What is Lumbar Microdecompression?
Lumbar microdecompression, also known as lumbar microdiscectomy, is a minimally invasive surgical procedure to relieve pressure from pinched nerves in the lower back or lumbar region using microsurgical techniques. The procedure involves the removal of a small section of the bone and/or disc material pressing on the spinal cord and/or nerve roots in the lumbar spine to relieve painful symptoms.
Herniated lumbar disc and spinal stenosis are the two most common reasons for which lumbar microdecompression is recommended.
A herniated disc, common in the lower back (lumbar spine) occurs when the inner gelatinous substance of the disc escapes through a tear in the outer, fibrous ring (annulus fibrosis). This may compress the spinal cord or the surrounding nerves, resulting in pain, sensory changes, or weakness in the lower extremities.
Spinal Stenosis involves the narrowing of the spinal canal due to arthritic changes in the facet joints and intervertebral discs. This causes enlargement of the joint leading to pressure on the spinal nerves causing symptoms of back pain or radiating pain into the hips, buttocks, or legs, numbness or muscle weakness, and tingling sensations in the back and lower extremities.
Anatomy of the Lumbar Spine
The spine or vertebral column consists of 33 vertebral bones stacked one on top of the other, with cushioning discs present between each vertebra. A cylindrical bundle of nerve fibers called the spinal cord passes through the entire vertebral column and branches out to various parts of the body. The lumbar spine in the lower back is composed of 5 vertebrae numbered L1–L5. Towards the front of each vertebra is a cylindrical block of bone called the vertebral body. Spongy vertebral discs are present between the vertebral bodies providing support and enabling movement. Damage or degeneration of the vertebral bodies or discs can lead to nerve compression causing pain, weakness, or numbness.
Indication for Lumbar Microdecompression
Some of the indications for lumbar microdecompression include:
- Herniated lumbar disc
- Spinal stenosis
- Spinal injury or spinal tumors
- Slipped disc and sciatica
- Degenerative disc disease
- Metastatic spinal cord compression
- Failure of conservative treatments such as medications or physical therapy to relieve symptoms
Preparation for Lumbar Microdecompression
Preoperative preparation for lumbar microdecompression surgery will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a week before and 2 weeks after surgery to prevent increased risk of infection, slower wound healing, and bleeding problems.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You will be placed on a special diet prior to surgery and laxatives may be used to clean out your bowel.
- You may be instructed to shower with an antibacterial soap the night prior to surgery to help lower your risk of infection after surgery.
- Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Lumbar Microdecompression
A lumbar microdecompression is performed under general anesthesia. During the surgery, you will be lying on your stomach. An X-ray is taken to determine the exact location of the herniated disc. Your surgeon will make a small incision in the midline over your lower back. Through this incision, a series of progressively larger tubes are placed and positioned over the herniated disc. The affected nerve root is then identified. Your surgeon removes a small portion of the bony structure or disc material that is pressing on the spinal nerve using microsurgical techniques. The incisions are closed with absorbable sutures and covered with a dressing.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after lumbar microdecompression will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- Most patients can go home the same day. However, some may need to stay in the hospital for a day or two before discharge to home.
- You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Application of cold and heat therapy on the low back area is also recommended to reduce inflammation and pain.
- Walking and moving around in bed is strongly encouraged to prevent the risk of blood clots.
- Antibiotics are prescribed as needed to address the risk of surgery-related infection.
- Your diet is slowly advanced post surgery. You will start with clear liquids, then progress to having normal solid foods, as tolerated.
- Instructions on surgical site care and bathing will be provided.
- Eating a high-calcium and low-fat diet is strongly recommended to promote healing and a faster recovery.
- Avoid lifting, bending, or twisting your back for the first 6 weeks. Do not lift anything heavier than 5 pounds for the first 2 weeks. Refrain from any strenuous activities such as housework, yard work, or sex for at least a month.
- Refrain from smoking as it inhibits bone growth and delays healing.
- A physical therapy protocol is recommended to help strengthen low back, pelvic, and leg muscles and optimize their function. Walking is a good exercise and is strongly recommended to improve your endurance.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- You will be able to resume your normal activities in 2 to 3 weeks but may have certain activity restrictions.
- Complete recovery and return to work vary from patient to patient as it is related to a patient’s age, overall health status, and the type of work one does.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Benefits of Lumbar Microdecompression
Some of the key benefits of lumbar microdecompression over traditional open decompression technique include:
- Less disruption of muscle and soft tissues
- Faster recovery time
- Shorter hospital stay
- Minimal post-operative pain and discomfort
- Decreased blood loss
- Minimal risk of post-operative infection
- Smaller incision and minimal scar formation
- Fewer risks of complications
Risks and Complications
Lumbar microdecompression is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Blood loss
- Blood clots or deep vein thrombosis
- Anesthetic/allergic reactions
- Injury to nerves and vessels
- Persistent pain
- Recurrent stenosis
- Spinal fluid leakage
- Bowel or bladder problems