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Lumbar Laminectomy
Lumbar Microdiscectomy
Microscopic Discectomy
Spinal Fusion
Interbody Fusion
Interbody Fusion with Cages
Recovery
Lumbar Laminectomy
What is it?
Lumbar laminectomy is an operation that involves approaching
the spine through an incision in the lower back to remove
a portion of the bone over and/or around the nerve roots to
provide them additional space.
Why is it done?
Patients who have pain caused by pinched nerves are potential
candidates for this procedure.
The Operation
The operation is performed with you lying on your stomach.
Incision:
Your surgeon makes an incision in your lower back to access
your spine. To have a clear view of your spine, the surgeon
then retracts the muscles and ligaments.
Bone/Disc Removal:
Your surgeon removes a portion of the lamina, the bony rim
around the spinal canal, if it is contributing to pressure
on the dural sac or nerve roots. This part of the procedure
is called a laminectomy. The term laminectomy is derived from
the Latin words lamina (thin plate, sheet, or layer), and
-ectomy (removal).
An opening is then cut in the ligamentum flavum – a
ligament that connects vertebrae to the sacrum. A portion
of the bone over the nerve root and/or disc material around
the nerve root is removed to give your nerve root additional
space.
Closure:
The operation is completed when your surgeon closes and dresses
the incision. Your surgeon may choose to place a drain into
the wound after the surgery to protect the incision.
Recovery:
Your surgeon will have a specific post-operative recovery/exercise
plan to help you return to normal life as soon as possible.
The amount of time that you have to stay in the hospital will
depend on this treatment plan. By the end of your first day
after surgery, you will normally be up and walking in the
hospital.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information. _________
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Lumbar Microdiscectomy
What is it?
Pain in the lower back (lumbar spine) and legs, among other
symptoms, may occur when an intervertebral disc herniates
– when the annulus fibrosus (tough, outer ring) of the
disc tears and the nucleus pulposus (soft, jelly-like center)
squeezes out, and places pressure on, or "pinches,"
an adjacent nerve root.
Lumbar microdiscectomy is an operation that involves using
a surgical microscope and microsurgical techniques to access
and treat the lumbar spine. By providing magnification and
illumination, the microscope allows for a limited dissection.
Only that portion of the herniated disc, which is pinching
one or more nerve roots, is removed. The term discectomy is
derived from the Latin words discus (flat, circular object
or plate) and -ectomy (removal).
Why is it done?
Pressure placed on one or more nerve roots by a herniated
disc may irritate these neural structures and cause:
Debilitating leg pain
Weakness and/or numbness in the legs and/or feet, and
Bowel/bladder incontinence.
Patients who suffer from these symptoms as a result of a
pinched nerve are potential candidates for this operation.
The Operation
An understanding of what a lumbar microdiscectomy involves
will help you to approach your operation and recovery with
confidence.
Incision:
The operation is performed with you lying on your stomach.
Because the operation is viewed through a microscope, this
approach only requires a small incision. Your surgeon makes
an incision in your lower back. Through this incision, microsurgical
instruments are then inserted.
Removal:
Once your pinched nerve is located, the extent of the pressure
on the nerve can be determined. Using microsurgical techniques,
your surgeon removes the herniated portion of the disc as
well as any disc fragments that have broken off from the disc.
The amount of effort required to complete the microdiscectomy
depends, in part, on the size of the disc herniation, the
number of fragments present, and the difficulty presented
in finding and removing these fragments.
Closure:
The operation is completed when your surgeon closes and dresses
the incision.
Recovery:
Your surgeon will have a specific post-operative recovery/exercise
plan to help you return to normal life as soon as possible.
The amount of time that you have to stay in the hospital will
depend on this treatment plan. You will normally be up and
walking in the hospital on the same day after your surgery.
Lumbar microdiscectomy is usually performed on an outpatient
basis, with no overnight stay in the hospital.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Microscopic Discectomy
What is it?
The procedure using the METRx™ System is an operation
on the lumbar spine performed using microscope and microsurgical
techniques.
The METRx™ System procedure requires only a very small
incision and will remove only the portion of the ruptured
disc, which is "pinching" one or more spinal nerve
roots. The recovery time for this particular surgery is usually
much less than is required for traditional lumbar surgery.
Why is it done?
Lumbar microdiscectomy using the METRx™ System is usually
recommended only when specific conditions are met. In general,
surgery is recommended when a ruptured disc is pinching a
spinal nerve root(s) and you have:
- Leg pain which limits your normal daily activities
- Weakness in your leg(s) or feet
- Numbness in your extremities
- Impaired bowel and/or bladder function
The Operation
Incision:
In the operating room, the METRx™ System begins with
a small incision in your lower back. Through this opening,
your surgeon will insert the endoscope and surgical instruments.
Because the work is viewed through an endoscope, this approach
requires a relatively small incision.
Reaching the "Pinched" Nerve:
Guided by diagnostic studies, your surgeon may remove a small
portion of bony material from the back of your vertebra. Once
this material is removed, the surgeon can locate the exact
area where the nerve root is being pinched.
Identifying the Cause of the Pressure:
Once the "pinched" nerve is located, the extent
of the pressure on the nerve can be determined. Using endoscopic
microsurgical procedures, your surgeon will remove the ruptured
portion of the disc and any disc fragments which have broken
off from the main disc. The amount of work required to complete
your METRx™ System will depend in part on the number
of disc fragments present and the difficulty presented in
finding and removing them.
Closing the Incision:
The operation is completed when the endoscope is removed and
the incision is closed with suture materials and a bandage.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Spinal Fusion
The Incision:
The patient is positioned on the operating table in a prone
position. The incision is made over the anatomic position
of the spinous process.
Bone is Removed:
When indicated, soft tissue and bony decompression are performed
to relieve neurological compression.
Screw Placement:
For a degenerative spondylolisthesis case, a blunt probe is
inserted through the pedicle and into the vertebral body.
Once the pedicle canals are prepared and the screw length
determined, the TSRH-3D® screws are sequentially inserted.
Bone Graft:
The facet joint capsules are removed and cancellous bone graft
is placed into each facet joint. The transverse processes,
sacral alae, and the lateral walls of the facet joints are
decorticated with high-speed burs and curettes.
Corticocancellous bone graft taken from the iliac crest,
along with any fragments of bone taken during decompression
are firmly pressed into the bone fusion bed.
Compression:
Once the construct has been assembled, segmental distraction
and compression may be carved out.
It is important that you discuss the potential risks,
complications, and benefits of TSRH-3D® Pedicle Screws
with your doctor prior to receiving treatment, and that you
rely on your physician's judgment. Only your doctor can determine
whether you are a suitable candidate for this treatment.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Interbody Fusion
What is it?
An Interbody Fusion is the uniting of two bony segments, whether
a fracture or a vertebral joint. In time, normally within
4 months, the bone grafts will unite with the vertebrae above
and below to form one piece of bone.
Why is it done?
The reasons for the operation are to:
- Remove the degenerative disc
- Separate the two vertebral bodies, as they were before
the disc degenerated
- Keep them in that position by interposing several pegs
of bone (bone graft)
The Operation
Incision:
There are a number of techniques for an interbody fusion of
the lumbar spine.
Lamina are Removed:
First the suregon removes the lamina or the portion of the
vertebra that covers the spinal cord. Removing the lamina
relives some of the pressure on the spine.
Bone is Removed:
Then any bone that may be pinching the nerve roots is removed.
Bone Grafts:
Bone grafts are added.
Rods and Screws:
Rods are secured to the spine with screws in order to hold
the discs in place while the bone graft fuses.
Closing the Incision:
The incision is closed. The bone graft will fuse over time.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Interbody Fusion with Cages
What is it?
An Interbody Fusion using cages is designed to be a less invasive
method to obtain spinal fusion. The procedure can be performed
through an anterior or posterior approach.
Why is it done?
The reasons for the operation are to:
· Remove the degenerative disc
· Separate the two vertebral bodies, as they were before
the disc degenerated
· Keep them in that position
The Operation
Incision:
The disc space is approached through an incision. The muscles
are not cut because they run vertically and can be moved to
the side. The disc is removed by excising the front portion
and removing the disc material back to the spinal canal. This
removes the inflammatory proteins within the disc.
Spacers:
Temporary spacers are impacted into the empty disc space disctracting
and realigning the vertebral bodies into the proper position.
This maneuver opens the collapsed foramen (nerve canal) and
lifts pressure from the pinched nerve roots.
Reamer and Thread Tap:
A hole in the vertebral body is created using a reamer and
a thread tap. A threaded titanium cage is packed with bone
graft and then screwed tightly into the hole. The threaded
cage replaces the distraction plug and maintains the proper
position of the vertebral bodies.
______________
Temporary Plug Removed:
The other temporary plug is removed and the hole is made ready
for the second implant. The other implant packed with bone
is inserted.
Incision Closure:
The incision is closed and the bone graft will grow through
and around the implants, forming a bone bridge that connects
the vertebral bodies above and below.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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Recovery
As you prepare yourself mentally to undergo spinal surgery,
you also need to prepare yourself for the recovery period
that will follow your operation. While the surgery entails
work on the part of the surgeon, after that, the brunt of
the work is in your hands. To ensure a smooth and healthy
recovery, it is important that, as a patient, you closely
follow the set of instructions that your surgical team gives
you.
Hospital Recovery
After the operation, you will be brought to the recovery room
or intensive care unit (ICU) for observation. When you wake
up from the anesthesia, you may be slightly disoriented, and
not know where you are. The nurses and doctors around you
will tell you where you are, and remind you that you have
undergone surgery. As the effects of the anesthesia wear off,
you will feel very tired, and, at this point, will be encouraged
to rest.
Members of your surgical team may ask you to respond to some
simple commands, such as "Wiggle your fingers and toes"
and "Take deep breaths." When you awaken, you will
be lying on your back, which may seem surprising, if you have
had surgery through an incision in the back; however, lying
on your back is not harmful to the surgical area.
Prior to the surgery, an intravenous (IV) tube will be inserted
into your arm to provide your body with fluids during your
hospital stay. The administration of these fluids will make
you feel swollen for the first few days after the operation.
When you awake from the anesthesia, you may feel the urge
to urinate. So, in addition to the IV, a catheter tube (also
commonly called a Foley Catheter) will be placed into your
bladder to drain urine from your system. The catheter serves
two purposes: (1) it permits the doctors and nurses to monitor
how much urine your body is producing, and (2) it eliminates
the need for you to get up and go to the bathroom. Once you
are able to get up and move around, the catheter will be removed,
and you can then use the bathroom normally.
During your hospital stay, you will get additional instructions
from your nurses and other members of your surgical teams
regarding your diet and activity.
Proper nutrition is an important factor in your recovery.
Your surgeon may restrict what you drink and eat, or place
you on a special diet, depending on the surgical approach
that was used during the operation. Calories and food intake
are an important part of recovery. Some patients find that
their physician orders are less restrictive than the diet
they follow at home. After the surgery, you will continue
to receive intravenous fluids until you are able to tolerate
regular liquids, which typically involves gradually transitioning
you from sips of clear fluids to full liquids (including JELL-O®
gelatin). From there, you will be given small amounts of solid
food until you are ready to return to a regular diet.
With respect to physical activity, in most cases, your surgeon
will want for you to get out of bed on the first or second
day after your surgery. Nurses and physical therapists will
assist you with this activity until you feel comfortable enough
to get up and move around on your own.
Home Recovery
Before you are discharged from the hospital, your doctor and
other members of the hospital staff will give you additional
self-care instructions for you to follow at home - a list
of "dos and don'ts," which you will be asked to
follow for the first 6 to 8 weeks of your home recovery. So,
if you are unsure of any of these instructions, ask for clarification.
Following these instructions is crucial to your recovery.
Nowadays, surgery involves one or more incisions depending
on the surgical approach used to perform the operation. Therefore,
when you are discharged home you may still have a surgical
dressing on your incision(s). Either a nurse will visit your
home to change the dressing or a caregiver, such as one of
your family members, will be taught to do it for you. It is
important that the dressing be changed daily and kept dry.
If any signs of infection are observed while changing the
dressing, call your doctor. These signs include:
- Fever - a body temperature greater than 101°F (38°C)
- Drainage from the incision(s)
- Opening of the incision(s), and
- Redness or warmth around the incision(s).
In addition, call your doctor if you experience chills, nausea/vomiting,
or suffer any type of trauma (e.g., a fall, automobile accident).
During this recovery period, you will also be instructed
to keep your incision(s) clean, making sure only to use soap
and water to cleanse the area. In general, you should not
shower until your doctor has permitted you to do so.
In addition to caring for your incision(s), you will also
be encouraged to:
- Drink plenty of fluids
- Maintain a healthy diet (high in protein)
- Walk or do deep-breathing exercises, and
- Gradually increase your physical activity.
Activities to avoid include any heavy lifting, climbing (including
stairs), bending, or twisting. You should also avoid the use
of skin lotion in the area of the incision(s); you need to
keep this area dry until it has had the opportunity to heal
well.
Follow up with your doctor on a regular basis during this
post-operative period, and make sure to call your doctor if
you have any concerns or questions.
As you read this, please keep in mind that all treatment
and outcome results are specific to the individual patient.
Results may vary. Complications, such as infection, blood
loss, and bowel or bladder problems are some of the potential
adverse risks of spinal surgery. Please consult your physician
for a complete list of indications, warnings, precautions,
adverse events, clinical results, and other important medical
information.
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