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Key points
- A discectomy removes the piece of disc pressing on a nerve; a decompression removes bone or thickened tissue narrowing the spinal canal.
- Both operations are mainly for leg pain (sciatica or spinal stenosis), not back pain.
- Most sciatica settles without surgery, so operations are usually reserved for pain that has not improved after several weeks.
- Surgery tends to speed up recovery, but long-term results with and without it are often similar.
- Serious complications are uncommon, and your surgeon will discuss your individual risks.
What are these operations?
Spinal nerves leave the lower back through narrow channels before travelling down the legs. If something presses on them, the result is often pain, tingling, numbness or weakness in the leg.
- Discectomy treats a slipped (prolapsed) disc. Only the bulging fragment pressing on the nerve is taken out; the rest of the disc stays in place. This is the usual cause of sciatica in people in their thirties and forties.
- Decompression treats lumbar spinal stenosis, a narrowing of the canal caused by age-related changes. It is more common in older people and typically causes leg pain or heaviness when standing or walking (sometimes called spinal claudication). Bone and ligament that crowd the nerves are trimmed away.
Some people need a combination of the two.
Do I need surgery?
Often not. The British Association of Spine Surgeons (BASS) web pages note that 75% of people seeing their GP with a first episode of sciatica are better within 28 days. The BASS disc protrusion booklet adds that around 6 in 10 improve by six weeks and 7 to 8 in 10 by three months. Painkillers, staying active, physiotherapy and nerve root injections can help while this happens.
According to BASS, surgery is generally considered when severe leg pain has not settled after about 6 to 8 weeks, and some research suggests operating around four months after symptoms began may give the best results. These operations are about quality of life, so the decision is shared between you and your surgeon. Earlier surgery may be needed if there is significant nerve damage or cauda equina syndrome.
Research such as a Dutch trial cited by BASS found that early surgery relieved sciatica faster, but by one year results were similar to those of people who waited. Faster recovery is the main advantage of operating.
The operation
Both procedures are usually done under general anaesthetic. The most common technique is a microdiscectomy, performed through a small midline cut (BASS describes it as usually up to about 4 cm) using an operating microscope. The muscles are moved aside, a window is made between the bones, the nerve is gently eased to one side and the disc fragment is removed. Variations include tubular and endoscopic (keyhole) approaches; BASS reports that outcomes are broadly similar between techniques.
In a decompression, the surgeon removes the bone and thickened ligament pressing on the nerves, often beneath the facet joints, which is known as an undercutting facetectomy.
What results can I expect?
| Outcome | Figure (source) |
|---|---|
| Good relief of leg pain after disc surgery | About 85 to 90% (BASS disc protrusion booklet) |
| Significant improvement in leg pain | 70 to 75% (BASS discectomy page) |
| Better but with some leg pain remaining | 20 to 25% (BASS discectomy page) |
| No benefit | About 5% (BASS discectomy page) |
| Worse pain | About 1% (BASS discectomy page) |
| Pain improved after decompression for stenosis | About 65 to 70%, with walking distance often around four times greater (BASS discectomy page) |
Back pain may also improve, but this is less predictable. Numbness or weakness can persist even after a technically successful operation, and leg pain may take 6 to 8 weeks or longer to settle.
Recovery
- Most people go home the same day or the next day.
- Get moving early; BASS notes that an early return to activity is linked to better results.
- Avoid heavy lifting for at least 2 to 3 weeks, and possibly up to three months.
- BASS advises avoiding driving for 2 to 4 weeks; you need to be able to make an emergency stop.
- Most people take around two weeks off work, or up to six weeks for physically demanding jobs.
- Because of the clot risk, BASS suggests your surgeon may advise no flying for six weeks, with long-haul trips deferred for up to three months.
- Keep the wound dry for 48 hours and avoid baths for two weeks.
Risks and complications
All surgery carries some risk. The figures below come from BASS patient information; different BASS documents give slightly different estimates, so both are shown where relevant. Your own risk depends on your health, age and whether you have had previous spinal surgery.
| Risk | Approximate frequency (source) |
|---|---|
| Tear in the nerve lining (dural tear), causing a spinal fluid leak | About 3% of disc operations and 8% of decompressions (BASS discectomy page); fewer than 5 in 100 (BASS booklet) |
| Further surgery for a persistent fluid leak | Less than 0.05% (BASS booklet) |
| Superficial wound infection | 2 to 4% (BASS discectomy page); up to 4 in 100 (BASS booklet) |
| Deep infection | Less than 1 in 100 (BASS discectomy page and booklet) |
| Nerve root damage | Less than 1 in 100 for first operations; up to 10 in 100 for repeat surgery (BASS booklet) |
| Recurrent disc prolapse | About 5 in 100 (BASS booklet); 7 to 15% within ten years, similar with or without surgery (BASS discectomy page) |
| Blood clot in leg or lung (DVT/PE) | Fewer than 1 in 700 (BASS booklet) |
| Paralysis, e.g. from bleeding around the nerves | Fewer than 1 in 300 (BASS discectomy page) |
| Major blood vessel or organ injury | Fewer than 1 in 10,000 (BASS discectomy page and booklet) |
| Death | Probably fewer than 1 in 700 for sciatica surgery and around 1 in 350 for stenosis decompression (BASS discectomy page) |
| Fatal complication of general anaesthetic | About 1 in 250,000 (BASS booklet) |
The BASS nerve root pain page puts the risk of a catastrophic complication, such as death or paralysis, at around 1 in 400 to 500. It also cites a Swedish study of 25,000 operations that found a 7% chance of needing further surgery for sciatica within ten years. Other possible problems include bleeding, pressure injuries from positioning on the operating table and, very rarely, operating at the wrong level, which surgeons guard against with X-ray checks during surgery.
You can lower your risk by stopping smoking, losing excess weight and improving fitness. Always tell your team about blood-thinning medicines such as aspirin, clopidogrel, warfarin or rivaroxaban.
Outlook
For most people with persistent sciatica or stenosis, surgery offers faster and often lasting leg pain relief. It does not stop the disc ageing, so staying active and keeping fit remain important.
Seek urgent medical help (A&E or 999) if you have:
- numbness between your legs or around your genitals or back passage;
- new difficulty passing urine, or loss of bladder or bowel control;
- new or rapidly worsening weakness in one or both legs;
- after surgery, a red, hot or leaking wound with a high temperature, clear fluid leaking from the wound, or a painful swollen calf or sudden breathlessness.
Saddle numbness and bladder or bowel change can be signs of cauda equina syndrome.
- BASS: Lumbar discectomy and decompression
- BASS patient booklet: Lumbar disc protrusions
- BASS: Nerve root pain and some of the treatment options
- Royal College of Surgeons: Get well soon after discectomy
- NHS: Lumbar decompression surgery
This guide is general information and is not a substitute for advice about your own situation. Please speak to your GP or specialist.
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