Lower Back Surgery Post
The recovery period after low back surgery depends on a number of factors, including the patients condition before the surgery, the extensiveness of the surgery, and the surgeons skill and experience. For example:
- A microdiscectomy for a lumbar herniated disc is considered minimally invasive, and the patient usually has no overnight hospital stay and recovery time is about a week.
Stabilization Surgery For Spinal Stenosis
Not everyone who has surgery for spinal stenosis will need stabilization, which is also known as . It’s especially helpful in cases where one or more vertebrae has slipped out of the correct position, which makes your spine unstable . In these cases, the bones slipping can pinch nerves. The need for stabilization also depends on how many vertebrae your surgeon needs to work on. For example, if he or she needs to remove the lamina in multiple vertebrae, your spine may be unstable without those structures. You’ll need to have spinal fusion to help stabilize your spine.
Spine stabilization surgery has been common for many years. It can be done alone or at the same time as a decompression surgery. In spine stabilization, the surgeon creates an environment where the bones in your spine will fuse together over time . The surgeon uses a bone graft or a biological substance . Your surgeon may use spinal instrumentationwires, cables, screws, rods, and platesto increase stability and help fuse the bones. The fusion will stop movement between the vertebrae, providing long-term stability.
Goals Of Spine Surgery
Depending on the condition the surgeon is treating, immediate goals of the surgery can be classified in one of the following categories:
- Stabilization of the spine.
- Combination of both, decompression of neurological structures and stabilization of spinal segments.
In the long term for spine surgery, our goal is to reduce pain and increase patients function.
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Common Spine Surgical Procedures
There are a number of conditions that may lead to spine surgery. Common procedures include:
- or Microdiscectomy: Removal of a herniated intervertebral disc. Therefore, removing pressure from the compressed nerve. Microdiscectomy is a MISS procedure.
- Laminectomy: Removal of the thin bony plate on the back of the vertebra called the laminae to increase space within the spinal canal and relieve pressure.
- : Removal of a portion of the vertebral arch that covers the spinal cord. A laminotomy removes less bone than a laminectomy.Both laminectomy and laminotomy are procedures. Decompression usually means tissue compressing a spinal nerve is removed.
- : Removal of bone or tissue at/in the passageway where nerve roots branch off the spinal cord and exit the spinal column.
- Disc replacement: As an alternative to fusion, the injured disc is replaced with an artificial one.
- Spinal fusion: A surgical technique used to join two vertebrae. Spinal fusion may include the use of bone graft with or without instrumentation . There are different types of bone graft, such as your own bone and donor bone . A fusion can be accomplished by different approaches:
ALIF, PLIF, TLIF, LIF: All pertain to lumbar interbody fusion used to stabilize the spinal vertebrae and eliminate movement between the bones.
Why Might I Need A Laminectomy
Low back or neck pain can range from mild, dull, and annoying to persistent, severe, and disabling. Pain in the spine can restrict your ability to move and function. Laminectomy may be done to ease pressure on the spinal nerves, treat a disk problem, or remove a tumor from the spine.
One common reason for having a laminectomy is a herniated disk in the spine.
A disk may be displaced or damaged because of injury or wear and tear. When the disk presses on the spinal nerves, this causes pain, and sometimes numbness or weakness. The numbness or weakness will be felt in the body part where the nerve is involved, often the arms or legs. The most common symptom of a herniated disk is sciatica. This is a sharp, shooting pain along the sciatic nerve, extending from the buttocks to the thigh and down the back of the leg.
If medical treatments no longer work, surgery may be a choice. Some medical treatments for pain may include:
- Changes in activity
- Smoking cessation
- Assistive devices, such as mechanical back supports
Laminectomy is usually done for back or neck pain that continues after medical treatment. Or it is done when the pain is accompanied by symptoms of nerve damage, such as numbness or weakness in the arms or legs. Loss of bowel or bladder control from pressure in the cervical or lumbar spine also usually needs surgery.
There may be other reasons for your healthcare provider to recommend a laminectomy.
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Why Are These Procedures Done
Laminotomy and laminectomy are commonly done to relieve symptoms of spinal stenosis, including pain, and weakness or numbness that can radiate down the arms or legs.
Your doctor may recommend one of these procedures if non-surgical treatments do not improve symptoms, or if muscle weakness or numbness makes standing or walking difficult.
There are many other spinal conditions that may be treated with a laminotomy and/or laminectomy:
- Spinal stenosis
- Herniated disc
In some cases, these procedures may be necessary as part of surgery to treat a herniated spinal disk. Your surgeon may need to remove part of, or the complete lamina to gain access to the damaged disc.
What Happens During Surgery
There are seven steps of the procedure. The operation generally lasts 1 to 3 hours.
Step 1: prepare the patientYou will lie on your back on the operative table and be given anesthesia. Once asleep you will be rolled over onto your stomach with your chest and sides supported by pillows. The area where the incison will be made is cleansed and prepped. If a fusion is planned and you have decided to use your own bone, the hip area will be prepped to obtain a bone graft. If youâve decided to use donor bone, a hip incision is not necessary.
Step 2: incisionA skin incision is made down the middle of your back over the appropriate vertebrae . The length of the incision depends on how many laminectomies are to be performed. The strong back muscles are split down the middle and moved to either side exposing the lamina of each vertebra.
Step 3: laminectomy or laminotomyOnce the bone is exposed, an X-ray is taken to verify the correct vertebra.
Laminectomy: The surgeon removes the bony spinous process. Next, the bony lamina is removed with a drill or bone-biting tools . The thickened ligamentum flavum that connects the laminae of the vertebra below with the vertebra above is removed. This is repeated for each affected vertebrae .
Step 7: closureThe muscle and skin incisions are sewn together with sutures or staples.
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Spine Surgery For Leg Pain
If most of the patient’s pain is leg pain , the pain may be due to a pinched nerve. If the leg pain does not start to resolve with conservative treatment after 4 to 6 weeks, an imaging study may be recommended to determine whether or not there is nerve pinching .
If there is pressure on the nerve, then either injections or a lumbar decompression spine surgery to take pressure off the nerve may be recommended. Back surgery for a pinched nerve can usually be done with a minimally invasive approach, and will usually result in early return to normal function . The success rate for decompression spine surgery is high, with approximately 90% of patients experiencing good relief of the leg pain after the surgery.
- What to Expect from Spine Surgery for Low Back Pain
Anterior Cervical Discectomy And Fusion
Anterior Cervical Discectomy and Fusion is a surgical procedure where the disc is removed through the front of the neck in order to relieve pressure from the spine and relieve pain. This procedure is combined with a fusion surgery in order to stabilize the neck.
ACDF is used to treat herniated disc and degenerative disc disease.
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What Is Sciatica Surgery
The goal of sciatica surgery is to relieve the pressure being placed on the sciatic nerve from the nerve roots and the resulting nerve pain.
The sciatic nerve is the longest and thickest nerve in the body that comprises five nerve roots from the lumbar spine of the low back and the sacrum . It travels from the low back, down the hip and thigh, to below the knee, where it separates into two branches: the tibial nerve and common peroneal nerve.
Compression of one or more of the nerve roots comprising the sciatic nerve can be relieved through sciatica surgery.
Why Might I Need A Belt Lipectomy
If you lost a lot of weight after weight-loss surgery, this surgery may be an option for you. You may not like how you look if you have extra folds of skin tissue.
These skin folds are not just unsightly, but they can also cause other problems. These can include:
- Swelling, rash, or ulcers between the skin folds in your groin. This can lead to an infection.
- Problems with hygiene
- Blood clots in your legs . These clots may travel to your lungs .
- Nerve damage
- Problems from anesthesia
You also may not get the results you want from surgery. Then you may need to have another surgery to fix this.
Your risks depend on your age, the amount of weight you lost, your health conditions, and the amount of tissue you need removed. Ask your surgeon about the risks that apply to you.
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Metastatic Spinal Cord Compression
Cancer in one part of the body, such as the lungs, sometimes spreads into the spine and presses on the spinal cord. This is known as metastatic spinal cord compression.
Initial symptoms can include:
- back pain, which may be mild at first, but usually gets worse over time the pain is constant and often worse at night
- numbness in your fingers and toes
- problems urinating
Without treatment, metastatic spinal cord compression is potentially very serious and can result in permanent paralysis in the legs.
For people in good enough health to withstand surgery, metastatic spinal cord compression is best treated with surgery. However, if the problems only become apparent late on, many people are too ill to withstand or benefit from surgery.
What Is A Lumbar Discectomy
Lumbar discectomy is a type of surgery to fix a disc in the lower back. This surgery uses smaller cuts than an open lumbar discectomy.
Your backbone, or spinal column, is made up of a chain of bones called the vertebrae. Your spinal cord runs through the spinal column. The bones help protect the cord from injury. Discs sit between each vertebra to provide cushioning and support. Large nerves called nerve roots lead from the spinal cord through small holes in the bones called foramen. These nerve roots send and receive signals to and from the body. The signals are sent to and from your brain through the spinal cord.
Sometimes the outer wall of one of these discs may dry out and weaken with age or injury. When this happens, the soft, inner part of the disc bulges out. This is called a herniated or bulging disc. This bulging disc can press on the spinal cord and cause symptoms such as pain, tingling, or weakness in a nearby part of the body.
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Most Common Types Of Spine Surgery
For many patients who are experiencing pain or discomfort from a spinal condition, spine surgery can be an excellent option to relieve pain and return to every day activities.
Before having surgery, patients must be properly qualified by an experienced orthopedic spine surgeon and fully informed of their treatment options. Any surgery can be scary, and knowing the facts is an important step on the road to recovery.
Here, Ill describe the most common types of spine surgery.
The most common spine surgeries fall into two categories: decompressing the neurological structures and stabilizing the spine. The categories are often combined during spinal procedures. More specifically, there are four common types of procedures that represent about 90 percent of all spine surgeries:
- Discectomy: This procedure usually consists of removing herniated disc material that presses the nerves or spinal cord. Discectomy is a decompressive type of surgery.
- Laminectomy/ laminotomy: An opening over the nerve or spinal cord is performed to relieve compression of those structures. The terms laminectomy and laminotomy correlate to the location of said opening in the posterior elements of the spine and their size. This is also a type of decompression.
What Are The Most Common Back Surgery Types
Having back surgery is a big commitment, and many people are overwhelmed by the thought of undergoing such an invasive procedure. Fortunately, most back surgeries fall into three main categories, which doctors perform regularly with positive results. Heres a look at three of the most common back surgery types so youll know what to expect.
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Fusion: The Gray Areas
Men end up having fusions for a variety of reasons. In some cases, the spine may show signs of changes that potentially could explain the painsuch as breakdown of the cushioning spinal discs between the vertebrae. But sometimes it’s difficult to clearly trace the pain to a specific cause. For such cases of “nonspecific” low back pain, research suggests that the benefit of fusion is hit-or-miss. “You can say half of those who have fusion will have significant pain relief, but flipping a coin is not such a great thing,” Dr. Atlas says.
When there is pain relief, it is often limited. The pain, measured on a scale of 1 to 10, may decrease from an 8 to a 4. “Your pain is typically decreased by 50 percent,” Dr. Atlas says, “but there are very few people who really have no pain after spinal fusion.” The relief may last only a few years before the condition worsens again.
Another concern about fusion is that joining the vertebrae transfers the motion of the spine to the adjacent joints. This can speed up the wear-and-tear in those other locations.
Despite these cautions, many men with nonspecific low back pain still end up choosing fusion. Often, they have already tried physical therapy and other nonsurgical measures, but still end up with disabling pain.
The alternative to fusion is an intense, long-term back rehabilitation program to control pain and maintain function. It works as well as fusion, but doesn’t involve surgery and the risk of complications.
Importance Of Being Qualified For Spine Surgery
The vast majority of patients who have been appropriately qualified for spine surgery achieve very good to excellent results, and they return to normal or near normal function with significant improvement in their pain.
In general, the small number of patients who do not achieve positive results were often not appropriately qualified and were likely not good candidates for surgery in the first place.
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Back Surgery Pros And Cons
Each type comes with its own risks and benefits.
Spinal fusion. This is the most common surgery for chronic nonspecific back pain with degenerative changes. The doctor will join spinal bones, called vertebrae, together. This limits the motion between them and how far your nerves can stretch. But it probably wonât limit your activity. Itâs rare, but the bones donât always fuse completely. Smoking can make this complication more likely. If it happens, you may need another operation to fix it.
Laminectomy. This is the most common surgery for lumbar spinal stenosis. In this procedure, a surgeon removes parts of the bone, bone spurs, or ligaments in your back. This relieves pressure on spinal nerves and can ease pain or weakness, but the procedure can make your spine less stable. If that happens, youâll probably need a spinal fusion as well. Doctors sometimes do the two procedures together.
Foraminotomy. This surgery is used to relieve pain associated with a compressed nerve in the spine. The surgeon cuts away bone at the sides of your vertebrae to widen the space where nerves exit your spine. The extra room may relieve pressure on the nerves and ease your pain. Like a laminectomy, this procedure can also make your spine less stable. So the surgeon may do a spinal fusion at the same time. Thatâll increase the amount of time you need for recovery.
Be Aware Of These Surgical Risks
As with any operation, there are risks involved with surgery for spinal stenosis. Your doctor will discuss potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:
- general risks of anesthesia
- injury to your spinal cord or nerves
- non-healing of the bony fusion
- failure to improve
- infection and/or bone graft site pain
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Exposure Of The Nerve Root
In a minimally invasive discectomy, after a small incision is made, the muscles of the spine are dilated, or gently separated, and a tubular retractor is inserted to create a tunnel through which the surgeon may perform surgery. A microscope or an endoscope is used to look down the tube and visualize the spine. Through the tubular retractor, a portion of the lamina is removed to expose the compressed area of the spinal cord or nerve root.
What Can Cause Lower Back Pain
Most acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back fit together and move. Some examples of mechanical causes of low back pain include:
- Skeletal irregularities such as scoliosis , lordosis , kyphosis , and other congenital anomalies of the spine.
- Spina bifida which involves the incomplete development of the spinal cord and/or its protective covering and can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis.
- Sprains , strains , and spasms
- Traumatic Injury such as from playing sports, car accidents, or a fall that can injure tendons, ligaments, or muscle causing the pain, as well as compress the spine and cause discs to rupture or herniate.
- Intervertebral disc degeneration which occurs when the usually rubbery discs wear down as a normal process of aging and lose their cushioning ability.
- Spondylosis the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.
- Arthritis or other inflammatory disease in the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae.
Nerve and spinal cord problems
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