This procedure is performed for spinal canal stenosis (decreased space in the spinal canal for the nerves) leading to neurogenic claudication. Typically this presents with pain in the legs and buttock with standing and walking, and generally resolves with rest. Often people find leaning forward helpful, such as walking with a shopping trolley.
Non-surgical treatments such as physiotherapy, weight loss, simple analgesia and steroid injections are generally recommended as the first line of management. For patients who do not improve and the symptoms are causing limitations in everyday activities, surgery is an option.
Xray is used to guide the position of the incision, and then a vertical incision is made at the appropriate location. The muscles are dissected off the spinous process and a specialised retractor is placed to allow for visualisation.
Once the correct level has again been checked, part of the spinous process is removed and an operative microscope is then used for the remainder of the procedure. A high speed surgical drill is used to remove enough of the lamina to address the area of compression. Using special spinal instruments the thickened ligamentum flavum, overgrown facet joints, and where appropriate disc herniations are removed. The nerves that exit at that level are checked into their foraminae (exit holes), and the top and bottom of the decompressed area are thoroughly checked to confirm that the compression has been fully removed.
You will have a urinary catheter and sometimes a surgical drain to prevent a haematoma. You will be monitored in the recovery until you are safe to be taken to the surgical ward.
You will begin to walk under the supervision of a physiotherapist on the day after surgery. You will have the drain tube and catheter removed when safe, and you will be given enough pain killers to make you comfortable. Once you have been assessed by the hospital team (including nursing staff, physiotherapist, occupational therapist, general physician, rehab physician and Dr Anderson), you will be given options for your ongoing recovery. Your progress so far will determine if it is best for your recover at home with outpatient rehabilitation, or as an inpatient in a rehabilitation facility. Most patients will stay in the acute hospital for 3-4 days after their operation.
Most people will have a reduction in the amount of leg pain, however in some instances this does not completely resolve or may take some time to improve. The risk of this is higher if you have had the symptoms for a long period of time.
The risks of surgery include, but are not limited to:
Dr Anderson will discuss these with you during your consultation, as well as any other specific questions that you may have about the procedure