Anaesthetics - Awake Lumbar Decompression Surgery

What is lumbar decompression?

Lumbar decompression is a procedure through which a surgeon aims to relieve pressure on your spinal nerves.

Compressed spinal nerves can cause symptoms such as pain, numbness, tingling, and in some cases can even affect your ability to move or control your bladder and bowels.

The word lumbar is a medical term used to refer to a portion of the lower back.

Types of decompression surgery

There are different types of lumbar decompression surgery. The type that is best for you will depend on what is causing the compression of your spinal nerves.

Options for surgery without general anaesthesia are laminectomy and discectomy.

Discectomy - Where a section of a damaged disc is removed

Laminectomy - Where a section of bone is removed from one of your vertebrae (spinal bones) to relieve pressure on the affected nerve

Please scan the QR code below to view a video that will provide more detail on these procedures, including their risks.

Before the surgery

It helps if you are as fit as possible before surgery, to help you recover from your operation and reduce your risk of complications.

As soon as you know you're going to have lumbar decompression surgery, it's recommended to stop smoking, eat well and exercise regularly.

Pre-operative assessment

You'll be asked to attend a pre-operative assessment appointment a few days or weeks before your operation.

During this appointment, you may have some blood tests and a general health check to make sure you're fit for surgery, as well as an X-ray or magnetic resonance imaging (MRI) scan of your spine.

This assessment is a good opportunity to discuss any concerns you may have or ask questions about your operation.

You should be told who will be doing your operation and you may be introduced to them. Lumbar decompression surgery is carried out either by a neurosurgeon or an orthopaedic surgeon with experience in spinal surgery.

The Operation

You'll be admitted to hospital either on the day of your operation or the day before. Your surgeon and anaesthetist will explain what will happen during the operation. This will give you the opportunity to ask any questions you may have.

Before the operation, you'll be asked to sign a consent form to confirm that you know what's involved and the potential risks.

Unlike operations done under general anaesthesia, you won’t need to stop eating or drinking before your surgery, as only a spinal anaesthetic will be needed.

The spinal anaesthetic will ensure you do not feel any pain during the operation. Unlike general anaesthetics, spinal anaesthetics do not put you to sleep. Spinal anaesthetics are also used in types of surgery, like c-section deliveries and hip replacement.

Though you will be awake during the procedure, you will not have to see the surgeon operating during the surgery. A partition will be put in place if needed.

Members of the operative team will communicate with you throughout the surgery to make sure everything is going well and address any concerns you may have.

The exact level of decompression required will be determined using an X-ray. An incision will be made in the middle of your back, running vertically along your spine. The length of the incision will depend on:

• How many vertebrae and/or discs need to be treated
• The complexity of the surgery
• Whether fusion has been considered

The muscles in your back will be lifted from the backbone, to expose the back of the spine. The affected tissues or nerves will be removed little by little, taking the pressure off the spinal cord or nerves. Once adequate decompression has been achieved, the muscles will be stitched back together, and the incision will be closed and stitched up.

For more information on spinal anaesthesia, please refer to the Royal College of Anaesthetists leaflet on 'spinal anaesthetics' by scanning the QR code below:

This is how you will be positioned on the operating table during your surgery. This position gives the surgeon good room to operate and is optimised for comfort. More specific adjustments can be made to maximise your comfort.

After the surgery

Your nurse will help make you comfortable and monitor your blood pressure and pulse (and temperature if needed).

They will explain any drips, drains, packs or bandages you may have and will give you tablets or injections for pain and sickness if you need them.

What are the benefits of having my surgery while awake?

Benefits to yourself

When general anaesthetics aren’t used, recovery after operations can be faster. This means it is more likely you will be able to go home earlier.

Studies have shown that after awake surgery, patients have a lower risk and shorter periods of post-operative pain, nausea and headaches.

Benefits to the environment

Anaesthetic gases are used for general anaesthesia, these can be powerful greenhouse gases. Studies have shown that these gases contribute to a major part of hospital greenhouse gas emissions. These gases are not needed during awake surgery.

Artificial airways are made of disposable materials. These airways are not usually needed during awake surgery. This is one way awake surgery can reduce waste and help minimise the carbon footprint of surgery.