A posterior lumbar
decompressive laminectomy with a fusion is performed to decompress
nerve roots, and attempt to relieve lower extremity pain,
while allowing the bones of the spine to fuse. 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. The surgeon
will then dissect the muscle off of the transverse processes
(bones sticking out to the side of the spine) as these will
be needed for the fusion later on in the operation.
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. After completing the decompression,
your surgeon will begin the fusion portion of the operation.
Bone may be taken from the hip, or the bone from the back
of the spine may be used. Other types of bone growth
stimulating substances may be used to supplement the bone.
Next, the cortex (outer surface of the bone) is removed from
the transverse processes as well as the facets of the spine.
This allows a fresh "raw" surface of the spine to
come into contact with the harvested bone, which is carefully
laid over the transverse processes. The goal is that
over the next year, a "fusion mass" will develop,
effectively fusing the spine at the intended levels.
Once completed, the retractors are removed and the muscle
falls back into place. The muscle 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. A drain may be left
in to evacuate blood from the wound over the following 1-2
days. The wound is dressed with a sterile dressing,
and the patient is returned to the recovery room.
lumbar decompressive laminectomy with fusion 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.
related to the operative site:
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.
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. The bone may potentially
not fuse, and if so, slippage of the spine and additional
pain may occur.
Smoking decreases the likelihood of a successful fusion.
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
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.
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. You will
likely be required to wear a lumbar brace or corset for
three months after surgery.
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.
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.
- Wear your
lumbar brace or corset as prescribed by your surgeon.
- Lift nothing
heavier than a half gallon of milk until seen by your
- 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
- 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
- Sexual activities
- 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.
- NO SMOKING.