Lumbar laminectomy (spinal decompression): reasons, recovery and risks

The spinal cord passes through a canal made up of the vertebrae, with nerves branching out between them. The NHS explains that lumbar decompression surgery is an operation on the lower section of the spine, done to relieve symptoms of compressed nerves such as tingling or numbness in the legs. A laminectomy is the part of the operation in which small pieces of bone are removed from a vertebra to give the nerves more room.

Sometimes a part of the disc between the vertebrae is also removed, which the NHS calls a discectomy. Because the two are often done together, you may see the operation described as lumbar decompression, laminectomy or nerve root decompression, depending on the hospital leaflet.

Cambridge University Hospitals describes the typical underlying problem as lumbar stenosis, a narrowing of the space for the nerves caused by natural wear and tear changes in the discs, ligaments and joints. The pressure may cause pain in the lower back, buttocks and legs and sometimes numbness, weakness and disturbance of bladder, bowel or sexual function.

The NHS lists several reasons you may need lumbar decompression: narrowing of the space inside each vertebra because of age-related change or arthritis (spinal stenosis), a compressed sciatic nerve (sciatica), a disc that has moved out of place (slipped disc), compression of the nerves at the base of the spine (cauda equina syndrome), a spinal injury such as a fractured vertebra, or a tumour or abscess in the spine.

Most people in the first two groups do not go straight to surgery. The NHS says that, depending on the cause, you may have other treatments first, such as physiotherapy, weight loss or steroid injections. The NHS sciatica page adds that decompression surgery can sometimes help relieve sciatica if the pain is severe and other treatments have not helped.

• Spinal stenosis: narrowing of the spinal canal from age or arthritis.

• Sciatica or a slipped disc that has not improved with other treatment.

• Cauda equina syndrome, which is an emergency.

• Spinal injury, tumour or abscess pressing on the nerves.

Not all back pain needs surgery, but some symptoms point to a serious problem with the nerves at the base of the spine. The NHS tells people with sciatica to go to A&E or call 999 if they have sciatica on both sides, weakness or numbness in both legs that is severe or getting worse, numbness around or under the genitals or around the bottom, difficulty starting to pee, being unable to pee or control it, or not noticing when they need to poo or being unable to control it, when this is not normal for them.

These could be symptoms of a serious back problem that needs to be treated in hospital as soon as possible. Do not drive yourself to A&E; ask someone to drive you or call 999 for an ambulance.

The NHS says lumbar decompression is done in hospital and can be done several ways depending on the condition. The hospital will tell you when to stop eating and drinking and whether to stop any medicines. You are given a general anaesthetic so you will be asleep and feel no pain.

The surgeon makes one larger cut in the back or several small cuts, removes small pieces of bone (laminectomy) and sometimes part of a disc (discectomy). The wound is closed with dissolvable stitches or with clips and stitches that are removed after healing. The operation usually takes around 2 to 4 hours.

You will wake in a recovery area and be given medicine for pain and swelling. The NHS says you will usually have a drip in an arm vein and may have a catheter in the bladder, usually removed after 1 or 2 days. Nurses will help you get up and moving as soon as possible.

Cambridge University Hospitals gives practical advice for the weeks after going home. The wound is covered by a small waterproof dressing that can be removed carefully after 48 hours to check the wound and be replaced. You can shower 48 hours after surgery if you avoid the surgical area and pat the dressing dry. Stitches are often absorbable.

The leaflet says you are likely to have mild to moderate back pain that may worsen slightly at first and then improve gradually over 6 to 8 weeks, with a significant improvement by 12 weeks. Regular simple pain relief such as paracetamol or ibuprofen usually helps. It encourages gradually increasing walking, and for the first few weeks avoiding heavy lifting (more than 5kg in each hand), strenuous exercise, contact sports and twisting, bending, pushing or pulling.

Driving is possible once you can make an emergency stop, provided you were safe to drive before the operation. Desk work can often resume when you feel ready, and manual work should be discussed at the follow-up appointment. A follow-up is typically arranged about three months after surgery, and the leaflet notes some people continue to improve for up to two years.

The leaflet also addresses common concerns. Spinal surgery raises the risk of blood clots, so anti-embolism stockings are worn until you can walk around comfortably. Constipation is not uncommon, partly from the medicines used, and a pharmacist can advise on laxatives. About 1 in 5 patients have a return of earlier symptoms a few days after surgery, most often from fluid collecting over the nerves, which usually settles.

The NHS says serious complications are uncommon but may include a leak of spinal fluid, which may mean more surgery, damage to spinal nerves or paralysis, back pain that does not get better, and other vertebrae moving out of place after surgery, which may mean another operation.

Cambridge University Hospitals lists signs after discharge that need urgent assessment at A&E: clear, watery fluid leaking from the wound with a headache or temperature, new limb weakness, numbness in the genitals or new bladder, bowel or sexual dysfunction, swollen calves, or chest tightness and shortness of breath. Redness and swelling over the wound with fever should also be assessed urgently. New severe back pain or worsening pain should prompt a call to the specialist nurse, GP or NHS 111.

Within the NHS, referral for spinal surgery usually follows a period of non-surgical treatment and an MRI scan, with the decision made jointly between you and a spinal or neurosurgical team. After surgery, an NHS team usually provides physiotherapy advice and a follow-up appointment, and the Cambridge leaflet mentions contributing to the British Spine Registry to record outcomes.

Some people choose to see a private spinal surgeon, often for faster access to a first appointment or to the operation. The operation is the same in principle. Questions that apply either way include the type of decompression planned, whether fusion could be needed, how many such operations the surgeon performs, and who to contact if you are worried after discharge.