Lumbar Decompression (laminectomy and microdiscectomy)
Decompression is a surgical procedure that is performed to alleviate pain caused by pinched nerves (neural impingement).
During a lumbar decompression back surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to give the nerve root more space and provide a better healing environment. There are two common types of spine surgery decompression procedures:
A microdiscectomy (a microdecompression) is typically performed for pain from a lumbar herniated disc. The surgery is considered reliable for leg pain caused by the herniated disc, most commonly called sciatica by patients, and most commonly referred to by medical practitioners as a radiculopathy.
Typically performed for a herniated disc, a microdiscectomy relieves the pressure on a spinal nerve root by removing the material causing the pain. During the procedure, a small part of the bone over the nerve root and/or disc material under the nerve root is taken out.
- For leg pain, patients will normally feel pain relief almost immediately after a microdiscectomy. They will usually go home from the surgery with significant pain relief.
- For numbness, weakness, or other neurological symptoms in the leg and foot, it may take weeks or months for the nerve root to fully heal and any numbness or weakness to subside.
See Leg Pain and Numbness: What Might These Symptoms Mean?
As general rule, microdiscectomy is considered a relatively reliable surgery for immediate, or nearly immediate, relief of sciatica from a lumbar herniated disc.
Indications for Microdiscectomy
If a patient’s leg pain due to a disc herniation is going to get better, it will generally do so within about six to twelve weeks of the onset of pain. As long as the pain is tolerable and the patient can function adequately, it is usually advisable to postpone surgery for a short period of time to see if the pain will resolve with non-surgical treatment alone.
If the leg pain is severe, however, it is also reasonable to consider surgery sooner. For example, if despite nonsurgical treatment the patient is experiencing pain so severe that it is difficult to sleep, go to work, or perform everyday activities, surgery may be considered before six weeks.
These are typical reasons for recommending a microdiscectomy:
- Leg pain has been experienced for at least six weeks
- An MRI scan or other test shows a herniated disc
- Leg pain (sciatica) is the patient’s main symptom, rather than simply lower back pain
- Nonsurgical treatments such as oral steroids, NSAIDs, and physical therapy have not brought sufficient pain relief
The results of surgery are somewhat less favorable after three to six months have passed since the onset of symptoms, so doctors usually advise people not to postpone surgery for an extended period
A lumbar laminectomy (open decompression) is typically performed for pain from lumbar spinal stenosis. The goal of the surgery is to allow more room for the nerve root, thus reducing pain (and potentially any leg weakness or neurological symptoms) and restoring the patient’s ability to participate in everyday activities.