Lumbar
Treatments and Procedures
At Northern Neurosurgery and Spine, patients and health care providers are able to learn about spine anatomy, different spinal conditions, and the vast array of traditional and minimally invasive treatment options. We offer a full spectrum of spine information, ranging from simple, basic descriptions to up-to-date information from recent medical journal articles, so that you may learn as much as possible about the spine.
Minimally Invasive Lumbar Microdiscectomy
Diskectomy is a surgical procedure to remove the damaged portion of a herniated disk in your spine. A herniated disk can irritate or compress nearby nerves. Diskectomy is most effective for treating pain that radiates down your arms or legs.
The procedure is less helpful for treating actual back pain or neck pain. Most people who have back pain or neck pain find relief with more-conservative treatments, such as physical therapy.
Surgeons usually perform diskectomy using general anesthesia, so you’re unconscious during the procedure. Small amounts of spinal bone and ligament may be removed to gain access to the herniated disk.
Ideally, just the fragment of disk that is pinching the nerve is removed, relieving the pressure but leaving most of the disk intact.
If the entire disk must be taken out, your surgeon may need to fill the space with a piece of bone — taken from a deceased donor or from your own pelvis — or a synthetic bone substitute. The adjoining vertebrae are then fused together with metal hardware.
After surgery, you’re moved to a recovery room where the health care team watches for complications from the surgery and anesthesia. You may be healthy enough to go home the same day you have surgery, although a short hospital stay may be necessary — particularly if you have any serious pre-existing medical conditions.
Depending on the amount of lifting, walking and sitting your job involves, you may be able to return to work in two to six weeks. If you have a job that includes heavy lifting or operating heavy machinery, your doctor may advise you to wait six to eight weeks before returning to work.
Open Lumbar Microdiscectomy
A herniated or “ruptured” disc is a common source of low back pain. Discs are the shock-absorbing pads that are between vertebrae. A herniated disc occurs when its outer layer ruptures and the contents come out of the disc. If the contents extend into the spinal canal, it can put pressure on the spinal nerves.
A herniated disc can cause tingling, numbness, pain, and weakness in one or both legs. It can also cause back pain. Most herniated discs can resolve with non-surgical treatments. However, when conservative treatments fail, Lumbar Discectomy surgery is recommended to relieve pain and restore function.
You will be sedated for your Open Discectomy surgery. Your surgeon will make an incision, about an inch long, on the middle of your spine. Muscles will be detached from the vertebrae and moved aside with care to expose the disc. In some cases, the lamina on the vertebrae and ligaments need to be removed to allow the surgeon to see and gain access to the disc. If all of the lamina is removed, the procedure is called a Laminectomy. A Laminotomy involves removing only part of the lamina.
You will most likely stay overnight in the hospital following your surgery. You will receive medication to help ease your pain. You will begin walking with supervision as soon as you have recovered from the anesthesia. You will continue exercising with a physical therapist or an exercise program when you have returned home.
Minimally Invasive Lumbar Decompression
A minimally invasive lumbar laminectomy involves removing a portion of the lamina; a thin piece of bone located at the back of each vertebral body that covers and protects the spinal canal. A micro-laminectomy may include removing bony overgrowths (ie, osteophytes) and ligament tissue compressing spinal nerves at one or more levels of the spine.
Prior to surgery, general anesthesia specific to outpatient surgery is administered.
Throughout surgery, the surgeon utilizes real-time x-ray images known as fluoroscopy. The images captured in real-time enable the surgeon to navigate and precisely guide his surgical instruments.
The surgeon makes a small skin incision (almost puncture-like), about 1-inch long directly over the level(s) in the low back where surgery will be performed. Next, the surgeon slides sequentially-sized tubular retractors through the incision and separates soft tissues (eg, muscles). The tubular retractor holds the tissues apart. While operating, the surgeon may wear special eyeglasses (loupes) or may use a specialized surgical microscope that gives him/her microscopic vision of the surgical field. The loupes’ or microscope’s ability to magnify and illuminate enables the surgeon to see small tissues that may be compressing spinal nerves. In addition, bone drills and other instruments specially designed for MISS are utilized to remove bone spurs (ie, osteophytes) or ligament tissue causing nerve compression while preserving the lamina and sometimes the interspinous ligament.
When the procedure is finished, the surgeon removes the tubular retractors allowing the soft tissues to move back into their natural places. The surgeon closes the tiny incision using sutures that dissolve within 2-4 weeks.
It will take about 4 to 6 weeks for you to reach your expected level of mobility and function (this will depend on the severity of your condition and symptoms before the operation). When you wake up after lumbar decompression surgery, your back may feel sore and you’ll probably be attached to 1 or more tubes.
Open Lumbar Decompression
Lumbar decompression surgery is a type of surgery used to treat compressed nerves in the lower (lumbar) spine.
It’s only recommended when non-surgical treatments haven’t helped.
The surgery aims to improve symptoms such as persistent pain and numbness in the legs caused by pressure on the nerves in the spine.
The aim of lumbar decompression surgery is to relieve the pressure on your spinal cord or nerves, while maintaining as much of the strength and flexibility of your spine as possible.
Depending on the specific reason you’re having surgery, a number of different procedures may need to be carried out during your operation to achieve this.
Three of the main procedures used are:
- laminectomy – where a section of bone is removed from one of your vertebrae (spinal bones) to relieve pressure on the affected nerve
- discectomy – where a section of a damaged disc is removed
- spinal fusion – where 2 or more vertebrae are joined together with a bone graft
You’ll usually be well enough to leave hospital about 1 to 4 days after having surgery, depending on the complexity of the surgery and your level of mobility before the operation.
Most people are able to walk unassisted within a day of having the operation, although more strenuous activities will need to be avoided for about 6 weeks.
You may be able to return to work after about 4 to 6 weeks, although you may need more time off if your job involves driving for long periods or lifting heavy objects.
Minimally Invasive Lumbar Fusion (Transformainal Lumbar Interbody Fusion)
Spinal fusion is a surgical procedure to join 2 or more bones of your spine together permanently. A minimally invasive spinal fusion uses a smaller cut (incision) than a traditional spinal fusion surgery.
Your vertebrae are the small bones that make up your spinal column. These vertebrae stack on top of each other, separated by intervertebral discs. These bones protect your delicate spinal cord, which sends and receives information from your brain to the rest of your body.
Your healthcare provider can help explain the details of your particular surgery. They will depend on the nature of your injury and the surgical approach. An orthopedic surgeon and a team of specialized nurses will perform the surgery. The whole surgery may take a couple of hours. In general, you can expect the following:
- You will be given anesthesia so that you’ll sleep and won’t feel any pain or discomfort during the surgery.
- Your vital signs, like your heart rate and blood pressure, will be carefully watched during the surgery. You may have a breathing tube inserted down your throat during the surgery to help you breathe.
- You may be given antibiotics during and after the procedure, to help prevent infection.
- Your surgeon will make a small incision, usually on your side or back.
- Using special tools, he or she will dilate your back muscles, pushing them out of the way.
- Your surgeon will remove the intervertebral disc between your affected vertebrae.
- He or she will place some sort of material in the space between your vertebrae. This might be bone or a synthetic bone-like material.
- Your surgeon may use special screws or other material to anchor your bones in place.
- Your surgeon will make other repairs, if needed.
- The layers of skin around your incision will be surgically closed.
Talk with your healthcare provider about what you can expect after surgery. You may have some pain around your incision after the procedure, but you can take pain medicines to relieve it. You should be able to resume your normal diet and activities fairly quickly. You may have some sort of imaging procedures, like X-ray, done to see how your surgery went. Depending on the extent of your injury and your other medical conditions, you might be able to go home within the next couple of days.
Open Lumbar Fusion
Spinal fusion is a major surgery and medical procedure used to treat back injuries. The surgery includes using rods and screws, and bone grafts to stabilize the spine. This surgery is usually a last resort after other treatments have been tried and failed.
At each level in the spine, there is a disc space in the front and paired facet joints in the back. Working together, these structures define a motion segment and permit multiple degrees of motion.
Two vertebral segments need to be fused together to stop the motion at one segment, so that an L4-L5 (lumbar segment 4 and lumbar segment 5) spinal fusion is actually a one-level spinal fusion. An L4-L5, L5-S1 fusion is a 2-level fusion.
A spine fusion surgery involves using bone graft to cause two vertebral bodies to grow together into one long bone. Bone graft can be taken from the patient’s hip (autograft bone) during the spine fusion surgery, harvested from cadaver bone (allograft bone), or manufactured (synthetic bone graft substitute).
After surgery, you can expect your back to feel stiff and sore. You may have trouble sitting or standing in one position for very long and may need pain medicine in the weeks after your surgery. It may take 4 to 6 weeks to get back to doing simple activities, such as light housework. It may take 6 months to a year for your back to get better completely.
You may need to wear a back brace while your back heals. And your doctor may have you go to physiotherapy.
Extreme Lateral Lumbar Interbody Fusion (XLIF)
Extreme lateral interbody fusion (XLIF) is a minimally invasive procedure performed through the side of the body to treat spinal disorders and reduce long-term back or leg pain that has not responded to other treatments, such as steroid injections, physical therapy and pain medication.
During XLIF, surgeons work in areas that are close to nerves on the spinal column. To prevent nerve damage, nerve monitoring, called electromyography or EMG, is used that provides surgeons with real-time information about nerve position relative to his or her instruments.
XLIF, which typically takes about an hour, is performed under general anesthesia so you’ll be asleep during surgery. Steps of the surgery include:
- Once you are asleep, you will be positioned on your side. The surgeon will use X-ray to locate the disc to remove and will use a marker to mark your skin above the disc.
- A small incision is first made toward your back. The surgeon places his or her finger through this incision to protect the peritoneum (sac containing abdominal organs) as instruments pass through the lateral space to the spine.
- A second incision is made on your side through which the instruments will pass to remove the herniated disc.
- With the spinal disc visible, the disc is removed.
- An implant is placed into the empty disc space. The implant is filled with bone graft for fusion.
- An X-ray image ensures the implant is correctly placed. .
- Depending on a patient’s condition, additional support, such as screws, plates or rods, may be inserted to stabilize the spine for fusion.
Because XLIF is less disruptive than conventional surgery, most patients can walk the evening after surgery and are discharged from the hospital the next day.
Your surgeon and health care team will determine the best course for you, depending on your comfort and other health problems you might have. Your surgeon will discuss with you any appropriate pain medications as well as a prescribed program of activities. In general, XLIF surgery results in quick recovery and return to normal activities.
Anterior Lumbar Interbody Fusion (ALIF)
The ALIF is defined as Anterior Lumbar Interbody Fusion. This approach requires a 4-6” incision in the abdomen to access one or two levels. The surgeon works around the great vessels to access the anterior longitudinal ligament. The ligament must be removed to access the disc. The surgeon can then remove the diseased disc nucleus to prepare the vertebral bodies for fusion. After the disc is prepared, a biocompatible polymer implant is filled with bone graft material and placed in the disc space. With an ALIF implant, the surgeon may choose to add an anterior plate to replace the anterior ligament and prevent movement of the implant. This procedure is normally accompanied by a posterior fixation with pedicle screws or facet screws The implant maintains the spacing of the vertebrae while the fusion takes place. After the fusion is completed and a solid bone mass forms; the two vertebrae are joined together.
The ALIF is performed in a hospital setting. Patients typically go home a day or two after surgery; recovery takes 6 to 12 weeks.
Removal of Spinal Tumors
As with any tumor, the best-case situation is its complete removal. However, since treatment options may put the spinal cord at risk, many factors are considered before treating a spinal tumor. These factors include your age and general health, the type of tumor and where it’s located, and whether it originates in the spine or spread from another part of the body.
Therefore, it’s possible that treatment for your tumor may simply be monitoring, particularly if it isn’t producing any symptoms. For patients who are older or susceptible to the risks of surgery or radiation treatments, periodic observation and testing may be the best approach.
Your best solution for treatment is the team of experienced spine and neurosurgeons of Northern Neurosurgery and Spine, located in Fargo, ND. izona.
Most benign tumors and many malignant vertebral column tumorscan often be totally removed with advanced surgical techniques. Surgery to decompress the spinal cord, called decompression surgery, consists of removing the portion of the vertebra involved with the tumor.
For most intradural tumors, you can expect to recover from the effects of the operation itself after three to four weeks. A complete recovery, however, which consists of healing and therapy to recover from the neurological deficits caused by the tumor, can take a year or two in more severe cases.
Removal of Synovial Cysts
Synovial cysts are abnormal fluid-filled sacs in joints in the spine. These cysts are benign, which means they are not cancerous. Synovial cysts typically develop as a result of degenerative changes that occur with aging. They can be found throughout the spine, but are most common in the lumbarregion (low back).
The goal of surgical treatment is to remove the cyst and decompress (provide more room for) the spinal cord and nerve roots. This surgery is similar to a microdiscectomy.
After removing the cyst, the surgeon may need to fuse the affected joint. This procedure prevents the cyst from re-forming by preventing any movement at the affected joint. An example of this type of surgery is a lumbar fusion.
No one treatment is right for everyone. Our experienced surgeons will determine the best treatment for each patient and each situation.
The L4-L5 level has the most motion, and fusing it creates more stress on the other non-fused levels of the lower spine. Also, the surgery is more to go through since a fusion is an open procedure, and it takes about six to nine months or more for the fusion to heal.