Some surgeries are less invasive, such as the X-Stop procedure where an interspinous process device is placed at the back of the spine to restore intervertebral height and prevent the patient from bending too far backwards. This can provide effective relief from sciatica and associated symptoms in a similar fashion as to when a patient with sciatica bends forward and relieves spinal nerve compression. More invasive decompression back surgeries can allow the surgeon to ascertain the degree of decompression achieved much more easily than in the minimal access techniques. However, those operations which are much more invasive than an X-Stop procedure and use traditional open techniques often require several muscles and ligaments to be cut in order to access the degenerative material putting pressure on the spinal nerves and spinal cord. A laminectomy, for example, may successfully decompress the spine across many vertebral levels but the significant degree of tissue removed often necessitates a bone graft in order to maintain the spine’s stability after surgery. A secondary procedure to harvest bone from a patient’s iliac crest may be performed, or donor bone used, to facilitate fusion between the vertebrae in the spine where the lamina was removed. This can take months, or even years, to fully recover from and involves various risks including spinal nerve or cord damage, pseudoarthrosis, adjacent segment syndrome, and infection.
Foraminotomy, Laminotomy, and Discectomy
Decompression back surgery such as foraminotomy and laminotomy may be performed in either a minimally invasive fashion using endoscopic techniques or open traditional methods. These surgeries are often combined in order to allow pressure to be removed from both the nerve roots as they exit the foramen and the spinal cord itself. Osteophyte growth or disc fragments may cause pinched nerves in the back or neck and a foraminotomy can widen the foramina to remove them. A discectomy may also be performed alongside a foraminotomy or laminotomy to achieve further decompression, although this may then risk a loss of intervertebral height and the need for further, stabilization surgery at a later date.
Bulging discs rarely require surgery in order to decompress the spine as they often resolve themselves within a number of weeks. Symptoms, such as radiculopathy, neck or back pain, and alterations in sensation are likely to be treated conservatively for the first six months at least, with back surgery usually only considered if medications, physical therapy, and activity avoidance fail to relieve the condition. Specific exercises for a bulging disc can help prevent the need for decompression back surgery, although these should be discussed with a physical therapist in order to reduce the risk of exacerbating the disc bulge or herniation.
Other reasons for decompression back surgery include the excision of tumors in the spinal canal, or the removal of a hypertrophic facet joint or other structure. These may be isolated cases and require a single procedure to achieve decompression. However, they may involve the use of adjunct therapies to address more widespread problems such as a cancer which has metastasized, or an autoimmune condition such as rheumatoid arthritis.
Non-surgical decompression techniques do exist, and may provide benefit for some patients; usually those with milder symptoms. Non-surgical traction may be offered at a chiropractor’s clinic, for example, although this has little in the way of research or clinical trial evidence proving its efficacy or safety. Tra