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Lumbar 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.

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.

t 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.

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)

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:

  1. You will be given anesthesia so that you’ll sleep and won’t feel any pain or discomfort during the surgery.
  2. 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.
  3. You may be given antibiotics during and after the procedure, to help prevent infection.
  4. Your surgeon will make a small incision, usually on your side or back.
  5. Using special tools, he or she will dilate your back muscles, pushing them out of the way.
  6. Your surgeon will remove the intervertebral disc between your affected vertebrae.
  7. 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.
  8. Your surgeon may use special screws or other material to anchor your bones in place.
  9. Your surgeon will make other repairs, if needed.
  10. 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.

ALIF: Anterior Lumbar Interbody Fusion (with bone graft and metal plate)

ALIF is generally used to treat back or leg pain caused by degenerative disc disease. The surgeon will stabilize the spine by fusing vertebrae together with bone graft material.

Lumbar Disc Microsurgery

This minimally-invasive procedure relieves pressure on nerve roots caused by a herniated disc. It can eliminate the pain of sciatica.

Laminotomy (of the Lumbar Spine)

This surgery creates more space around your spinal nerves. It gets rid of pressure and pinching. It can relieve pain, numbness and weakness linked to spinal nerve compression.

XLIF® Lateral Lumbar Interbody Fusion

Unlike traditional back surgery, XLIF® is performed through the patient’s side. By entering this way, major muscles of the back are avoided. This minimally-invasive procedure is generally used to treat leg or back pain caused by degenerative disc disease. It can be performed on an outpatient basis.

Lumbar Disc Microsurgery

This minimally-invasive procedure relieves pressure on nerve roots caused by a herniated disc. It can eliminate the pain of sciatica.

ALIF: Anterior Lumbar Interbody Fusion (with bone graft and pedicle screws)

ALIF is generally used to treat back or leg pain caused by degenerative disc disease. The surgeon will stabilize the spine by fusing vertebrae together with bone graft material.

Artificial Disc Replacement (in the Lumbar Spine)

This surgery treats a bad vertebral disc in your lower back. It replaces the bad disc with an artificial one. The new disc will let your spine bend and twist. For some, this surgery is an alternative to spinal fusion.

Spinal Fusion (Lumbar)

In many spinal surgeries, two or more vertebral bones are permanently joined with a technique called “spinal fusion.” A fusion creates a solid mass of bone. It stabilizes your spine.

TLIF: Transforaminal Lumbar Interbody Fusion

TLIF is generally used to treat back or leg pain caused by degenerative disc disease. The surgeon will stabilize the spine by fusing vertebrae together with bone graft material.

Lumbar Disc Microsurgery

This minimally-invasive procedure relieves pressure on nerve roots caused by a herniated disc. It can eliminate the pain of sciatica.

Lumbar Radiculopahy (Sciatica)

This condition is an irritation or compression of one or more nerve roots in the lumbar spine. Because these nerves travel to the hips, buttocks, legs and feet, an injury in the lumbar spine can cause symptoms in these areas. Sciatica may result from a variety of problems with the bones and tissues of the lumbar spinal column.