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Spinal decompression

Spinal decompression is the procedure which reduces pressure on the spinal cord.

Spinal decompression is the relief of pressure on the spinal cord or on one or more compressed nerve roots passing through or exiting the spinal column.[1] Decompression of the spinal neural elements is a key component in treating spinal radiculopathy, myelopathy and claudication.

Surgical methods

Decompression of nerve roots

When a single spinal nerve root is compressed, the resulting clinical outcome is termed radiculopathy, and is usually labeled according to the specific nerve root compressed (hence, compression of the nerve root exiting the spinal column below the left-sided pedicle of the L5 vertebra will be diagnosed as "left L5 radiculopathy").

Microdiscectomy (or microdecompression) is a minimally invasive surgical procedure in which a portion of a herniated nucleus pulposus is removed by way of a surgical instrument.[2] The purpose of this procedure is to relieve the pressure and reduce the local inflammatory reaction around a nerve root, caused by the herniated nucleus pulposus.

Decompression of the spinal cord or cauda equina

Laminectomy is an open or minimally invasive surgical procedure in which a portion of the posterior arch of the vertebrae and/or spinal ligaments is removed from the spine to alleviate the pressure on the spinal canal contents. This procedure is usually performed when decompression of more than one nerve root is needed. In the lumbar spine, it is commonly used to treat spinal claudication caused by spinal stenosis, and is considered the most effective treatment for this condition based on current evidence.[3] In the cervical and thoracic spine it is used to treat myelopathy caused by compression of the spinal cord itself.

Non-surgical methods

Physiotherapy

Traction is offered as a non-surgical method of spinal decompression.[4] A 2021 meta-analysis showed physiotherapy was an effective method of managing prolapsed lumbar intervertebral discs;[5] but was unable to establish the source of the pain relief reported.

Mechanical traction

Mechanical traction decompression has been shown to be superior to conventional physical therapy (physiotherapy) in the short term (weeks), but not in all long-term (over 6 months) studies.[6]

Nucleoplasty

Nucleoplasty is the removal of tissue from the nucleus pulposus using a bipolar radiofrequency device. Nucleoplasty reduces patient pain and increases patient mobility, with a minimally invasive procedure having few complications.[7]

See also

References

  1. ^ Spinal Stenosis~treatment at eMedicine
  2. ^ "Back and Leg Pain – Definition List | Resources | HJD Spine Center". Med.nyu.edu. Archived from the original on 25 August 2010. Retrieved 18 December 2010.
  3. ^ Weinstein, James N.; Tosteson, Tor D.; Lurie, Jon D.; Tosteson, Anna N.A.; Blood, Emily; Hanscom, Brett; Herkowitz, Harry; Cammisa, Frank; Albert, Todd; Boden, Scott D.; Hilibrand, Alan; Goldberg, Harley; Berven, Sigurd; An, Howard (2008). "Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis". The New England Journal of Medicine. 358 (8): 794–810. doi:10.1056/NEJMoa0707136. PMC 2576513. PMID 18287602.
  4. ^ Daniel, DM (18 May 2007). "Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media?". Chiropractic & Osteopathy. 15: 7. doi:10.1186/1746-1340-15-7. PMC 1887522. PMID 17511872.
  5. ^ Singh, V; Malik, M; Kaur, J; Kulandaivelan, S; Punia, S (March 2021). "A systematic review and meta-analysis on the efficacy of physiotherapy intervention in management of lumbar prolapsed intervertebral disc". International Journal of Health Sciences. 15 (2): 49–57. PMC 7934127. PMID 33708044.
  6. ^ Wang W, Long F, Li S, Lin J (2022). "Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis". Computational and Mathematical Methods in Medicine. 2022 5670303. doi:10.1155/2022/5670303. PMC 9239808. PMID 35774300.
  7. ^ Eichen PM, Achilles N, Kirchner R (2014). "Nucleoplasty, a minimally invasive procedure for disc decompression: a systematic review and meta-analysis of published clinical studies". Pain Physician. 17 (2): E149–E173. PMID 24658486.

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