need emergency care: losing feeling in one or both legs, numbness around the bottom or genitals, being unable to pee, or being unable to control the bladder or bowels. In the UK that means calling 999 or going to A&E, and elsewhere it means using the local emergency number.