Spinal decompression surgery

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1 Other formats Spinal decompression surgery If you need this information in another format such as audio tape or computer disk, Braille, large print, high contrast, British Sign Language or translated into another language, please telephone the PALS desk on Further to your hospital appointment and consultation with the orthopaedic and spinal team, this leaflet is designed to give you some information about your forthcoming spinal decompression surgery. What is spinal decompression surgery? This is a specific type of surgery performed to widen the space around the bundle of nerves (known as the spinal cord) in your back. Why is it needed? The most common reason for decompression surgery is due to a condition known as spinal stenosis. In this condition there is an abnormal narrowing in the canal where your spinal cord lies, causing compression of the nerves. This narrowing can cause symptoms such as persistent pain, numbness and weakness in your legs which eventually can interfere with your ability to walk. Another reason for decompression surgery is a slipped disc (also known as a disc hernia). The spine is made up of 24 individual bones called vertebra and between each of these lies a disc which acts as a cushion. When a fragment of disc escapes from the disc space, it can protrude and trap nerves. This often causes one sided leg pain described as sciatica. Numbness and pins and needles are also known symptoms. Widening the space around the spinal cord can release pressure on the nerves and improve leg pain and therefore walking distance. The success rate is approximately 60-80% but depends on individual circumstances. It does not however have any effect on other symptoms such as weakness, numbness, or any bladder or bowel dysfunction. It is not designed to improve back pain although some patient report improvements. Leaflet number: 569 / Version number: 1 / Review date: January of 5

2 What does it involve? There are three main types of spinal decompression surgery. Laminectomy: Where a section of the vertebrae is removed to relieve pressure on the nerves. Discectomy: Where part of the disc which is causing pressure on the nerve is removed. Spinal fusion: Occasionally metal rods and screws have to be used to stabilise the spine if your original scan shows that the spine is unstable and likely to move further out of line. This usually is not required and does have increased risks. Your surgeon will decide which operation is necessary based on scans and patient factors. Each operation will usually be done using a general anaesthetic but this will depend upon individual factors. The operation will take approximately one to three hours and most patients will be up and walking within 24 hours of their operation. What are the alternatives? Initially a non-operative approach can be used. This includes taking regular painkillers, rest and later maybe physiotherapy. If this fails and the pain is so severe that it is interfering with your quality of life, a surgical approach is recommended. Special preparations A letter will be sent to you in the post prior to your operation explaining when and where the procedure will take place. You will have a pre-operative assessment a few days before your operation, which may involve taking some blood and doing some further imaging. You will not be allowed to eat or drink anything at least eight hours prior to your procedure. On the day of your procedure you will meet your surgeon and the anaesthetist who will ask you to sign a consent form. How will I feel afterwards? After having a general anaesthetic you may feel nauseated, shivery and generally groggy. This effect should be temporary. You will experience some pain around the site of the operation but we will give you pain killers to help. This will take approximately two to three weeks to get better. It may be that you feel an immediate effect of pain reduction in your legs if the operation is successful. However, you may not notice this effect until you start mobilising. Spinal decompression surgery 2 of 5

3 What happens after the procedure? Most patients will be up and walking within 24 hours of surgery. You will be able to go home when you are comfortable and mobilising enough. You will be seen by the ward physiotherapist who will assess your mobility and advise you on dos and don ts following your surgery. You will not be able to drive after the surgery and so it would be best if you could arrange for someone to pick you up when you are ready to be discharged. What are the risks? As with all surgical procedures, spinal decompression surgery carries a risk of complications. These can be divided into general complications (those which occur from all surgeries) and specific complications for this type of surgery. General - General anaesthetic risk (uncommon): chest infection, allergic reaction - Infection: 1 in 10 wounds become infected (superficial) and can be treated with a course of antibiotics. Rarely, deep infection can occur (1 in 100) and may require operative intervention. - Blood clots: This is uncommon as this surgery does not significantly reduce mobility. If you are at high risk of developing blood clots you may be placed on a blood thinning medication during your stay in hospital. Specific - Spinal fluid Leak (1 in 25): A tear in the lining of the nerve can cause some fluid to leak out. This is usually fixed with a suture and the patient is asked to lie flat overnight to avoid any increased pressure on their back whilst this heals. Nausea and headaches can occur for a few days following spinal fluid leak. - Epidural Haematoma (rare): Occasionally, due to continued bleeding around the nerve, a large blood clot can form (haematoma). This can compress the nerve, increasing leg pain and affecting the nerve to your bladder. This is a surgical emergency and you may need reoperation to evacuate the blood. - Nerve damage (1 in 500): During the operation the nerve is touched and you may experience some temporary numbness/tingling/weakness in the legs. More uncommonly, if the nerve is actually damaged, this effect can be permanent. Extremely rarely, (1 in 1000) if the nerves to your bladder or bowel are damaged, this can cause incontinence and may result in permanent catheterisation. Spinal decompression surgery 3 of 5

4 - Recurrence: around out of 100 people may get recurrence of their slipped disc. Recurrence of spinal stenosis may occur but will be a gradual process over a few years. - Pain: around 1-2% of patients develop long term low back pain after spinal decompression. This operation is not a cure. The leg pain should improve although in some cases pain may persist. Aftercare Your sutures or skin clips can be removed by your local surgery practice nurse, usually at days following your operation It is best to keep active following your surgery and we advise to gradually increase your activities from the day of surgery. It is expected that you should be able to walk up to a mile from day five or six post-surgery. We will give you any necessary pain killers before you leave hospital but should you require any more you may have to see your GP. Time off work is variable (three to six weeks) and depends on the type of surgery and your job. This can be discussed with your surgeon during your hospital stay and we can arrange the necessary paperwork for this. Driving is not advised in the first three to five weeks after surgery. Follow up You will be followed up in six weeks following your operation with your surgeon. This appointment will be sent to you in the post. References ge.aspx Spinal decompression surgery 4 of 5

5 PALS The Patient Advice and Liaison Service (PALS) ensures that the NHS listens to patients, relatives, carers and friends, answers questions and resolves concerns as quickly as possible. If you have a query or concern call or You can also visit the PALS and Information Centre in person at North Devon District Hospital, Barnstaple. Alternatively, it may be possible for us to arrange an appointment in your area. Have your say Northern Devon Healthcare NHS Trust aims to provide high quality services. However, please tell us when something could be improved. If you have a comment or compliment about a service or treatment, please raise your comments with a member of the ward staff or the PALS team in the first instance. Patient Opinion comments forms are on all wards or online at Northern Devon Healthcare NHS Trust Raleigh Park, Barnstaple Devon EX31 4JB Tel Northern Devon Healthcare NHS Trust This leaflet was produced by the Communications Department. Please contact to help us improve our leaflets. Spinal decompression surgery 5 of 5

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