We cover many topics on this website in regard to Failed Back Surgery Syndrome. This article will deal with problems of Lumbar Decompression Surgery.
Decompression means you are removing the compression, the pressure or force on the pinched nerves in the spine. Medically pinched nerves is called a neural impingement. During the surgical procedure a surgeon will shave or cut away enough bone or disc material from the spine to remove the pressure/compression and free the nerve root from the painful impingement.
When a patent considers lumbar decompression surgery they will hear terms that include: minimally-invasive, or poke-hole incision to give the impression that this is a much simpler procedure than standard spinal surgery. The term microdiscectomy is reflective of this thinking.
A patient will be recommended to lumbar microdiscectomy or lumbar decompression surgery if the have leg pain caused by the herniated disc, most commonly diagnosed as sciatica or lumbar radiculopathy.
Did your spinal operation create a new pain condition?
Doctors in Germany who examined a potential connection between lumbar decompression surgery and new onset of sacroiliac joint-related pain causing a diagnosis of failed-back-surgery syndrome.
Here is what they said in their published research: The change of body position and walking behavior after successful surgery might lead to changed force effects on the entire spine and on the sacroiliac joint. in the future.
In other words, lumbar decompression surgery changed the patient’s natural movement to one that irritated the and caused SIJ-related pain after surgery.(1)
Lumbar decompression in patients over 80
Doctors at the Mayo Clinic evaluated lumbar decompression in the elderly, including octogenarians, to evaluate for associations between age and patient outcomes.
The doctors looked at patients 65 and older with diagnosis and procedure codes inclusive of degenerative spine disease and lumbar decompression without fusion.
Morbidity (complications) and mortality (death) within the 30-day postoperative period were the primary outcomes. Secondary outcomes of interest included unplanned readmission (return to hospital stay) within 30 days or discharge to a nonhome (nursing home) facility.
Increased age was associated with readmissions within 30 days, nonhome discharge, any complication, length of stay, and blood transfusion.
With younger than 65 years as the reference, increased age, including patients older than 80 years, demonstrates that increased age is associated with more extensive operations, resulting in longer hospital stays, increased rates of nonhome discharge, and minor complications.2
Dangers of injuring spinal ligaments
Doctors at the Osaka City University Graduate School of Medicine, Japan acknowledge that spinal ligament damage is possible in spinal surgery because the posterior spinal bony prominences (parts of the vertebral structure) are commonly used as landmarks during posterior spinal surgery; however, the exact relationship of these structures with ligamentum flavum (LF) borders and attachments has not been clarified.
Surgeons, they say need to design safe and adequate lumbar spinal decompression surgeries with the idea of not damaging the ligamentum flavum.3
Trying conservative care DOES NOT cause failed decompression surgery
Many surgeons suggest that patients should not consider conservative care prior to surgery as it may have an impact on their surgical success. Doctors at the University of Bern in Switzerland have disproved this.
“The incidence of lumbar spinal stenosis continues to rise, with both conservative and surgical management representing options for its treatment. The timing of surgery for lumbar spinal stenosis varies from shortly after the onset of symptoms to several months or years after conservative treatment.
The aim of this study was to investigate the association between the duration of pre-operative conservative treatment and the ultimate outcome following surgical interventions for lumbar spinal stenosis.
Cases of lumbar spinal stenosis with a documented duration of conservative treatment, undergoing spinal decompression with at least one post-operative patient assessment between 3 and 30 months, were included in the study.
“The duration of pre-operative conservative treatment was not associated with the ultimate outcome of decompression surgery.”4
1. Schomacher M, Kunhardt O, Koeppen D, Moskopp D, Kienapfel H, Kroppenstedt S, Cabraja M. Transient sacroiliac joint-related pain is a common problem following lumbar decompressive surgery without instrumentation. Clin Neurol Neurosurg. 2015 Sep 11;139:81-85. doi: 10.1016/j.clineuro.2015.09.007.
2 Murphy ME, Gilder H, Maloney PR, McCutcheon BA, Rinaldo L, Shepherd D, Kerezoudis P, Ubl DS, Crowson CS, Krauss WE, Habermann EB. Lumbar decompression in the elderly: increased age as a risk factor for complications and nonhome discharge. Journal of Neurosurgery: Spine. 2017 Mar;26(3):353-62.
3 Akhgar J, Terai H, Rahmani MS, Tamai K, Suzuki A, Toyoda H, Hoshino M, Ikebuchi M, Ahmadi SA, Hayashi K, Nakamura H. Anatomical analysis of the relation between human ligamentum flavum and posterior spinal bony prominence. J Orthop Sci. 2017 Mar;22(2):260-265. doi: 10.1016/j.jos.2016.11.020. Epub 2016 Dec 23. [Pubmed]
4 Zweig T, Enke J, Mannion AF, Sobottke R, Melloh M, Freeman BJ, Aghayev E. Is the duration of pre-operative conservative treatment associated with the clinical outcome following surgical decompression for lumbar spinal stenosis? A study based on the Spine Tango Registry. Eur Spine J. 2017 Feb;26(2):488-500. doi: 10.1007/s00586-016-4882-9. Epub 2016 Dec 15. [Pubmed]