Lumbar decompression back surgery considerations

For a lumbar decompression (a discectomy, microdiscectomy or laminectomy), it can take a long time for the nerve root to heal. In general, if a patient is getting better within three months following the back surgery, he or she should continue to get better. If there has not been any improvement within three months, then the back surgery can be assumed to be unsuccessful, and further work up would be reasonable. Within the first three months the success of the back surgery really cannot be judged.

Lumbar decompression surgery will usually relieve the patient’s leg pain directly after the back surgery. However, for 10-20% of patients the pain will continue until the nerve starts to heal. In some cases, the pain may even be worse for a while after the back surgery because operating around the nerve root creates some increased swelling and this leads to pain.

Recurrent stenosis or disc herniation after back surgery
Years after a decompression surgery (lumbar laminectomy), the stenosis can come back (the bone can grow back) at the same level, or a new level can become stenotic and cause back pain and/or other symptoms.

Pain that is relieved right after back surgery but then returns abruptly is often due to a recurrent lumbar disc herniation. Recurrent lumbar disc herniations happen to about 5% to 10% of patients, and they are most likely to occur during the first three months after the back surgery.

Technical problems after back surgery
Three potential technical problems that can cause pain to continue after back surgery include:

• Missed fragment (of the disc or bone) is still pinching the nerve
• The back surgery operation was done at the wrong level of the spine.

Nerve damage during a discectomy or a lumbar decompression back surgery is very uncommon, but has been reported in about 1 in 1,000 cases. When it does occur during back surgery, a permanent neurological deficit with new weakness in a muscle group is possible, and a postoperative EMG (electromyography) can be helpful to see if there has been nerve damage and if there is any reinnervation (nerve healing) after the back surgery.

All of these technical problems following a back surgery should be very uncommon.

At times, decompressing a nerve root through back surgery will cause it to become more inflamed and lead to more pain temporarily until the inflammation subsides.

Inadequate decompression of a nerve root after back surgery
Decompressing a nerve root with back surgery is not always successful, and if a portion of the nerve root is still pinched after the back surgery there can be continued pain. If this is the case, there will usually be no initial pain relief following the back surgery, and subsequent postoperative imaging studies may show continued stenosis in a portion of the spine.