Lumbar Decompression Surgery

Everything You Should Know About Lumbar Decompression Surgery

Lumbar decompression surgery is used to treat compressed nerves in the lumbar spine (a condition known as “lumbar spinal stenosis” or “lumbar canal stenosis”). It is typically recommended only after other, non-surgical treatments have failed to produce relief from the significant and persistent leg pain experienced when standing or walking that is the result of compression of spinal nerves caused by inward buckling of the thickened ligament (AKA ligamentum flavum) within the lumbar part of spinal column.

NHS Funding for Lumbar Decompression

The bad news is that lumbar decompression when performed in the UK is not cheap. The good news is that NHS will often pay for this type of surgery if you have it abroad. There are typically two funding routes available to those wishing to have spinal decompression surgery abroad on the NHS. They are the “S2” route and the “EU Directive route”.

• S2 – The S2 route does not usually require any upfront payments from the patient and will usually cover the entire cost of your procedure; unless the county where you choose to have your surgery typically requires some form of co-payment. Even then you may be able to recoup some or all of the co-payment after the fact. S2 is only available for state sector treatments.
• EU Directive – With the EU Directive Route you will normally be required to pay for your treatment up front and obtain reimbursement from NHS afterward. With this funding route you can choose from state sector or private sector treatments.

The bottom line is that with S2 you won’t have any upfront costs but with the EU Directive route you’ll have more treatment options. The application process can be fairly involved with either funding route but the experienced team at Neuro Spine Riga will be happy to help you from start to finish.

What is Spinal Decompression Surgery?

Lumbar spine decompression surgery is carried out while the patient is under general anaesthesia so there is no pain during the procedure. It is a patient-friendly, minimally invasive operation that can take anywhere from a one and a half hours to several hours depending on the particulars of the patient’s physiology as well as the complexity of the surgery itself. During the procedure a small incision (usually no longer than 1 inch)  will be made in the middle of the patient’s back along the vertical axis of the spine over the affected vertebrae (usually L4/5, but other locations or more than one location is also possible). The attached muscles will be lifted away exposing the spine itself. The surgeon will then, under magnification of a surgical microscope, remove those parts of thickened ligament (flavectomy/ligamentectomy) and/or the surrounding tissue that has been bringing pressure on the spinal nerves. In short, the goal is to relieve pressure on the nerves of the spinal cord and to do so in such a minimally invasive way that the patient is able to regain full flexibility and strength.

Techniques

Several surgical techniques have proven effective at achieving lumbar decompression. Exactly which is used will depend on the specifics of the patient’s case.  

• Interlaminar decompression (AKA flavectomy/ligamentectomy) – This is the most commonly used technique. It is a patient-friendly, minimally invasive, individually tailored technique where only thickened ligament is gently removed through a small “keyhole” incision. As a result pressure on the spinal nerves is released. No compromise to the stability of spine is caused by using this technique. One of the benefits of this procedure is that the patient will have a shorter recovery time and can typically leave hospital the day after the surgery is performed.
• Interspinous distraction procedures (interspinous spacer implantation) – Interspinous distraction procedure is a relatively easy, minimally-invasive technique involving placement of an implant between the spinous processes (posterior part of the vertebrae) at the affected level thereby enlarging the space for compressed spinal nerves.
• Spinal fusion – With a spinal fusion two or more vertebrae are fused into a single unit. This technique is used in cases of “instability” – a combination of spinal lumbar stenosis with abnormal movement between two or more nearby vertebral bodies – or in case of “spondylolisthesis” – a forward shift of one vertebral body onto another.
• Discectomy (microdiscectomy) – in some cases bulging (herniation) of the intervertebral disc contributes to the compression of the spinal nerves. Therefore, sometimes removal of this bulging part of intervertebral disc is necessary as a part of decompression procedure.

Some patients may need a specifically tailored combination of above-mentioned techniques to be performed in order to achieve relief, although with the majority of patients only 1 will be required. Your surgeon will be able to tell you which of the above procedures you will need to undergo prior to your surgery.

When is Lumbar Decompression Indicated?

There are in fact a number of back conditions that may be helped by lumbar spinal decompression surgery, but the most common is known as lumbar spinal stenosis.

Lumbar spinal stenosis – This condition is most commonly caused by a degenerative disease of the lumbar vertebrae. The main symptom is leg pain when walking or standing (known as neurogenic claudication) which is relieved by sitting or bending forward. Pain when walking can be significant, severely restricting mobility. This type of leg pain is caused by compression of spinal nerves by a thickened (hypertophic), inward-buckling ligament known as ligamentum flavum.

There are also less common symptoms associated with lumbar spinal stenosis including sharp, telescoping pain down through the leg. You may also experience pins and needles, a tingling sensation, weakness in parts of your legs and/or numbness. This pain is most often referred to as “sciatica” and may be made worse by walking, coughing or sneezing.

As mentioned, with spinal stenosis even a simple act like walking is often painful and difficult. Spinal stenosis usually occurs in people over 60 years of age whose spinal columns have become worn down over time. Although it’s not unheard of for younger people to need spinal stenosis treatment as well.

Lumbar decompression surgery is indicated for those who do not improve with conservative treatments.

Contraindications and precautions for surgery

There are no absolute contraindications for the spinal decompression surgery procedure although there are some relative factors you may want to consider before undergoing this type of operation.

• Back pain only – Patients who are experiencing only or mostly back pain are not likely to be good candidates for this type of surgery. Decompression of the lumbar spine is intended for and will primarily benefit those experiencing significant leg pain (sciatica) when walking or standing.
• Discrepancy between clinical and radiological findings – Patients whose clinical and radiological findings don’t correlate are unlikely to see any benefit from lumbar decompression.

The Pre-operative Examination

When you schedule your surgery at Neuro Spine Riga you will be asked to participate in a pre-operative assessment. During this assessment there will be a general health check-up along with blood tests to ensure you are physically fit enough to undergo the procedure. If necessary, there will also be either X-rays or an MRI scan of the spine to confirm the procedure is warranted and to supply the surgeon with any last minute information that may be helpful. In the vast majority of cases you will meet the surgeon performing the operation during this assessment visit. This type of surgery is typically performed by a neurosurgeon who has experience with different types of spinal surgery.

Preparation for Lumbar Decompression Surgery

It is recommended that you stop eating 6 hours prior to the operation and that in the days leading up to the operation that you only drink clear liquids such as water, black coffee or tea. (Please, no milk.) You should stop consuming any liquids 3 hours prior to surgery.

Spinal Decompression Surgery Complications

Every form of surgery carries with it some risk. This is particularly true for those that require the administration of general anaesthesia. Here are some spinal stenosis surgery risks.

Possible Short Term Complications

• Infection – The rate of infection for this type of procedure is about 1%. These infections can range from mild to moderate and will likely include tenderness and redness around the infected area. Most infections related to decompression surgery are easily treated with antibiotics.
• Heamorrhage – Minor bleeding at the site of surgery is completely normal. Though in some rare cases a larger bleed may occur. In the event this bleeding causes compression of the nerves, the surgical wound may need to be washed out.
• Dural Tear – The spinal nerves are surrounded by a watertight sac. This sac – called the dura – plays a protective role for the spinal nerves. Although the likelihood of a dural tear during surgery is considered small your surgeon will be on guard for this possibility.
• Nerve Damage – While it is exceedingly rare the possibility of nerve damage during the procedure cannot be completely ruled out. Should this occur the patient will usually experience pins and needles, numbness or other types of tingling sensation. In more serious cases weakness in the feet or other forms of neurological deficit can occur.
• Bladder Retention – Anaesthesia has been known to sometimes affect the prostate gland in men which can lead to urinary retention following surgery. Should this occur the patient may be catheterised for the short term until the situation corrects itself.
• Constipation – Some analgesics are known to cause constipation. While this may not seem like a problem the fact is it is important that you are able to empty your bowels daily. This prevents strain on the lower back that can increase pain and make it more difficult to empty your bladder.
• DVT – Deep Vein Thrombosis or DVT occurs in about 5% of patients. With DVT blood clots form in the legs in the weeks following surgery. One of the most effective ways of avoiding DVT is to wear compression socks. Although in some cases the surgeon may deem it necessary to prescribe blood thinners for a short time in order to prevent blood clots in the legs.
• PE – Pulmonary Embolism or PE is a condition wherein a DVT-related blood clot in the leg migrates to the lungs via the heart. While this occurs in less than 0.1% of patients it is crucial to get immediate treatment if PE is believed to have occurred. Failure to do so could lead to a life threatening situation.

Possible Long-Term Complications

• Recurrence of symptoms – In most cases leg pain is relieved in the aftermath of this type of surgery. The important thing to remember is that the primary goal of lumbar decompression surgery is to relieve the pain radiating down your leg or legs (sciatica). While back pain relief is common and certainly welcome it is not the yardstick used to measure the success of this type of surgery. Note also that for a variety of reasons it is possible for lumbar spinal stenosis and leg pain to reoccur. The lifetime risk of this happening is only around 10% and is significantly reduced if the patient is diligent in adhering to their physiotherapy routine.

Spinal Decompression Surgery Recovery

Your experience regarding lumbar decompression surgery recovery will depend in large part on your level of physical fitness prior to the procedure. In the days immediately following surgery you’ll be encouraged to begin moving about and walking if the medical team deem it appropriate. Most patients are discharged from Neuro Spine Riga one to three days after the surgery.

In most cases it will take approximately four to six weeks for you to completely regain normal mobility and function. Although the length of your spinal decompression surgery recovery time may differ, depending as we said on your overall level of fitness as well as whether there are complications to deal with. But whether or not you experience complications recovery will encompass a range of issues and considerations. These include:

• Getting home – When you get back to the UK it will be important to follow the guidance provided by the medical and support staff carefully. This will affect your recovery time from spinal decompression surgery. You’ll be advised to gradually increase your level of physical activity although you should expect to need some assistance with household chores, food prep and the like for at least a week following surgery. So you should have some form of post-surgical assistance lined up before you undergo the procedure.
• Dealing with pain – There is no way to avoid the fact that having your back opened up will result in some pain afterward. However, thanks to the minimally invasive techniques employed by Neuro Spine Riga, pain after surgery is minor,  can be effectively managed by using painkillers and is not an issue. In most cases the surgery-related pain will dissipate in anywhere from a few days to a few weeks. You should inform the medical staff if yours does not.
• Stitches – Any stitches deep within the skin are designed to dissolve over time and will not need to be removed. At Neuro Spine Riga skin closure is also usually performed with intracutaneous, dissolvable sutures. Meaning there are no sutures to remove. In the case of non-dissolvable stitches or staples these will typically be removed 10 days after the operation. Keep in mind also that the surgical wound will be covered by a dressing for 10 days after surgery.
• Driving – Many patients are eager to get back behind the wheel after this type of surgery but it’s important not to drive if you are still on painkillers, regardless of how long it has been since your surgery. In the absence of painkillers however, most people are able to resume driving anywhere from two to six weeks after surgery.
• Returning to work – In most case people who undergo this type of surgery return to regular work anywhere from one to six weeks after the procedure. If, however, your job requires a lot of physical activity you may be advised to wait at least 6 to 8 weeks before returning to work and even then you may have to work your way gradually back to normal pre-surgery work levels.

Lumbar Decompression Surgery Cost Comparison Chart

We have mentioned a couple of times how affordable the lumbar decompression procedure is at Neuro Spine Riga. Below is a comparison chart showing the difference between Neuro Spine Riga and what this procedure will typically cost you in other European cities.

Note: Because there can be several different procedures involved with lumbar decompression it’s difficult to nail down a precise cost for the surgery. Suffice to say the above represent a reasonable average of costs in the various cities represented. Your exact cost will likely vary.As you can see the spinal decompression surgery cost at Neuro Spine Riga will save you a bundle of money without any loss in the quality of your care.

Why Riga?

Over the course of the past 25 years Latvia in general and Riga in particular have emerged from the shadow of their immense eastern neighbour to reclaim their rightful place within the larger European community. A city that was shunted away behind the iron curtain not too long ago is now a vibrant capital of European culture, business and the medical arts. More than 2.5 million people visited Riga last year and that number climbs with each passing year as more and more people become aware of its unique gifts.

The centre of Riga with its Art Nouveau and native Jugendstil architectural treasures has been designated a UNESCO World Heritage Site; one of only a handful of such sites in northern Europe outside Sweden and Denmark. But the joys of Riga don’t stop there. World class art galleries, historical landmarks and more attract visitors by the millions who come by land, sea and air to rediscover this essential European destination.

Conclusion

Having your lumbar decompression surgery at Neuro Spine Riga is the fastest, most affordable way to obtain the relief you need from the enervating effects of a pinched nerve in the spine. It’s often possible to have your lumbar surgery on the NHS and the dedicated, experienced team at Neuro Spine Riga can help guide you through the application process. Even if your application is turned down by NHS however, you’ll likely find that the cost of spinal decompression surgery at Neuro Spine Riga is so reasonable that you will be able to cover any cost yourself. And we can help you find a way to do just that.