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Procedure description
A posterior lumbar decompressive
laminectomy is performed to decompress nerve roots,
and attempt to relieve lower extremity pain. During
the operation, the patient is put to sleep by the anesthesiologist,
and is then gently turned to the prone (face and abdomen down)
position, using cushions and gel rolls to protect and cushion
the body. The lower back is cleaned in a sterile manner,
and the surgeon then makes a vertical (up and down).
The surgeon will dissect down to the spinous processes (bones
protruding back from the spine) and then push the muscle away
from the lamina ( the roof of the spinal canal).
Often, an x ray will be taken at this point to confirm that
the appropriate level is being operated upon. Next,
the surgeon will remove the lamina in order to allow
access to the spinal canal and nerve roots. This is
often done under magnification, usually using the microscope.
The surgeon will identify the nerves, and attempt to remove
sufficient bone and ligament in order to adequately decompress
them. If there is also offending disc material compressing
the nerves, the surgeon may remove that as well. Sometimes
quite a bit of the facet (joint holding the various vertebral
levels together) needs to be removed to allow adequate decompression
of the nerves, and if the spine appears unstable as a result
of this, your surgeon may elect to fuse the spine.
After completing the decompression, your surgeon
will close. The muscle falls back into place once the
retractor is removed, and it is approximated with suture,
and the deep fascia (firm fibrous tissue of the low back)
is sewn closed, as is the subcutaneous tissue (tissue deep
beneath the skin) and skin. The wound is dressed with
a sterile dressing, and the patient is returned to the recovery
room.
Procedure Risks
Posterior lumbar
decompressive laminectomy is a frequently performed procedure.
Even though the risks of complications are relatively low,
there are risks. These can be broken down into two categories,
1) those related to the operative site, and 2) those related
to the risks of anesthesia.
Risks related
to the operative site:
Surgical
Exposure: The
patient is placed in a prone position (on their abdomen).
In this position, there can be pressure sores, pressure
injuries to nerves, and injury to the eyes as a result of
pressure to them. During surgical dissection, injury
to muscle surrounding the spine can occur.
Spinal Cord/Nerve
Root injuries: If
there is any injury to the spinal cord (in the upper lumbar
area) or nerve roots, the consequences may involve
loss of sensation, increased burning sensation, paralysis,
weakness, loss of bowel, bladder, sexual function.
There may be a spinal fluid leak, which could occur after
a tear of the covering of the spinal cord or nerve roots. If
this did occur, it may be necessary to have the patient
flat in bed for several days after the surgery. Even
if everything goes as well as hoped, there is a risk of
instability of the spine and disc herniation in the future,
requiring additional surgery on the lumbar spine.
General
Risks: These
include such general difficulties, such as bleeding, infection,
stroke, paralysis, coma and death. Incisions on the
low back generally heal well, but if could be
tender, or may heal in an unpleasant manner. There
is also the possibility that the surgery may not relieve
the symptoms for which the procedure was performed.
The problem for which the surgery was performed may recur,
requiring additional surgery in the future. In addition,
although every attempt is made to protect all areas of the
body from pressure on nerves, skin and bones, injuries to
these areas can occur, particularly with prolonged cases.
Risks of
Anesthesia: Blood
clots in the legs, heart attacks, reaction to the anesthetic,
reaction to blood transfusion, if it given. Bone can
bleed quite a bit, and if sufficient amounts of blood are
lost during the surgery, a transfusion may be performed.
Post-operative care:
There shall be no bending,
twisting, or heavy lifting for several weeks after surgery.
Physical therapy may or may not be implicated. Your
doctor will gradually ease your work restrictions, depending
on your progress.
Remember to keep the wound
dry and clean. Notify your surgeon of any drainage
or temperatures greater than 101 Fahrenheit.
The goal of this surgery was
to relieve the pressure on the nerves in your back and reduce
your leg pain. We expect you to do normal activities
better because of the surgery. Some continuuing back
and leg pain is not unusual during the first few days and
weeks following surgery. Hurt does not necessarily
mean harm. You may experience numbness in the foot
or leg, but this does not impair function. The following
is a list of suggestions that should help speed your recovery
and give you every possible chance for the best results
from your surgery.
- Immediately upon discharge,
contact our office and set up an appointment for staple
removal if one has not already been set up.
- Take it easy until seen
by the physician. This does not mean bed rest, but
athletic activities during this period are definitely
not recommended. Please give your incision a chance
to heal. Avoid bending.
- Lift nothing heavier than
a half gallon of milk until seen by your doctor.
- Avoid sitting for periods
of time longer than 45 minutes. It is OK to sit
in a lounge chair which is laid back, for as long as you
wish.
- No jogging or running.
- After you get home, you
may begin walking up to one mile per day.
- You may walk up or down
steps as often as you like. Please take them smoothly
and slowly.
- No driving until OK with
your physician. Do not ride further than 50
miles at a time. This applies during the first month
after surgery.
- You may shower after you
go home unless otherwise instructed. Cover the incision
with plastic wrap before the shower and remove it afterward.
Change dressing immediately. Tub baths are not advisable.
You may shower without covering the incision one week
after the staples are out. Follow instructions concerning
care of tapestrips, stitches or staples. Your surgeon
or his nurse clinician will explain the techniques used
in the closure of your incision.
- Sexual activities are permitted.
- If you notice swelling,
redness or opening of the incision, or if there is any
clear fluid draining from it, please contact your surgeon
immediately! If you develop a fever, stiff neck
or chills, contact the office immediately. Take
your temperature at 4:00 PM daily until the clips are
removed. Call in greater than 101 degrees Fahrenheit.
- If you have any questions,
call our office, and for after hours emergencies, call
the medical society.
- Take your medications prescribed
on discharge, as directed.
- It takes 6 - 18 months for
a nerve to heal. During that time you may experience
numbness, tingling, fleeting pain, or creepy/crawly sensations.
- For three months after a
herniated disc repair, you are at increased risk for a
recurrence.
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