Segmental Decompression Advice Sheet

This is an example of information/advice about this condition and procedure. You should always take detailed advice from your surgeon and physiotherapist.

Segmental decompression

You have been scheduled for an operation called a segmental decompression.

This is a procedure that is performed in the low back with the aim of improving the space for the nerves (nerve roots) within the lumbar spine.

The aim of the surgery is to improve leg pain caused by a reduction in the space for the nerves at the bottom part of the back- a condition known as spinal stenosis.

The reason for segmental decompression surgery

Usually, patients undergoing this operation have severe leg pain affecting one or both legs and it will be significantly interfering with your ability to walk.

This is not an operation for the relief of back pain although some patients do find that their back pain is improved after this operation.

The operation is usually reserved for patients who have severe symptoms that are markedly reducing their walking ability to perhaps less than 200 yards. On occasions, patients may have weakness in the leg muscles and this would be another reason for consideration of surgery. However, please remember many patients have some reduction in their walking tolerance because of leg pain and do not require an operation.

What happens in segmental decompression

The nerves in the base of the spine sit in a tube called the spinal canal. In spinal stenosis, this space becomes narrowed and as a result, there is less space for the nerves.

The operation enlarges the space for the nerves. The condition often affects more than one segmental level (joint) of the spine. The surgery may therefore be done at several levels of the spine.

Segmental decompression with fusion

On occasions, some patients need to have a spinal fusion procedure performed at the time of their segmental decompression. This is at the discretion of the surgeon if he feels that improving the space for the nerves could lessen the structural stability of the low back. He may therefore choose to combine your operation with a fusion so as to ensure the strength of your back is not adversely affected.

For further information about fusion please see fusion advice sheet.

The benefits of segmental decompression surgery

Unfortunately, no operation is guaranteed to relieve you of your symptoms. It is however broadly accepted that approximately 80 - 90 % of patients who undergo this operation have significant improvement in their leg pain and improvement in walking ability.

Pain is the main symptom that one can predictably improve. If you suffer from tingling in the legs, this may be improved. Symptoms such as numbness, weakness and heaviness are far less predictable and may or may not improve as a result of this operation.

The risks of decompression surgery

All operations come with some small degree of risk. Risks of the segmental decompression operation include:

Problems associated with having general anaesthesia
Wound infection
A blood clot in the leg which in very rare circumstances could pass to the chest and be life threatening.
Nerve injury. During surgery, the nerve has to be moved to one side and this sometimes can result in the patients reporting more tingling in the leg, more numbness in the leg or in rare circumstances, weakness in the leg. These are usually temporary problems that should resolve. Patients are often extremely concerned that they could end up paralyse after surgery on the spine. This is an extremely rare event.
There is a small risk of injury to the protective coating around the nerves which may require repairing at the time of injury and does not usually result in any long term problems although it may delay your initial recovery.
Patients undergoing this operation are usually elderly and in particular if they have other medical problems, the risks of an operation may be slightly higher.

Recovery from spinal surgery

You will usually be in Hospital between 4 and 7 days. You will be up and walking approximately 24 hours after the operation although this will depend on how you feel at that time. Provided you were able to walk before the operation, then there should be no difficulties in your walking afterwards.

Some patients with severe spinal stenosis have great difficultly walking before their surgery and thus their post-operative recovery period may be longer.

We would normally anticipate you going home in a car but being driven by a family member or friend. You will be unable to drive for four weeks after your operation. We would recommend a shower rather than a bath for the first 4 weeks after surgery. After this time, we would expect a gradual return to normal activity. Your sex life can resume 4 weeks after surgery.

A summary of segmental decompression for spinal stenosis

Patients undergoing segmental decompression usually have a diagnosis of spinal stenosis. This results in pains in the legs when walking - when other causes have been excluded. Many people have this condition and are unaware of it. Many people have this condition and have no symptoms. In some cases however, patients have severe leg pain on walking and are unable to function normally because of this.

If the MRI scan appearances of your lower back confirm severe spinal stenosis, you may be suitable for an operation to improve the space of the nerves with the aim of relieving your leg pain. With the vast majority of people this is a successful procedure. There are some small but significant risks that are possible. A joint decision must be taken between you and your Surgeon to see whether an operation is indicated in your case.