Lumbar Decompression - What is It?

spinal stenosis

Lumbar decompression refers to a group of surgical procedures whose primary goals are to provide pain relief and bone stability in those who have suffered injury or disease involving the lumbar portion of the spine.

The lumbar spine consists of five individual vertebra and begins at the last vertebra that is attached to a rib and ends at the top of the pelvis. Between each vertebra is a structure that serves as a "shock absorber" called an intervertebral disc, or simply a disc. The disc also provides a space between the vertebra where the spinal nerves emerge before branching out into other areas of the body.

Due to its location and the fact that we humans walk upright, the lumbar spine is subjected to considerable stress and strain throughout our lives. In many cases the lumbar spine survives these stresses and strains without problem by repairing itself. However, trauma and disease may cause damage to a vertebra and/or disc that the body is incapable of repairing. In these cases lumbar decompression surgery may be necessary.

In many cases of lumbar spine disease the spinal nerve is compressed between two vertebra. It is this compression that causes the symptoms of spinal disease such as pain or loss of sensation in the legs. Surgical treatment of lumbar spine disease is targeted at relieving this compression and preventing its recurrence.

Traditional lumbar decompression surgery usually involves removal of tall or part of he disc and the insertion of a piece of bone to stabilize the position of the vertebra. Occasionally "hardware" such as screws or metal rods will be necessary to fully stabilize the spine. This is known as lumbar laminectomy and spinal fusion. There are a number of variations of this surgery that can be tailored to the needs of the individual patient.

More recently, lumbar decompression has been accomplished by what are known as minimally invasive surgeries. These procedures seek to relieve pain by directly focusing on the small areas that are responsible for the patients symptoms. A special instrument called an endoscope is used to visualize the area responsible for the patient's symptoms and the necessary surgery, including the insertion of screws or plates, is done "through the 'scope."

Minimally invasive procedures include:

-mini-laminectomy: only the portion of the disc that is directly compressing the nerve is removed via a small incision in the back

-chemical laminectomy: a special chemical compound is injected directly into the disc causing the disc to "shrink" or dissolve

-mini-fusion: similar to the traditional fusion operation but done through an endoscope and using smaller hardware

Some cases of lumbar disease are due to damage to the vertebra itself. The "collapsing" vertebra commonly seen in osteoporosis and the lumbar compression fractures seen in professional truck drivers are particular examples of these conditions. These two conditions are now being treated with a procedure known as vertebroplasty.

In vertebroplasty a special "bone cement" is injected directly into the veretbra itself to prevent further collapse. This is usually done after other corrective procedures such as laminectomy or fusion have been completed. Many patients report a dramatic decrease in pain following vertebroplasty.

Further information on lumbar decompression is available from your personal health care provider.