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The decompression discectomy surgery lessens pain in around 65-70% of patients and often improves the distance a patient can walk. The operations are aimed at improving the quality of life that the patient was living before the surgery. If the symptoms are tolerable to the patient, the question of having or not having a surgery needs to be made by patient after discussing it with the surgeon. The surgery is often done under general anaesthetic and involves a short hospital day, quite often just overnight. Most surgeons encourage an early return to normal activities as it helps them to get recover quicker.
The common techniques are microdiscectomy which involves using a microscope, or a minidiscectomy, the results of which are similar. They are mainly performed to relieve pressure on nerves, commonly by removing a disc prolapse. Decompression is a term used for removing bone that may be causing pressure on the nerve. It is common among older people to get a decompression discectomy. The doctor will discuss the specifics of the procedure with you, which are often tailored as per the individual.
Both procedures are performed operations to relieve pressure on the spinal nerves. The lumbar nerves send messages to your back and legs. When they are compromised, it can cause debilitating pain. It is often used to treat spinal stenosis, a disc bulge, a disc prolapse, spinal tumors and spinal injury. A discectomy operation is done to remove that part of disc which is causing nerve pain down the leg. A decompression removes bone or soft tissue compressing any portion of the spinal canal. For some patients, a combination of the two procedures may be needed.
Lumbar surgery is recommended when the back pain is affecting your quality of life and when alternative treatments, such as pain relief and physiotherapy, have failed to yield any positive results. If the patient has previously undergone a series of spinal injections but has not provided long-term benefit, it signals towards the fact that a definitive long-term treatment such as surgery may be needed. The main aim of surgery is to relieve the pressure on the nerve. This will mean that there is a good chance that the pain in your leg will go or at least be much improved.
How is it performed?
If the surgeon performs a discectomy, a small incision is made into the lower back. The disc bulge or gel-like disc material compressing the nerve is removed, and there is no need to remove the whole disc, just the bulging portion. If the surgeon performs an open decompression, the incision will be longer and more muscle will be stripped. A small portion of the bone over the nerve root and/or disc material from under the nerve root is removed; this gives the nerve more space to heal. After the operation, the patient shall get some immediate relief. Some remaining leg pain, numbness or weakness may linger for several weeks until the nerve has rejuvenated. The procedure is performed under general anesthesia and the patient will need to need to stay in hospital for one night.
Some vital points
If the patient felt pressure on the nerve for a long time or the nerve has got damaged due to pressure, you may not achieve a complete recovery of the nerve function. This means that there might always be some numbness in parts of the leg or arm, or weakness of some of the muscles after surgery. This Surgery provides greater chances for people to get people better quicker but like any other surgery, has some risks entailed with it. Certain types of disc prolapse are more likely to recur than others. Surgery for disc prolapse has a recurrence rate of between 7% and 15% within ten years. This is the same whether or not you have an operation. Surgery is the best when severe or quite troublesome symptoms have not settled to the patient's satisfaction and have lasted more than 6-8 weeks. Surgery has less risks and is safer on fit and healthy patients. It is common sense to take responsibility as a patient to reduce the risks whenever possible. Simple measures such as stopping smoking, losing weight and improving aerobic fitness all help. Diabetic patients are at a slightly increased risk of infection generally and the nerves in diabetic patients may not recover as properly as others. Around 70-75% patients experience significant improvement in leg pain, 20-25% are better but still have residual leg pain, and 1% may be worse in terms of pain.
Associated complications and risks
1) Infection - Wound infections may occur in between 2% and 4% of spinal operations. Deep spinal infections are more serious but less common. It occurs in less than 1% of cases. To reduce the risks of infection, antibiotics are often administered and the surgery is performed under strict sterile theatre conditions. In case of a deep infection, it may require follow-up operations to washout the spine and a prolonged course of antibiotics.
2) Incidental durotomy - An opening occurs here in the dura, the lining of the spinal canal. In nearly 8 % of the cases, the fluid within the spinal canal drains out of the hole. Sometimes, the hole can be repaired with stitches. The leaking of fluid generally dries up within a few days and there is no long term effect.
3) Damage to spinal nerves The spinal nerve causing the pain may be already damaged by the disease process. The disc prolapse can cause scarring within the nerve such that it is unable to recover despite technically successful surgery.
4) Paralysis - The risk of paralysis as in loss of use, sensation and control any body part, is less than 1%. Paralysis can occur as a result of damage to the blood supply of the nerves or spinal cord, and is not reversible.