Decompression is a surgical procedure that is performed to alleviate pain caused by pinched nerves (neural impingement). During a lumbar decompression back surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to give the nerve root more space and provide a better healing environment.
There are two common types of spine surgery decompression procedures: microdiscectomy (or microdecompression) or a lumbar laminectomy (or open decompression).
Several conditions may cause neural impingement and necessitate these surgeries, including spinal stenosis, a herniated disc, isthmic or degenerative spondylolisthesis, or a spinal tumor (rarely).
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How Decompression Surgery Is Performed
With modern spine surgery techniques, both a microdiscectomy and laminectomy can usually be done with a minimum amount of morbidity (e.g. post-operative discomfort) and a high degree of success in alleviating lower back pain and/or leg pain.
Sometimes in addition to the decompression procedure, a spine fusion surgery is also necessary in order to achieve adequate decompression of a nerve root. This is especially true if the nerve root is compressed as it leaves the spine (in the foramen), known as foraminal stenosis.
Foraminal stenosis is difficult to decompress simply by removing bone because if the bone is fully removed in the location of the foramen it is generally necessary to also remove the facet joint. Removing the facet joint leads to instability, so a spinal fusion is necessary to provide stability.
The foramen can be opened either through an anterior approach (by “jacking” open the disc space in the front of the spine) or by distracting between two pedicle screws inserted posteriorly (through the back of the spine). After the foramen is opened up, a spine fusion is also done to keep it open so the instrumentation does not fail and the stenosis does not return later.
As an alternative to spinal fusion, interspinous process spacers may be implanted to open the central canal and foramen, and address motion restrictions and pain from spinal stenosis.