The goal of spinal decompression is to relieve the pressure on the spinal cord and adjacent spinal nerves. Such compressive forces can produce a variety of symptoms such as pain, loss of sensory and motor function, bladder and bowel dysfunction, and overactive reflexes. Essentially, there are two ways to decompress the spinal cord or spinal nerves: nonsurgical therapies or decompression surgery. Surgery is usually considered when nonsurgical methods have failed.
Background
Spinal decompression, whether therapy or surgery, attempts to alleviate compression or pressure on the spinal cord or spinal roots. Such compression is caused mainly by disk rupture, fractured or misaligned vertebrae, tumors, or hematomas. Symptoms of spinal compression can vary, but generally include back pain radiating into the legs. Other sensory changes might occur such as onset of tingling or numbness. In severe cases, weakness, overactive reflexes, paralysis, bowel and genitourinary dysfunctions, or erectile dysfunction might occur.
Goals of Therapy
The most common reason for using nonsurgical therapy is to relieve the pain of spinal disk herniation. When herniated disks bulge onto the spinal nerves, one method to relieve that pressure is to minimize the vertebral pressure on the disk itself. Traction has been used to pull apart the vertebrae to relieving pressure on the disk. It requires extensive therapy time and its efficacy is controversial. Another therapy is spinal manipulation, often used by chiropractors, and includes the Cox Technique. Other treatments include steroid injections, prolotherapy injections, and acupuncture. However, their degree of efficacy is not well established.
Goals of Surgery
The goal of spinal decompression surgery is to physically remove the compressive forces on the neural tissue. Such forces may be relieved by repairing broken or misaligned vertebrae, removing compressive soft tissues such as disk material or tumors, and fusing vertebrae. In general, once the pressure on the neural tissue is relieved, the majority of the symptoms will disappear immediately. However, decompressive surgery is not without risks: there are the risks of general surgery, as well as the specific risks of injury whenever a surgeon undertakes delicate manipulation of structures near the spinal cord.
Considerations
A great benefit of nonsurgical therapies is that they are virtually free of risks. However, their effectiveness is not widely accepted. Opting for such therapy might delay necessary surgery. On the other hand, whereas surgery is more widely accepted as the most effective way to decompress the spinal cord and spinal nerves, spinal surgery has considerable risks. These include damage to underlying nervous tissues which can result in weakness, sensory and motor loss, or paralysis. Also, cerebrospinal fluid leakage or bleeding can have post-surgical consequences which may require an additional surgery to repair. Rods and screws may fail or can fracture vertebrae, resulting in additional problems requiring another surgery. Infection and blood clots are a possibility. No surgery guarantees success, and the possibility that the procedure simply may not yield the intended results must be considered.
Misconceptions
Many people falsely believe that spinal decompression therapy and surgery are almost guaranteed to be effective. However, no rigorous studies have been performed to compare the two treatments. Given that nonsurgical therapy has few or no risks; given the FDA approval of such therapies; and given the fact that surgery is at best 80 percent effective, many people would rather try nonsurgical treatments first.
References
- The Merck Manuals: Compression of the Spinal Cord
- PubMed Central: Chiropractic and Osteopathy: Non-surgical spinal decompression therapy
- Cleveland Clinic: Spinal Decompression Surgery
- AAOS: Lumbar Spinal Stenosis
- "Dynamic Chiropractic"; Decompression Facts, Myths; J. Edwards and C. Vaughn; September, 2008
