Lumbar decompression and laminectomy: when a narrowed spinal canal is opened up

In lumbar spinal stenosis the canal that carries the nerves narrows, often because of age-related wear. South Tees describes aching or cramping in the lower back, buttocks, thighs or calves that worsens with standing and walking and eases with sitting or bending forward, along with leg heaviness, weakness or tingling.

The NHS lists conditions that can need decompression, including spinal stenosis, sciatica, slipped disc and cauda equina syndrome, and says other treatments may be tried first depending on the cause. South Tees says surgery may be considered if symptoms are severe, if there is progressive neurological decline, or after a period of exercise therapy.

South Tees describes exercise as first-line treatment, with guidelines recommending an initial 12 weeks of progressive exercise therapy with or without a physiotherapist, and gives cycling, adjusted walking and stretching as examples, with swimming for severe pain. The NHS adds physiotherapy, losing weight if overweight and steroid injections as earlier options.

Choosing exercise first does not close the door on surgery. It also gives you and the team a clearer view of what the narrowing is really doing to your walking.

At pre-assessment the team reviews your heart and lung health, medicines and previous anaesthetics, and gives fasting instructions for a general anaesthetic. Tell them about blood thinners, diabetes and any mobility aids you use.

Prepare your home for a stay that the NHS puts at around 2 to 5 days: stock up on easy meals, plan help with shopping and washing, and set up a chair that suits you. If you smoke, ask about stopping.

According to the NHS you are given a general anaesthetic, so you are asleep. The surgeon makes one larger cut in the back or several small ones, removes small pieces of bone from a vertebra, and sometimes part of a disc, until the nerves are no longer squeezed. The NHS says the operation usually takes around 2 to 4 hours.

Afterwards you wake in recovery and then return to the ward. A physiotherapist will normally help you out of bed and show you how to move without twisting. North Bristol notes in its microsurgery leaflet that the skin is closed with paper strips or stitches, the exact method being the surgeon's choice.

The NHS lists serious complications including a leak of spinal fluid, damage to spinal nerves or paralysis, back pain that does not get better, and vertebrae moving out of place after surgery. It gives no percentages on the page retrieved, so none are quoted here.

South Tees is direct that there is no definitive evidence that laminectomy improves stenosis symptoms and that some people improve while others do not. That is not a reason to avoid surgery, but it is a reason to ask your surgeon what result to expect for your pattern of symptoms and what an unsuccessful outcome would mean.

The NHS gives around 2 to 5 days in hospital, return to work in around 4 to 6 weeks, and full activities up to 12 weeks. Gentle walking helps early on; the Hull aftercare leaflet advises building it up slowly and keeping the wound dry until stitches or clips are out.

Your surgeon will advise on lifting, driving and exercise. The leaflets retrieved do not give a single driving figure for this operation, so ask your team and check your insurer.

The NHS says to contact the hospital or NHS 111 for new symptoms such as pain, weakness or numbness, or for signs of infection around the stitches. Hull adds changes in bladder or bowel function and fluid or bleeding through the dressing. Numbness around the genitals or bottom, being unable to pee, or loss of control of bladder or bowel need 999 or A&E.

• Which levels will be decompressed and why those?

• Is there a risk my spine will become unstable and need fusion later?

• How likely is my walking distance to improve?

• Will I need a drain or a catheter, and how long will I stay?

• What exercise should I do before the operation?

The surgery is the same in both settings; the differences lie in waiting time, surgeon choice and inpatient room. On the NHS, a period of structured exercise may be expected before surgery, consistent with South Tees. Privately you may be offered surgery sooner, so it is worth asking what non-surgical options have been explored and what the stay and follow-up include.