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Spinal decompression

If you are considering surgery to fix trapped nerves in your back (spinal decompression), or have an operation planned, it is important to know all you can about it. This includes:

 

  • why you need a spinal decompression operation

  • what it will be like

  • how it will affect you

  • what risks are involved

  • any alternatives.

 

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when carrying out spinal decompression, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your choices of treatment for trapped nerves in your back with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

 

What is the problem?

You have pains in your legs because bone and ligaments are squashing the nerves in your spine (trapped nerves). The pain may be worse when you walk. You may also have had, and may still have, some back pain. You may also have weakness in your legs.

 

What is the spine?

The spine consists of 33 bones, called vertebrae. You have 5 vertebrae in your lower back. This is called the lumbar region. The front of each vertebra is solid and is called the vertebral body. Behind the body of each vertebra is an arch of bone called the lamina. The arches form a channel (the spinal canal or vertebral canal), which protects the spinal cord and nerves. The spinal cord runs up the vertebral canal to your brain. In the vertebral canal, the spinal cord and nerves are covered with a sleeve of tissue called the dura and are bathed in a watery liquid, called cerebro-spinal fluid (CSF). Ligaments hold the arches together. The ligaments are layers of gristle running inside the arches.

Spinal decompression

Between each vertebra there is a disc (intervertebral). The disc fits between each vertebral body. The discs act like shock absorbers to let the spine bend and twist.

 

Behind the discs are nerve roots, which leave the spinal cord to supply various parts of the body e.g. the legs, arms, etc. The nerves (called nerve roots) come out of the spinal canal at regular intervals and join up to form major nerves. The nerve roots pass through gaps in the bony arches.  Each gap is called a foramen.

 

The spinal nerves and cord carry feeling impulses from the body up to the brain and other impulses down from the brain to the muscles. The lowest spinal nerves run to the buttocks and bladder.

 

The spinal nerves run close to small joints on the sides of the bony arches. These joints, called facet joints, let one vertebra move on another, as you bend and twist your spine.

 

What has gone wrong?

As you get older wear and tear (degenerative changes) starts to affect the spine. Sometimes underlying conditions of the spine can lead to earlier degenerative changes. These changes can include: 

 

  • Arthritis causing changes resulting in bony spurs which press on the nerve roots (facet joint enlargement). These bony spurs press on the nerves just outside the arches
  • The ligaments in the spinal canal get thicker with age and press on the nerve roots. There is not enough room for your nerve roots within your spinal canal. This is called spinal stenosis
  • The discs between the vertebrae dry out with age. This allows the vertebrae to close together so that the gaps between the arches become smaller. The nerve root gets squashed as it passes though the foramen

 

The aims

The aim is to make more room for the nerves by removing the bone or ligament that is pressing on the nerves.

 

The benefits

The operation should stop the pain in your legs. If you have back pain this may improve. It will also help any weakness you may have.

 

Are there any alternatives?

Painkillers and anti-inflammatory drugs can help the pain. Some patients find that an injection of anti-inflammatory steroid around the nerves in the back can control the pain, but not the weakness. This injection is called an epidural. However, the pain can come back when the injection wears off.

 

Physiotherapy or osteopathy can help reduce back pain, but does not usually reduce leg pain or weakness.

 

What if you do nothing?  

If you do not have an operation, your pain is likely to continue and may get worse over time. If you have weakness or numbness, this may also get worse.

 

Who should have it done?

If you have numbness and weakness (neurological symptoms) or difficulties passing or controlling your urine, you should have an operation.

 

If you do not have neurological symptoms, you should have the operation if ALL of the following apply to you:

 

  • Tablets do not control your pain
  • Your leg pain is worse than your back pain
  • Your leg pain is interfering with your quality of life
  • You have had a special scan that shows that you have compression of the nerves in your back (trapped nerves)

 

Who should not have it done?

The aim of the operation is to cure your leg pain. Your back pain may still be there after the operation. If your back pain is more of a problem than your leg pain, you may need a different operation.

 

Author: Mr Boyd Goldie MBBS FRCS BSC DHMSA. Consultant in orthopaedics & trauma.

© Dumas Ltd 2006

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