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Lumbar Decompression and Fusion

Surgery :: Anterior lumbar interbody fusion :: Anterior Cervical Decompression Fusion
Lumbar Disc Replacement :: Posterior Cervical Spine Surgery :: Spinal Deformity Surgery
Lumbar Discectomy :: Surgical Risks :: FAQ

Spine Anatomy

Anatomy of the spine.

The spine consists of 33 small bones called vertebrae stacked one above the other with a soft intervertebral disc between each pair of vertebrae. The intervertebral disc consists of a soft jelly-like substance called the nucleus pulposus in the center, which is surrounded by multiple layers of collagen called the annulus fibrosis (like an onion). The disc connects and allows movement between vertebrae and acts as a shock absorber of the spine. The vertebrae surround and protect the spinal cord and nerve roots.

What does posterior spinal decompression mean?

Compression on the nerve roots exiting from the spinal canal can cause leg pain. A posterior spinal decompression includes either a partial (laminotomy) or complete (laminectomy) removal of the lamina along with the removal of the ligaments and new bone (osteophytes) that are compressing the nerve roots. The lamina is the bony portion of the vertebra that lies behind the spinal cord.

Spinal decompression is performed to relieve the compression on the nerves. The surgery is effective for the relief of the leg pain; however, weakness, numbness and pins and needles in the legs (if present) may take a few months to resolve and occasionally may not resolve completely, depending on the duration of symptoms.

What does spinal fusion mean?

Wear and tear (degeneration) of the spine can cause a loss of normal spinal alignment, excessive movement between vertebrae and arthritis of the spinal joints, all of which can cause low back pain. This can be treated by spinal fusion, where bone graft substitutes (VITOSS and OP-1) are placed around the vertebrae to form new bone connecting adjacent vertebrae so that they behave and move as one block.

The fusion is supplemented with rods (or plates) and screws to provide immediate stability. The screws are made of either titanium or stainless steel and are well tolerated by the body.

Which surgery will you need?

After assessing your symptoms, examining your spine and studying your x-rays and scans, the surgeon will decide whether you need a posterior spinal decompression, a spinal fusion or a combination of both.

About the surgery

Anaesthesia: The surgery is usually performed under general anaesthesia, with the patient lying face down.

Procedure: The surgeon makes a 5-10 cm incision in the skin over the affected area of the spine. The muscle is detached from the bone to expose the laminae, which are the portion of the bony vertebrae that lies behind the spinal cord. A portion of the lamina is removed (laminotomy) along with the surrounding ligaments to expose the compressed nerve roots. Occasionally, the whole lamina (laminectomy) is removed. The ligaments, intervertebral disc and new bone (osteophytes) that are pressing on the nerve roots are removed. This procedure is called a spinal decompression. Next, the surgeon may decide to fuse your spine using screws connected with rods or plates. A bone graft substitute (VITOSS and OP-1) is placed across the joints and bone at the back of the vertebrae to allow new bone to form (over 3-6 months) between the two adjacent vertebrae so that they now start behaving as one block. A drain tube removes the blood that collects at the surgical site. Skin sutures: Dissolvable sutures are used to close the skin. These will dissolve as your wound heals, however, the ends of the suture on either end of the incision will need to be cut on your first visit to the surgeon's office (7-10 days after surgery).

After surgery

In the recovery room: Following surgery, you will be transferred to the recovery room and may feel some pain at the operated site when you wake up. A patient controlled analgesia (PCA) pump will be provided, which releases a small dose of pain medication every time you press the button thereby putting you in control of your pain. You will be given intravenous fluids to keep you hydrated and a urinary catheter will empty your bladder. When the medical staff in the recovery room are confident that you are comfortable, you will be transferred to your room.

In the ward: You will be allowed to drink sips of fluids after surgery and gradually progress to a full diet. The day after surgery, the drain tube, urinary catheter and pain pump will be removed and you will be encouraged to walk wearing a brace to support your spine. You will stay in the hospital for 1-3 days and your surgeon will decide when you can go home.

Pain relief: Although we expect that you will be in pain or discomfort, we recommend that you take regular pain relief following surgery. Medications will be provided to reduce your pain after surgery and at home for the first 1-2 weeks. If pain persists after discharge please seek advice from Spine Service or your General Practitioner.

Skin sutures: Dissolvable sutures are most often used to close the skin. These will dissolve as your wound heals, however, the tip of the suture on either end of the incision will need to be cut on your first visit to the surgeon's office 7-10 days after surgery.

What to expect following surgery

Pain: You will feel discomfort and pain at the operative site immediately after surgery. You will be given pain medications; however, the soreness and stiffness in your back and/or limbs will continue for some time. Please ensure you take regular pain relief.

Tingling / Numbness: A degree of tingling and/or numbness in your limbs may be experienced after surgery and may take some time to subside.

Drains: Some patients may return to the ward with a drain tube near the surgical site to help prevent any collection of fluid at the operation site. The drain is usually removed in 24 to 48 hours.

Drips: You will have a small plastic needle (cannula) to receive fluids and antibiotics during and after surgery. The cannula will be removed when you are drinking sufficient fluids and after the doctor has stopped the prescribed antibiotics.

Catheter: A catheter will be inserted into your bladder under anaesthesia to drain you bladder during and immediately after surgery. This catheter will keep you comfortable, so you will not have to get out of bed to go to the toilet on the first day. The catheter is usually removed the day after surgery.

Calf compressors: Following your surgery, you will have inflatable compressors on your calves to reduce the risk of deep vein thrombosis (DVT). You may also be given a pair of anti-thrombotic stockings.

Coping with the Blues: It is not uncommon for patients to feel a little depressed or emotional after your surgery. The doctors and nurses will help you through this vulnerable phase.

Diet: You will be Nil by Mouth initially allowed only sips of fluid and crushed ice to suck. Once bowel sounds are present, you will start on a post-operative diet and gradually increase to a full diet. To avoid constipation, you should include plenty of roughage, cereals, fruit & vegetables in your diet. You should also aim to drink 2-3 litres of fluid daily.

Bowels: It is common not to have bowel movements for the first few days. Once you have started on a full diet, you will be given medications to help with bowel movements.

Are there any risks associated with this surgery?

All surgical procedures are associated with a risk of complications and all risks should be discussed with your surgeon. The risks may be associated with the anaesthesia given or the surgical procedure. Surgical complications can include bleeding, infection, spinal fluid leak, injury to the veins and arteries near the spine or injury to the nerve tissue or its surrounding protective layer.

Injury to the nerves may occur during surgery, resulting in paralysis of certain muscles in the legs and loss of sensations. Loss of bowel and bladder control can also occur following nerve injury. An injury to the covering layers of the nerves (dura) can result in leakage of spinal fluid and may occasionally require a repeat surgery to control the leak.

Although antibiotics are given before and after surgery, there is a 1-5% incidence of wound infection. Superficial infections can be treated with antibiotics, while deep infections may require a wound wash-out under anaesthesia. If you have had an infection in any other region (urinary bladder, chest and skin) immediately prior to surgery, you may be at a higher risk of post-operative infection in the spine, so let your surgeon know.

Venous thrombosis (DVT: clotting of blood in your calf muscles) and pulmonary embolism are uncommon after an elective spine surgery, particularly when you are out of bed and walking within 24 hours after surgery. We use calf compressors and TED stockings to prevent the clotting of blood in legs; we do not routinely use medications. However, if you have had an episode of DVT in the past, let your surgeon know.

The insertion of the screws can potentially cause nerve injury resulting in weakness and abnormal sensations in the legs. Great care is taken to ensure the accurate placement of the screws including the use of intra-operative fluoroscopy (x-rays).

There are certain warning signs you should look for after surgery that may indicate a problem, such as excessive bleeding, redness or discharge from the wound, fever, weakness or numbness of the legs or problems urinating. If you notice any worrisome symptoms, notify your surgeon at once.

Talk to your surgeon

This a brief overview and does not contain all the known facts about your condition and the surgery. Feel free to seek any clarifications from your surgeon and his or her team. It is important for you to obtain a clear understanding of your condition, the surgery, the potential risks and benefits before you sign the consent form.

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