Lumbar Spine

What is Lumbar Spine Surgery?

You may be a candidate for surgery if conservative therapy has not provided relief and you are continuing to experience debilitating neurological symptoms. Lumbar spine surgery is referring to lower back surgery. In general terms, there are two types of lumbar spine surgery which are typically referred to as lumbar decompression surgery or a lumbar fusion.

Lumbar decompression surgery, is often considered a minimally invasive surgery. This surgery is performed to relieve pain associated with the pinching of the nerve root. Such pain may be caused by a disc herniation or spinal stenosis. Decompression surgery typically involves removing a small portion of the bone over the nerve root or the removal of disc material from under the nerve root. By relieving the pinched nerve, more room is provided for the nerve to heal and thus there is relief of symptoms. The most common types of decompression surgery performed are the lumbar microdiscectomy and the lumbar laminectomy. In addition, disc replacement, disk arthroplasty and the laminectomy are other minimally invasive surgeries.

A spinal fusion surgery involves using a bone graft to stop the motion at a painful vertebral segment. By ceasing the motion, the pain generated from the joint should decrease. This surgery approach is often performed to limit pain or disability associated with degenerative disc disease or spondylothesis (displacement of the vertebra).

Our method of lumbar fusion is minimally invasive. Typically such surgeries involve one night hospital stays, minimal bleeding, minimal post operative pain medication requirements, fast recovery and excellent results.

For more information, please review more details about the individual surgeries below.

Microdiscectomy

In a microdiscectomy, also referred to as a decompression spine surgery, a small portion of the bone over the nerve root and/or any loose disc fragments from under the nerve root are removed to relieve neural impingement and to provide more room for the nerve to heal. This procedure typically requires a small incision of only one to two inches and is performed using a microscope and microsurgical techniques. Since the incision is quite small, the incidence of damage to surrounding tissues is quite rare.

The desired outcome of this surgery is to relieve symptoms such as leg and/or back pain, weakness, and numbness in the legs and feet. Patients will often feel relief almost immediately after the surgery. A microdiscectomy may be performed in different regions of the spine, cervical, thoracic and lumbar. In most cases, this surgery is performed on an outpatient basis and the patient will go home later in the day.

 

Laminectomy

A decompressive laminectomy is a common surgery often performed to treat spinal stenosis, herniated discs, tumors and spinal injuries. This surgery may be recommended to relieve pressure and to reduce inflammation in the spinal cord and to relieve an impinged or irritated nerve root. A laminectomy is most commonly performed on the vertebrae in the lower back and in the neck.

A laminectomy is surgery to remove or trim the lamina, which is the back part of the vertebra that covers your spinal canal. During a laminectomy, your spinal canal is enlarged to relieve pressure on the spinal cord and/or the spinal nerve roots.

 

Laminotomy

A laminotomy is a surgical procedure performed to increase the amount of space available for the nerve root to exit the spinal canal. This minimally invasive endoscopic procedure is performed with an end goal of increasing the amount of available space for neural tissues and releasing entrapped nerves, thus providing pain relief. The laminotomy is commonly performed to treat bulging discs, arthritis in the spine, herniated discs, bone spurs, pinched nerves and stenosis.

The term “laminotomy” is derived from the Latin words “lamina”, the bony plate that covers the posterior arch of the vertebra, and “-otomy,” which is the act of cutting or incision.

 

Foraminotomy

A foraminotomy is a surgical procedure designed to relieve nerve compression causing pain and numbness in the neck, back and extremities.

Cervical Foraminotomy

Cervical Foraminotomy Procedure:
1. Incision
2. Clear bone and soft tissue to access problem disc
3. Check nerve root freedom
4. Remove pressure on nerve root

During surgery, nerve root compression is addressed by enlarging the foraminal canal, the tunnel that passes the spinal nerves from the spinal cord, through the vertebrae and out into your body. Compression in the foramen may be caused by a bone spur, excessive ligament growth, scar tissue, a damaged intervertebral disc or other injuries. Once a nerve becomes pinched, pain and numbness are the typical result.

Foraminotomy surgery is most often performed as a minimally invasive technique either microscopically or endoscopically.

In a cervical foraminotomy, a small incision of one to two inches is made in the neck (through either the front or back). For a lumbar foraminotomy, the incision is made in the lower back, most often involving a posterior approach. Once the incision is made, the surgeon will peel the muscle away to gain access to the bone underneath where a small hole will be cut in the vertebra. At this point, the surgeon will be able to visualize the foramen with the aid of a microscope, an arthroscope, or an endoscope and will remove bone or ligament material or fragments. During the surgery, if any disc issues are found, they will also be corrected. Many patients will feel immediate relief. In most cases, this surgery is performed on an outpatient basis and the patient will go home later in the day.

 

Lumbar Fusion

A minimally invasive lumbar spinal fusion is similar to a “traditional” lumbar spinal fusion, but it uses smaller incisions and causes less damage to the surrounding tissues during surgery. A lumbar spinal fusion is an operation that causes the bones of the spine in the lower back to grow together, to fuse, so there is no longer any motion between the vertebrae.

Minimally invasive lumbar fusions are typically performed either percutaneously or through a circular tube retractor. Such procedures do not require the large incision or the muscle retraction typically used in conventional fusions. Patients undergoing these less invasive procedures have a faster recovery time and are back to normal activities on an earlier basis. Computerized image guidance systems are also used for many patients undergoing lumbar fusion. This has the advantage of aiding the surgeon in optimal placement of screws and avoiding injury to delicate nerve tissue. There are many approaches to fuse the vertebrae together including performing surgery through the abdomen, from the back, from the side, or any combination thereof.

Lumbar fusions are typically performed for patients with evidence of spinal instability and sometimes in conjunction with a lumbar laminectomy. Other patients, such as those with severe lumbar degenerative disc disease, may also be candidates for lumbar fusion.

The decision on what type of fusion is best for each patient is based on their specific complaints and the cause of symptoms. As is the case for all surgeries, spinal fusion can be very effective in the properly selected patient.