Our spine is made up of a stacking of individual bones known as vertebrae and intervertebral disks cushioning between them. Such arrangement forms a spinal cavity through which our spinal cord runs and protects against any potential damage.

The nerves that form the spinal cord passes through the openings between the vertebrae to other parts of our body. Sometimes, the nerves may get compressed due to the pressure from the surrounding structures such as bones, ligaments or soft tissues. This condition is known as nerve compression. This can happen anywhere along your spine, from your neck down to your lower back..

What are the conditions that may cause nerve compression?

The conditions that may cause nerve compression in spine may include:

• Bone spurs
• Bulging or herniated discs
• Spinal stenosis or narrowing
• Degenerative conditions like arthritis
• Improper bone alignment
• Spine injury
• Spine tumors
• Spinal infections

What is nerve decompression?

Nerve decompression is a surgical procedure to relieve symptoms associated with compressed nerve. The goal of the procedure is to either remove the structure that is creating pressure or to open up the narrowed space for the nerves.

When do we need to undergo nerve decompression?

A compressed nerve can cause pain, numbness, tingling, and muscle weakness. It may also lead to bowel or bladder incontinency and paralysis in severe cases. The symptoms may develop suddenly or gradually, depending on the cause of compression.

You may be a candidate for spinal nerve decompression if your symptoms persist even after trying conservative methods, such as physical therapy and painkillers for extensive period. Other conditions, such as Cauda equine syndrome (compression of nerve roots at the lower end of the spinal cord known as Cauda equine) may require immediate surgical intervention to release the compression.

What are the different procedures to perform nerve decompression?

The common procedures of nerve decompression include:

• Diskectomy: Removing a portion of a disk.
  
  
• Laminotomy or Laminectomy: Removing a section of lamina (bony arches of the vertebral arch) or entire lamina.
  
  
• Foraminotomy or forminectomy: Enlargement of the openings from which the nerves exit the spinal cord by removing the sections of bone or tissues.
  
  
• Osteophyte (bone spur) removal: Removal of bony growths called bone spurs.
  
  
• Corpectomy: Removal of damaged portion of the vertebrae and the intervertebral disks.

In some cases, spinal fusion may also be required. Spinal fusion is a surgical procedure that involves fusing the vertebrae with the help of screws or bone implants.

How to prepare for the surgery?

It is always important to discuss with your doctor to make yourself prepared for the surgery.

• Medications: Discuss about the medicines you take, as you may need to stop certain medications such as aspirin two weeks before surgery. Other medicines, such as painkillers are to be discontinued as per the doctor’s advice.
  
  
• Smoking: It is also recommended to stop smoking as it slows down bone healing.
  
  
• Ask for assistance: You may have to arrange someone to drive you home and to help you at home for few days.

What happens before the surgery?

A night before the surgery you will have to follow the instructions carefully regarding when to stop eating or drinking to avoid anesthesia complications.

On the day of the surgery

• On the day of surgery, you need to arrive in the hospital at your scheduled time.
• Remove all the accessories and jewellery; as well as contact lenses, eyeglasses and dentures.
• You need to change your dress and wear hospital gown.

What happens during the surgery?

The duration of the surgery depends on the extent and severity of the nerve compression.

• Before the surgery you will be given anesthesia to make you sleep while performing the surgery.
• You may also be given antibiotics to prevent infections.
• The surgery is performed while you are lying on your stomach
• Depending on the extent of the condition, the surgeon makes an incision in your back at or near the spine.
• Now, the muscles are moved in such a way that your spine is exposed. The surgeon will then locate and remove the tissue hat is causing pressure on your spinal nerves. Procedures, such as spinal fusion may be performed as required before closing the incision.
• The incision is then closed with the help of stitches or staples.

What happens after the surgery?

Post-surgery you will be shifted to recovery area in the hospital. You may be given medication to overcome pain. With the use of regular medication, you may notice improvement in the symptoms gradually. Nurses or a physical therapist may help you to move and to take few steps after your surgery. The surgery is usually minimally invasive allowing the patients to be discharged within a day or two. However, some patients may require longer hospital stay depending on the complexity of the surgery.

What is the post-surgical care to be followed?

You may be discharged from the hospital once your doctor confirms that your pain is under control and fit for discharge. You may need to continue pain medication as recommended and follow the instructions regarding wound care. It is important to avoid strenuous activity, such as heavy lifting, bending or twisting for about three months post-surgery. You may return to your work as per doctor’s advice. It is always beneficial get to involved in a rehabilitation program with the help of a physical therapist for better recovery.

What is the outlook of the surgery?

The recovery from the surgery is usually fast. It helps in eliminating pressure on the nerves and may provide immediate or gradual relief from pain. It can also prevent worsening of associated symptoms like numbness and weakness.

What are the risks involved in the surgery?

Nerve decompression surgery includes the risks involved in any other surgery like bleeding, infection, blood clots or allergic reaction to anesthesia.

Other risks associated with nerve decompression include:

• Nerve sac injury
• Damage to spinal nerves or spinal cord
• Spinal instability
• Failure in providing symptom relief

References

1. https://my.clevelandclinic.org/health/articles/10874-spinal-decompression-surgery

2. https://intermountainhealthcare.org/ckr-ext/Dcmnt?ncid=520444805

3. https://www.columbiaspine.org/treatments/anterior-cervical-corpectomy/

4. https://www.webmd.com/back-pain/guide/spinal-decompression-therapy-surgical-nonsurgical#2