There are several underlying issues that may lead a patient to consider decompression surgery. In general, decompression surgery refers to any procedure done to relieve pressure on the spinal cord or nerve roots that causes pain. This includes: bulging discs, collapsed discs, thickened joints, loosened ligaments and bony growths that narrow the spinal canal and nerve openings. “Minimally invasive” refers to the techniques and technology used during the surgery.
There are many procedures that focus on decompressing the spinal cord and/or nerve roots, but only some are minimally invasive. These include: foraminotomy, facet thermal ablation, laminotomy and discectomy. Which procedure a patient undergoes often is related to the ailment causing the spinal compression. For example, facet thermal ablation treats facet disease and arthritis of the spine but will not relieve a herniated disc. Many patients will opt for minimally invasive procedures when offered because it gives them a shorter recovery time and reduces many of the risks associated with open back surgery, including infection and blood loss.
During these procedures, part of a damaged disc is removed to relieve pressure on the spine. In many cases, bony spurs are also removed to release pinched nerves and reduce pressure put on the spinal cord. Sometimes a surgeon will use a tool to widen the openings, affectively relieving pressure on the spine and nerve roots.
Recovery is faster when only part of the damaged disc is removed because it is able to heal and stabilize the spine without the use of prosthetics or additional hardware.
During a disectomy—one of the common options for a minimally invasive disc compression procedure—the surgeon makes a one inch incision in the back (considerably smaller than open procedures) and uses small tools to access the damaged disc. Muscles are pushed aside instead of cut, reducing post-operative pain and further speeding up recovery time. When additional stabilization is needed, an artificial implant and sometimes a bone graft are used instead of larger hardware.
A foraminotomy is a laser-assisted procedure that relieves pressure on nerves that exit the spinal cord; often caused by herniated/bulging discs, scar tissue, bone spurs, thickening of the ligament and facet hypertrophy. In most cases this procedure is done to treat pain associated with foraminal stenosis.
In a laminotomy—another laser-assisted procedure—pressure caused by spinal stenosis is relieved by addressing the cause of stenosis (i.e. a herniated or bulging disc, bone spurs, hypertrophy of the ligament flavum, facet hypertrophy and scar tissue). This procedure addresses lamina, small bones at the back of vertebrae, that may compress the spine. This is most commonly caused by narrowing of the spinal canal, or spinal stenosis.
The laser-based facet thermal ablation targets the facet joint, deadening the nerves inside using a laser and correcting stiffness and loss of motion. With a minimally invasive approach, the chances of damaging surrounding nerves and tissues is greatly reduced.
The goal of minimally invasive decompression surgery is to relieve pain, numbness, tingling, weakness or unsteadiness caused by spinal compression. The surgery decompresses the spine, often widening the spinal canal or nerve root openings to lessen pressure felt on the spine.
Those who undergo a spinal decompression typically experience less pain and a reduction in other symptoms associated with spinal compression, including numbness, tingling, weakness or unsteadiness. In severe cases, patients experience mobility issues including paralysis and problems with their bladder or bowel. Decompression surgery can reverse all of these issues. With minimally invasive procedures, risks of complication are reduced and recovery time is faster. Most patients are back on their feet within a couple of hours of the procedure. Better mobility and less stiffness are also reported following surgery.
There are risks with every surgery, including many that are associated with general anesthesia specifically. All patients should be aware of the potential risk for infection and blood loss that could lead to an infusion (although those risks are reduced with minimally invasive procedures). Other risks include pain at the graft site, nerve damage, blood clots, complications from anesthesia, leaking of spinal fluid and persistent pain after surgery/minimal relief from pain. Most of these risks are lower with minimally invasive surgery when compared to open procedures.
Pain, numbness, tingling, weakness or instability in the back, neck, arms and legs associated with a pinched nerve. Other symptoms of degenerative disc disease should also subside, including decreased mobility and stiffness.
More invasive spinal decompression surgeries are available. Open back surgery uses a larger incision to allow access to the affected spine. Some hospitals so not offer minimally invasive disc decompression surgeries or have a small staff that are trained in the tools.
Costs for minimally invasive procedures tend to be lower than open procedures. Laser spine surgeries in general run about $30,000-$90,000. Insurance will often cover part of or all of a procedure, so check with your provider for a more accurate estimate. Sometimes cost for these procedures end up running more because of the technology needed to perform them. Undergoing MISS (minimally invasive spine surgery) also limits where patients can go for treatment as surgeons have to be trained in this unique type of surgery.
Laser Spine Institute. “Minimally Invasive Decompression Surgery.” Laser Spine Institute. Accessed May 15, 2018. https://www.laserspineinstitute.com/spinal_orthopedic_procedures/minimally_invasive_surgery/.
Laser Spine Institute. “Minimally Invasive Disc Decompression.” Laser Spine Institute. Accessed May 15, 2018. https://www.laserspineinstitute.com/back_problems/degenerative_disc_disease/treatment/decompression/.
“Minimally Invasive Spine Surgery.” Johns Hopkins Medicine Health Library. Accessed May 15, 2018. https://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopaedic/minimally_invasive_spine_surgery_135,350.
“How Much Does Laser Spine Surgery Cost? – CostHelper.com.” CostHelper. Accessed May 15, 2018. http://health.costhelper.com/laser-spine-surgery.html.