Mark W. McFarland, DO
A big part of my job as a Spine Surgeon is discerning how much surgery is needed to achieve the goal of pain relief and decompression of spinal nerves from structural spinal issues. The nerve compression could be caused by osteophytes (bone spurs) from arthritic changes in the spine, a bulging or herniated spinal disc, a desiccated (dried out and flat) spinal disc or spinal stenosis, which is the narrowing of the spinal canal that houses the spinal cord. We confirm these changes with a MR or CT scan before proceeding to surgery.
For those patients who have nerve compression in the lumbar spine without stability issues, the appropriate surgery is often a lumbar laminectomy. The human lumbar vertebral column is comprised of a stack of five bones (L1-L5), separated by cushiony discs filled with a jelly-like substance, that provides shock absorption. These bones are in the lower back and sit between the sacral bones and the thoracic bones of the spine.
Because the spinal vertebrae are complex, I thought pictures would be worth a thousand words in this case. In the images below, I have highlighted the word “lamina” so that you can visualize its location on the vertebra.
Now, that you know exactly where the lamina is located and what it looks like, this is the bony structure that I remove during a laminectomy. I also remove the spinous process, which is the long, protruding bone in the middle of the lamina. You can clearly see the spinous process in the cross-section view. You can also see the oval-ish-shaped opening below the lamina, called the Vertebral Foramen. This is the canal through which the spinal cord travels. By removing the lamina and spinous process, I open that space dramatically. This allows for the spinal cord and any nerve roots that may be compressed to have extra room to expand and takes the pressure off them, relieving pain and dysfunction.
Lumbar laminectomy is performed as minimally invasive, outpatient surgery. A small, one-inch incision is made in the back, correlating to the lumbar vertebral level I need to access. The procedure usually takes less than an hour.
The patient is taken to recovery to wake up and have a snack. We will make sure that the patient can ambulate well before they are discharged to go home, wearing a lumbar brace. I will encourage the patient to wear the brace when up and walking or out and about, but they can remove it when sleeping, bathing, or relaxing.
Patients will be given pain medication for the first one-two weeks after surgery. In the “protective phase” of their recovery, for about the first week, sitting should be limited to no more than 30 minutes at a time, with no pushing, pulling, bending or twisting. Short, 10-minute walks are encouraged to help the patient gain strength and stamina.
After the first week to 10 days, patients can do pretty much whatever they want, but they need to wear the lumbar brace and should not lift over 30 pounds. After the first month, I may send the patient to physical therapy, depending on their condition and range of motion and strength. Physical therapy will help most patients, especially those who went into surgery in less than optimal physical condition.