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Microscopic Decompression

Spinal decompression is necessary when there is increased pressure on the spinal cord nerves because of the bone or disc material that causes impingement. Thus surgery relieves the pressure and alleviates the correlated pain. Nowadays, spinal decompression can be performed with the aid of minimally invasive surgery.

This intervention is often necessary when the patient has herniated discs or disc rupture which increases the pressure on the nerves, spinal cord, or nerve roots. Consequently, the patient might feel pain or numbness in the neck, arms, or legs and other symptoms like muscle weakness. Neural impingement can also be caused by spinal stenosis, tumors, or spondylolisthesis.

Doctors may deploy different procedures for achieving spinal decompression. In order to choose the best technique, the doctor must understand what functional and structural changes have caused the neurological problem and how severe the impact is on the spine. The patient’s medical history will play an important role in helping the surgeon determine the best surgical procedure.

During a typical decompression procedure, the surgeon performs the following steps:

• makes an incision in the area where the affected vertebra(e) is located
• vertebra(e) is then exposed by pulling aside the tissue covering it (skin, muscle, fat)
• compression source is dealt with; pressure is released by cutting all or part of the vertebra
• additional pressure sources like disc material or bone spurs are also removed
• the incision is closed after the soft tissue is put back in place

Nowadays, spinal decompression can also be achieved with the aid of minimally invasive surgery. Through this technique, the surgeon is able to avoid spine and muscle separation by working around the surrounding muscle. One of the advantages of minimally invasive spinal decompression is that the patient’s scar will be much smaller than it would be after traditional surgery.

Moreover, some patients may be able to check out of the hospital on the same day the surgery took place. The discomfort patients feel after the intervention can be relieved by using appropriate medication.

To understand whether you qualify for this procedure, you should discuss it with your doctor.

Spinal decompression surgery is beneficial in relieving symptoms that result from pressure exerted on your spinal nerves, such as pain, weakness, a feeling of tingling, and numbness. With this surgical procedure, the pain seems to get better in about 65-70% of patients, and the distance a person is able to walk increases by about four times.

Usually, a microscopic decompression procedure is performed on an outpatient basis, which means that you don't need to spend the night in the hospital or you may have a shorter hospital stay and return to your routine activities quickly. As microscopic decompression is a minimally invasive approach, it involves smaller incisions and lesser damage to the soft tissues and muscles allowing a faster recovery.

The potential benefits of this procedure include:

• minimal scarring due to small incisions
• minimal loss of blood during surgery
• decreased risk of infection and injury to muscles
• lesser postoperative pain
• faster recovery and rehabilitation
• reduced necessity of pain medications following surgery

After the surgery, your doctor will provide you with a precise recovery and exercise program that will help you turn back to your daily routine as soon as possible. Some of the symptoms you felt will disappear soon after the intervention, others will require more time.

Your hospitalization period will vary based on the treatment plan you have to follow. Some patients who undergo the surgery are released the same day. Normally, patients are able to stand and walk on the same day the surgery is performed. You will be able to return to work based on how well you heal and what type of activities your job implies.

Help your spinal surgeon determine what recovery plan is appropriate for your case by working closely together. After you receive your doctor’s indications, try to follow them thoroughly in order to ensure a fast recovery process. 

The surgery’s outcome depends on the overall health of each individual patient. Some of the possible complications are: infections, blood loss, nerve damage, anesthesia complications, blood clots, bowel or bladder issues.

In spinal fusion, the surgeon permanently joins two segments of the backbone, which then grow together over time. The aim is to achieve stability and decrease the pain caused by the disc located between the vertebral bodies or the joints. Through fusion, the nerve irritation will also be decreased. Basically, the back pain caused by the disc and joints degeneration and the leg pain caused by nerve compression are both reduced through fusion.

There are several requirements that make the intervention effective and achieve a solid fusion:

• eliminating joint motion (like a cast)
• having enough bone area to allow bone growth  
• having enough weight loading across the bone so that the body can make bone
• having the appropriate environment that can help the body make bone

In most fusions we carry on, the disc is removed before fusing the vertebrae within the space left over. This process is what we call 'interbody fusion' and by it we aim to make the bone grow from one vertebral body to another. Stability can be achieved by placing a spacer (from bone or plastic) into the disc space. When the disc is removed, sufficient area is obtained for bone growth. The disc space bears 80% of the joint’s load. The disc space environment conducts to bone growth after the disc removal.

The spine can be approached from different directions so that interbody fusion can be performed across the disc space. ALIF, DLIF/XLIF, TLIF, and PLIF are the abbreviated forms used for lumbar fusion. The initial letter shows the approach direction: anterior, posterior, transforaminal, direct/extreme lateral. The next letter stands for lumbar and the last two for interbody fusion. The best direction will be chosen after assessing each patient’s case.

Typically, we try to opt for TLIF instead of PLIF since it implies less nerve root retraction and a higher safety degree for patients. Both procedures are performed from the person’s back.