Risks of lumbar decompression surgery

Like all surgical procedures, lumbar decompression surgery carries some risk of complications.

Recurrent or continuingsymptoms

Lumbar decompression surgery is generally effective in relieving symptoms such as leg pain and numbness. However, up to one in three people continue to have symptoms after surgery, or develop symptoms again within a few years of surgery.

Recurrent symptoms can be caused by a weakened spine, another Slipped disc , or the formation of new bone or thickened ligament that puts pressure on your spinal cord. Scarring around the nerves can also sometimes develop after surgery, which can cause similar symptoms to nerve compression.

Non-surgical treatments, such as physiotherapy , will usually be tried first if your symptoms recur, but further surgery may sometimes be needed. Repeat operations have a higher risk of complications than first-time operations.

Unfortunately, there's no effective treatment for scarring around the nerves. However, you can reduce your risk of scarring by doing regular exercises as advised by your physiotherapist after surgery.

Infection

One of the most common complications is an infection where the incision was made. This is estimated toaffect up to one in every 25 people who have lumbar decompression surgery. Itcanusually be treated successfully with antibiotics .

Blood clots

There's a risk of developing a blood clot after lumbar decompression surgery, particularly in your leg. This is known as deep vein thrombosis (DVT) .

DVT can cause pain and swelling inyour leg and,in rare cases,may lead to a serious problem called a pulmonary embolism . Thisis where a piece of the blood clot breaks off and blocks one of the blood vessels in the lungs.

The risk ofdeveloping a blood clotcan be significantly reduced by staying active during your recovery or wearing compression stockings to help improve your blood flow. The dura is a watertight sac of tissue that covers the spinal cord and spinal nerves.

Theres some uncertainty about the actual likelihood of a dural tear occurring, with estimates varying from around 2% to 17% of people who have spinal surgery.

If the tear isnt identified and repaired at the time of surgery, it can lead to cerebrospinal fluid (CSF) leaking after the procedure (see below).

Your surgeon will be aware of the risk of a dural tear, and if it does occur will close the tear with stitches. In most cases, the repair is successful and no further problems or issues arise. However, further corrective surgery may be required in a small number of cases.

Leakage of cerebrospinal fluid

During lumbar decompression surgery, there's a risk of accidental damage to the lining of thenerve, which can lead to the leakage of cerebrospinal fluid (CSF).

If this is discovered during the operation, it will be patched and repaired. However, small leaks can sometimes only become apparent after the operation, causing problems such as a headache and the wound to leak.Further surgery to repair this may be needed.

Facial sores and loss of vision

As you're positioned face down during lumbar decompression surgery, you'll be resting on your forehead and chin while the operation is carried out.

The anaesthetist will check regularly to make sure this isnt causing any problems, but many people will wake up with a slightly puffed up face. In some cases, a red sore can develop over the forehead or chin, which could last several days.

In very rare circumstances (about one in every 30,000 cases), a person can slip during the operation and rest on their eyes rather than forehead and chin. This couldlead to loss of vision.

Nerve injury and paralysis

Around one in every 20-100 people who has lumbar decompression surgery will develop new numbness or weakness in one or both legs as a result of the operation.

Paralysis is an uncommon, but serious, complication that can occur as a result of lumbar decompression surgery. It's estimated to occur in less than one in every 300 operations.

Nerve injuries and paralysis can be caused by a number of different problems, including:

• bleeding inside the spinal column (extradural spinal haematoma)
• leaking of spinal fluid (incidental durotomy)
• accidental damage to the blood vessels that supply the spinal cord with blood
• accidental damage to the nerves when they're moved during surgery

Death

As with all types of surgery, there's a risk of dying during or after lumbar decompression surgery, although this is rare. A blood clot, a bad reaction to the anaesthetic and blood loss can all be life-threatening.

The British Association of Spine Surgeons (BASS) estimate that there's around one death for every 350 operations carried out to treat spinal stenosis, and one death for every 700 operations carried out to treat a slipped disc.

The risk of death is higher for spinal stenosis, because most people with the condition tend to be older and in poorer health than people with a slipped disc.