Lumbar canal stenosis is a common problem in the elderly. The gold standard of treatment for this condition is a lumbar decompression surgery. As the name suggests, decompression refers to the removal of pressure.
Lumbar canal stenosis is a condition which denotes tightening or stenosis of the lumbar canal. The nerves within the canal do not function properly due to the pressure. This leads to pain and numbness in legs on walking. This condition is quite common in the elderly population. The most common cause of this condition is degenerative or age related. A ligament called Ligamentum flavum becomes thick with age and leads to narrowing of the spinal canal. There are other causes of pressure on nerves in lumbar canal like a herniated disc or tumour, but this article is specifically for degenerative lumbar canal stenosis.
Lumbar canal stenosis
The most common presenting complaint is pain, numbness or tingling in legs on walking. These are also known as Neurogenic claudication. As a person starts to walk, after a certain distance, he starts to have these complaints in his legs. Because of these symptoms, one may need to rest frequently as rest tends to improve the symptoms. The treatment of lumbar canal stenosis aims at improving the symptoms by relieving the pressure on the nerves within the spinal canal.
Open vs Keyhole lumbar decompression surgery
Lumbar decompression can be done in different ways. The traditional surgical technique of decompression is an Open lumbar laminectomy. In this surgery the back part of a vertebra called lamina and Ligamentum flavum is removed to open up the spinal canal.
The newer techniques focus on achieving the same objective through small incisions, called keyhole spine surgery. MIS Lumbar decompression refers to the surgery for decompression of the nerves using Minimally invasive surgical techniques. These offer a lot of advantages like less blood loss, faster recovery, minimal pain and excellent results.
The decompression is noted by the number of levels or number of lamina removed. A one level decompression refers to removal of pressure from one spinal level like L45. Similarly L45-L5S1 decompression is a two level decompression. In some patients multiple levels may need to be decompressed.
Outcome after lumbar decompression surgery
Lumbar decompression is very effective if the symptoms of the patient and the radiology match. In classic cases of Neurogenic claudication, the symptoms get relieved very fast after surgery. Most patients can feel the improvement from first day after surgery and keeps on improving with time.
Most people would show improved walking distance after the surgery. The improvement is well sustained over time too. The pain, and tingling in legs on walking tend to show significant improvement after the lumbar decompression surgery.
Also read- Why spine surgeries fail?
Complications of lumbar decompression surgery
Lumbar decompression, be it open or MIS lumbar decompression are very safe and well tolerated procedures. There are very few complications which are directly related to surgery. As the condition is common in elderly, who may have other medical problems like Diabetes, medical complications may slow down or complicate the recovery.
- Infection- Infection can happen after any interventional procedure. It is not very common, but poorly controlled Diabetes may increase the chances of infection after the surgery. The infection is more common after the open laminectomy as compared to the MIS lumbar decompression.
- Injury to nerves- is another rare complication. During decompression, sometimes the nerves can get injured and can lead to paralysis of a part of or complete leg. This complication is exceedingly rare and happens in less than 0.5%. The paralysis may be temporary or permanent depending upon the severity of the injury.
- Spinal fluid leakage- This may happen if the covering layer of nerves, called Duramater develops a hole during the surgery. This leads to leakage of spinal fluid or CSF through the surgical wound. This may need bed rest, medicines, use of a lumbar drain or re-operation to repair the duramater defect.
- Recurrent stenosis- Sometimes pressure on nerves may recur months or years after a successful surgery. This can happen if the initial decompression was incomplete or due to progressive degenerative changes of spine.
Recovery after decompression surgery
In uncomplicated surgery, the hospital stay is 1-3 days after the procedure. Physical therapy is started early during the post-op period. Patients are encouraged to walk as soon as they feel comfortable to reduce risk of blood clots in legs. Patients are encouraged to increase their activity as per their comfort. Use of a lumbar support after surgery helps in reducing post surgery pain and early mobilisation. Climbing of stairs can be attempted if the patient feels comfortable in walking on flat surfaces and is confident enough. This can usually be done by second day of surgery.
Return to work may take 4 to 6 weeks after the surgery. It depends a lot on the level of activity before surgery, age and medical problems of the patient. The recovery may be slightly slower in case of open laminectomy surgery as compared to MIS lumbar decompression due to pain at surgery site. However, in both open or keyhole surgery, physical therapy and rehabilitation play a crucial role in recovery.
Disclaimer- This is for the general awareness of the patients and cannot replace expert medical advice. Patient treatments need to be individualised and that can be decided based on clinical examination and evaluation by a trained physician.
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