Lumbar Spine – 5 vertebrae/bones stacked above the buttock
Laminectomy — removal of the bony covering over the nerves
Microdiscectomy – disc removal
Indications For A Lumbar Laminectomy
This surgery is most often recommended when a herniated disc or overgrown ligaments pinch the nerves, creating symptoms of leg or hip pain, weakness in legs or feet, numbness in legs or feet, and problems with bowel or bladder functions.
On some occasions, the lumbar laminectomy will be the best approach:
Under general anesthesia, an incision is made in the back, cutting the muscles, and pulling them to either side and thereby exposing the posterior elements and lamina. The lamina may be removed on one or both sides, allowing access to the foramen, nerve roots and disc.
From this position, the foramen may be “cleaned out” to provide more space for the nerve roots to exit, and the part of the disc that is pressing on the nerve can be removed. If your surgeon decides to do a discectomy, about 10-15% of the disc will be removed. Muscles will be sutured back together and the incision closed. A small drain may be left in the incision site for 1-2 days to allow excess fluid out.
A lumbar laminectomy usually takes 1 to 1 ½ hours, with additional levels taking as long as 2 to 2 ½ hours.
Your physician will recommend the best procedure to address your condition.
Hospital stay for lumbar laminectomies and discectomies is usually overnight.
Minimally Invasive Microdiscectomy
Discectomy for herniated discs can now be made with a smaller incision, approx 2.5 cm. The procedure time may take slightly longer than a traditional open surgery, but studies have shown that there is less pain, less blood loss, and patients often return to work sooner. The incision is made a few centimeters away from the center of the back and a tube is passed down to the spine using X-ray guidance. The surgery is then performed in the same manner as a traditional open procedure.
Risks And Possible Complications For The Lumbar Laminectomy/Discectomy
There is a 90% chance for a good outcome from lumbar laminectomies and discectomies. Complications are rare, but you do need to be advised that they can occur.
Before surgery, you will sign a “consent and disclosure” form stating that the risks have been explained and that you understand what surgery will be performed, and that you wish to proceed with the surgery. Listed will be 7 potential complications:
- Pain numbness, and clumsiness could occur even if the surgery is correctly done.
- There could be impaired muscle function or paralysis which is temporary or permanent.
- Incontinence or impotence could occur. This refers to loss of bowel, bladder or sexual function.
- Unstable spine is a possibility. Sometimes, in order to resolve the problem, so much bone is removed that the spine is left with weakness or instability. If there is not enough bone left to provide the appropriate amount of stability, it might be necessary in the future to contemplate having a spinal fusion which is a more extensive surgical procedure to reconstruct he weakness in the bones.
- Recurrence or continuation of the condition that required the operation. There is a possibility that the disc that has been removed might rupture again. This occurs 10% to 15% of the time, although it can be many years later.
- Injury to major blood vessels. The area in front of the vertebral column is immediately adjacent to the major large arteries and veins that come from the heart to supply the organs in the lower part of the body. It is extremely rare, but it is possible for a surgical instrument to go beyond the annulus in the front part of the spine and injure one of these vessels. If that were to occur, we would be dealing with an internal hemorrhage situation and we would need to do an immediate operation from the front side to correct it.
- Leakage of spinal fluid requiring re-operation. The dura is the hard covering of the nerves and spinal cord. Underneath the dura is the spinal fluid surrounding the nerves. If a hole is accidentally placed into the dura, then the spinal fluid could be allowed to exit this area. If that occurs while we are in surgery, then it is a fairly simple matter to place a stitch through the small tear and close the opening so that fluid can no longer exit. However, occasionally either the stitches will not hold, or there could be a small tear and leakage could occur. If that should happen, we would have to take you back to surgery and do another operation to sew up the hole in the dura. Usually this is not a major complication, but you need to be aware of this so that if it does occur it will not be a major shock or surprise to you.
Additional Risks Include:
- Formation of a blood clot in the wound which may require re-operation.
- Infection which may require further surgeries and long term IV antibiotics.
There Are 4 Possible Outcomes From Any Surgery
- Your symptoms or pain may be completely improved.
- Your symptoms or pain may be partially improved.
- Your symptoms or pain may be the same as before surgery.
- Your symptoms or pain may be worse than before surgery.
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