This group of procedures is all about removing an area of bone or tissue which is compromising the spinal cord within the spinal canal or the nerve roots as they leave this area through the neural foramina. Depending on the cause of the complaint, there are generally three methods Nick uses to do this:
This procedure is undertaken where there is irritation or compression to neural tissue by boney or ligamentous growth and is more commonly known as spinal stenosis (see pictures below). These changes are normally a reflection of chronic wear or segmental overload. In simple terms, each level or segment of the spine should operate mechanically within a certain optimal range but changes in the spinal biomechanics such as disc degeneration can cause overloading of the joints and surrounding tissues. This will commonly lead to a narrowing of both the spinal canal and neural foramen (see spinal stenosis section for anatomical details) leading to symptoms in the back and lower limb/s.
Decompressive surgery is basically the removal of these intrusive tissues or bony spurs to restore to openings thus allowing ample room for unobtrucive travel of the neural tissue.
2) Partial Discectomy
The diagram below shows an overhead view of an intevertebral disc that has deveolped a one sided disc bulge, in this case on the left hand side. The level of bulge and consequential nerve compression will govern the type and severity of your symptoms. Minor disc bulges will often settle with conservative management however if this is not the case or, there are gross neurological deficits (drop foot, continous numbeness, pins and needles, bowel/bladder dysfuntion) then a partial discectomy may be necessary.
Although this surgery may not appear as techniquely challenging as more invasive procedures such as fusions, there is an art form to removing enough disc material to remove your symptoms but leaving enough in situ to maintain your normal spinal as much as possible. Occasionally it is necessary to remove far more disc material (radical discectomy) but this would only be in severe or recurrent presentations. In some cases a minimal laminotomy may also be undertaken which removes a small section of the bony arch (picture above and to right, the bony thinner part of the bony ring behind the yellow spinal cord) to help relieve any remaining pressure.
3) Discectomy/Decompression (D/D)
This is quite simply when a mixture of both procedures is warrented and is really quite common in disc related surgery.
There is more detailed anatomical inroation pertaining to spinal stenosis and disc prolapse/herniation on their didicated pages with good links to altrnative sites for further learning. For more in depth information regarding precedural descriptions, intial rehabilitation and precautions, please click here for our pre operative booklet. This aid is distributed to all of our clients however it is freely available to download here within the ‘pdf leaflets’ section. If you are not patient then please be aware that the post operative information is related to our individual practice and this may vary from surgeon to surgeon and you must always follow the advice of your own individual consultants. The anatomical and surgical descrip[tion will applicable in a morjoity of sitautions however so ma be useful to you as a reference tool.
A pre-surgery questionnaire is completed upon your admission and scores your pain and functional restrictions, that is how you are coping with general daily activites. This score is converted into a percentage figure that then allows us to catagorise you into one of five groups:
a) 0-20% = Minimal
b) 21-40% = Moderate
c) 41-60% = Severe
d) 61-80% =Crippled
e) 81-100% = Bedbound
You will be sent the same questionnaire complete with a patient satisfaction form on your 3 month surgical anniversay by post, which we ask you to return promlty in the stamped addressed envelope. This primarily allows us to monitor your progress but also allows us to undertake regualar audits so we can make our service to you as effective as possible. We can also use this data however to give patients an idea prior to surgery as to what their improvement can be estimated to be on average. This can be shown in the 3 charts below, one for each individual procedure. Each of the 5 catagories (a-e) have been pooled and the average score recored at the pre and 3 month timeframe. The data was collected from all patients undergoing surgery between 1st March 2008-9. We try to update these 6-12 monthly.
e.g You are coming in for a D/D and your preop score is catagorised as moderate. This encompasses score range of 21-40 but as you can see on the chart (maroon) the average was a score of 29.14%. The average score for this group of people at the 3 month follow up was 8.67%. This is a guide for you to give you a ‘ball park figure’ however you should always appreciate that each and every one of you is different and this will be reflected in the individual scores.
If you need to undergo any of these interventions then the details will be discussed with you individually by Nick however you will also be encouraged to read for yourself to broaden your understanding and is the main reason for this sites evolution. Should this further reading then lead to any queries you can be sure to raise then before your surgery goes ahead.