For a number of reasons the nerves in the spine can occasionally become trapped or irritated. Sometimes the disc becomes weakened allowing the disc to bulge, or for the soft center to protrude through the disc wall. The joints of the spine can thicken and encroach on the nerves, or one of the bones can displace slightly. As a result the nerve can be irritated and becomes painful. Nerve pain is usually felt along the path of the nerve, which varies depending on which nerve root is effected. Nerve pain is often very difficult to control with pain killers.Sometimes the nerve does not function and weakness and numbness can occur. Rarely bowel and bladder function can be effected. If such neurological symptoms are experienced they should be reported immediately as they may require emergency treatment.
Decompression is designed to take away the tissue which is irritating the nerve resulting in resolution of leg symptoms. The procedure is performed using a incision in the middle of the back. The spine is approached and a window is made in the spinal canal. The nerves are identified, protected. Any bone, ligament or disc, which appears to be compromising the roots is removed.
A microscope may be used to improve light and vision. When possible an anti adhesion gel is used to coat the nerve roots to reduce the risk of tethering due to scar tissue. Decompression is sometimes combined with a fusion procedure.
The wound is closed with absorbable sutures leaving a short scar with no cross hatching and no need for suture removal. Occasionally the suture ends do require trimming.
After the operation you will be encouraged to mobilize as soon as possible with the assistance of physiotherapists and nurses. Once mobile enough to manage at home you can be discharged. You will be give instructions with regard ongoing mobilization and physiotherapy. An outpatient appointment will be arranged.
The outcome of any surgery can not be guaranteed. Most patients experience a dramatic reduction in leg pain. Improvement in numbness and weakness if present is less certain. Any reduction in back pain is considered a bonus as the operation is not designed to primarily treat back pain.
To monitor the results of surgery you will be asked to complete outcome questionnaires from time to time.
Most patients are pleased with the result of their surgery and do not suffer any adverse problems. Occasionally complications do occur and can require further treatment.
Nerve damage is rare during surgery. If it occurs it can cause areas of numbness, pins and needles and weakness. Neuralgic pain can also be troublesome.
Corda equina syndrome is very rare and occurs when the nerves to the bowel and bladder are effected. Any numbness around the bottom or problems with passing stool or water should be reported immediately.
Scar tissue can form around the nerve root tethering the nerve causing on going pain. A gel is used when possible to reduce the risk of this happening. Occasionally further surgery is required to free up the nerve.
Infections can occur in the wound and rarely deep in the disc. These can be treated usually with antibiotics but occasionally require surgical cleaning and debridement.
Recurrence can occur as the bone, ligaments and disc heal and may require a further decompression.
Residual material can sometimes be left behind despite careful exploration and further exploration may be required.
Damage to the lining of the nerve root (Dura) can result in a leak of fluid (csf). This is usually noticed and repaired at the time of surgery. A short period of bed rest is advised after the operation. Rarely the leak persists and has to be repaired surgically.
Following surgery, due to the underlying degeneration, and surgery the spine may become painful and sometimes unstable. It causes aching in the low back and sometimes further leg symptoms. It is usually treated with pain relief and physiotherapy and some modification of activity. Occasionally further surgery can be helpful.
Bleeding, most commonly from the small veins within the spine can be troublesome and is controlled at the time of surgery. Rarely bleeding continues post operatively and a second procedure is required to control it. If a collection of blood occurs drainage surgically may be required.
Neuralgic pain occasionally persists after surgery despite successful discectomy, and is thought to be due to inflammation, damage and fibrosis inside the nerve itself. This cannot be treated surgically.
Anaesthetic complications will be explained by your anaesthetist.
Please be assured that every effort is made to avoid the complications listed and any others which can very rarely occur.
If you have any questions or wish to discuss things further please ask at any time. It is important that you have all the information you require and we will assist you in every way possible.
MR ANDREW HOWARD
Consultant Spinal and Orthopaedic Surgeon
Ref No SD0205