Mr Chris Brown is a Consultant Orthopaedic Spinal Surgeon at Circle Reading. Here, he shares with us his expert knowledge on spinal decompression, and when it might be appropriate for you.
I see a lot of older patients with back complaints, who experience a combination of pain in the lower back and legs, weakness, and difficulty walking, and a common cause of this can be a spinal stenosis. This is a condition where the nerves running down the inside of your spine start to narrow, leading to aches and pains in your back and legs. These symptoms tend to get worse over time, with the potential for nerve damage if left untreated.
A stenosis can occur through the natural aging process, as the discs in your back start to erode through general wear and tear, causing the spinal canal to narrow and the surrounding nerves to get bundled up or pressed together. Patients tend to be over 60, although occasionally I will see younger patients who may have developed a stenosis as a result of a trauma or perhaps through an inherited condition. An MRI will help me determine which of these factors is causing the problem, and I can then tailor my approach accordingly.
As with many of these conditions, I prefer to lead with a non-invasive treatment plan, as this can often provide relief without the need for surgery. If, however, physiotherapy has not helped your symptoms improve, spinal decompression may be the best option in finding a more definitive solution.
The aim of the surgery is to create space around the nerves leaving the spine, relieving any pressure that may have built up due to the narrowing of the spinal canal. It can help reduce your symptoms, often eliminating the symptoms felt in your legs, easing back pain and allowing a more active lifestyle again. As with a microdiscectomy, it is performed via a small cut in the centre of your back (the length of which depending on how many discs or vertebrae are affected), and tissue and/or bone is removed around the disc until the affected nerves are freed.
You will need to undergo a general anaesthetic for the procedure, which carries its own risks such as blood clots, strokes, and heart attacks, but there are other serious risks related specifically to this kind of surgery. Although very rare, spinal decompression can result in the leakage of spinal fluid, infection, nerve damage, and paralysis. If nerve damage has occurred prior to the surgery, this means some of your symptoms may remain. I always intend to set any patient expectations from the first consultation, talking you through all of these potential risks in greater detail so you can make an informed decision about your treatment plan.
One key piece of advice I give my patients whenever they are facing surgery is to be in the best shape you can be. Try to maintain a certain level of activity rather than complete bedrest, as otherwise your back is in danger of ‘seizing up.’ It’s a good idea to set small targets for yourself, attempting to push through your symptoms ever so slightly each time. If you are not sure what is safe to try, consult our physiotherapy team, who will be more than happy to advise you on safe practice.
I also advise my patients to give walking poles a try. Rather than a walking stick, which encourages you to place pressure on one side of your body, walking poles ensure that there is no uneven load towards one side, evening out your gait. If you regularly use walking poles, it can really help in terms of relieving some pressure from your lower back.
Your level of fitness prior to surgery will greatly affect your recovery time, although typically my patients will be able to leave hospital one-to-two days after the operation. You’ll need to take it easy at first, and if possible, it would be wise to have some help at home from family or friends, at least during the first week. Usually, you’ll be up on your feet the next day, but it will likely be around six weeks before you can undertake any highly physical activity again. As with your pre-surgery preparations, set those small targets for yourself again and gradually try to increase your level of activity, starting by walking short distances and slowly building up. I will see you for a follow-up consultation to check your progress; in the meantime, our physiotherapy team will work with you to offer exercises to aid in your recovery.
With a multi-disciplinary team at Circle Reading for all your treatment needs, I would certainly encourage you to book a consultation with me if you are experiencing any of the symptoms mentioned here. Without any waiting lists, I can get you diagnosed quickly, and can advise you if spinal decompression may benefit you.