Lumbar Laminectomy (and possible Fusion surgery)

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When needed:

Though there are many potential causes for spinal stenosis, the most common cause is the natural wear and tear brought upon by aging. As we get older, the ligaments of the spine that hold the bones together can thicken and pinch the nerves the run through and out of the spinal canal.  In other instances, the nerve pinching may be caused by bone spurs as they grow throughout the bones of the lumbar spine.  Additionally collapse of the disc spaces between the vertebrae, called spondylosis, can occur which puts greater pressure on the joints between the vertebrae.  These joints, called facet joints, begin to enlarge and sometimes become unstable requiring additional fusion surgery in some cases.  

If the facets joints and spinal stenosis progresses they can be accompanied by a condition called “spondylolisthesis”. This condition exists when there is slippage of one vertebral body over another, and the result is pain associated with nerve compression. The varying degree of slippage may cause further spinal instability that requires a fusion operation to be done at the time that stenosis is surgically addressed. 

In summary, the lumbar laminectomy is intended to decompress the area of stenosis and, if required, the fusion is performed to prevent any spondylolisthesis progressions by granting stability to the spinal segments.

What is Needed?

Generally, conservative treatment is helpful in the early phase of stenosis, but, as the condition persists over time, many people seek surgical intervention. An MRI or CTS is typically required to diagnose the condition, and occasionally a myelogram is done to determine the degree of stenosis. 

The surgery used to treat spinal stenosis is the lumbar laminectomy. This surgery is somewhat more invasive than a microdiscectomy because the area of the incision tends to be slightly larger. Depending on the levels of the spine requiring decompression, an incision is made in the lumbar area, and the lamina, or outer bone of the vertebra, is exposed. With the use of specialized instruments and an operating microscope, the lamina is removed along with any other potential compression points. The nerve roots that connect to the legs and under lying spinal nerves are explored and decompressed.

The surgery can last one to two hours depending on whether an additional fusion surgery is required to lock the vertebra in place and to provide spinal stability.  After surgery you may experience incisional pain but typically the leg symptoms are improved such that you are walking the night of surgery and generally home the next.  If a fusion is required you will be fitted with a lumbar brace that you will be asked to wear after surgery for 4 to 6 weeks. 

Prior to Surgery

Conservative therapy, or non-surgical treatment, is often used before surgery. Occasionally, conservative therapy may relieve the symptoms associated with a herniated disc, bone spurs or arthritic nerve compression (spinal stenosis) and relieve the need for surgery. However, when conservative therapies, such as bed rest, medication, injections, physical therapy, traction and others have proven ineffective, an Lumbar Laminectomy may be considered.

Diagnostic tests are required prior to surgery and may include lumbar computed tomography (CT), magnetic resonance imaging (MRI), and Myelograms all of which can indicate the degree of herniation, bone spurring or disc space collapse and allow your neurosurgeon to perform the procedure according to your level of severity. One or more of these tests may be required in order to diagnose the problem most accurately.

When needed:

Lumbar Laminectomy with or without fusion is often recommended in order to correct a stenosis and spinal instability once conservative therapies have failed or rapid neurological deterioration is occurring. The Lumbar Laminectomy procedure often done using minimally invasive techniques, through a microscope, which allows for reduced tissue trauma and often faster healing times. In most cases, the patient is released from the hospital the next and is able to return to many of the daily activities performed prior to the surgery. There are generally no additional restrictions after 1 to 3 months after surgery.

Despite an overall success rate of 80 to 90%, there are, as with all procedures, certain risks to be made aware of; these risks include, but not limited to: infection, excess bleeding, no relief of symptoms, excess scarring, increased neurological dysfunction, bladder or bowel problems and anesthetic complications which will be reviewed with you by the anesthesiologist on the day of surgery.

Following the surgery, minor discomfort resulting from the incision is common, but temporary. If such pain occurs, it can be relieved through the use of mild pain medication. Additionally, persistent numbness, weakness, and pain along the path of the decompressed nerve may result, but such symptoms are generally temporary.

What to Know at your Office Visit

Please remember to bring your insurance information and a completed medical history form. You should have received this form by mail or at the time of your visit or is available to print out online. This medical history form provides information about your current and past medical history, along with any prior anesthesia complications, your current medications and any drug allergies.

Please bring the results of any prior diagnostic test related to your condition. Also bring the actual X-ray pictures or CD of any computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, myelogram, plain X-rays or other test that was done to evaluate your spine problem.

Your examination

Your neurosurgeon and his staff will interview you in the examination room. This will include a review of the medical history form you have completed and questions about your back problem. A comprehensive neurological and physical exam will be performed, and any diagnostic tests and X-rays, will be reviewed. Results of this exam may indicate the need for further-diagnostic tests, conservative therapies or possible, surgical recommendation.

If Surgery is Required

You may need to do several things to ensure that your insurance company has approved, the operation scheduled for you. Many insurance companies require pre-certification and second opinions. It is your responsibility to ask your insurance company about its particular requirements although our staff can help with this process.

If you have a pre-existing medical condition and are under a doctor’s care, you will receive a consultation clearance form to be completed by your doctor. This should be faxed by your doctor to your neurosurgeon’s office as soon possible, so surgery is not delayed. Also, plan to bring a copy of this form to the hospital’s Same Day Surgery Unit on the day of your surgery.

UPMC Presbyterian Pre-op Surgery

Phone: 412-692-2222

UPMC Passavant Pre-op Surgery

Phone: 412-367-6567

Testing before your Surgery

On the day of your office visit, you will receive a prescription for pre-surgical testing to detect any blood abnormalities. These tests can be done up to 14 days prior to your surgery date. The results must be reviewed by the neurosurgeon’s office no later than two working days before your surgery date. The prescription allows UPMC Presbyterian University Hospital, UPMC Passavant or any certified laboratory approved by your insurance company, to do the blood, urine, EKG and X-ray tests and forward the results to the neurosurgeon’s office for review.

Pre-admission packet

A pre-admission packet will be given to you by the neurosurgeon’s office on the day of your visit or mailed to you if surgery is required. Included in the packet is general information about the hospital you will have your surgery at and its procedures. Please read all of the pre-admission materials completely. This brochure does not cover all the steps you’ll need to take on the day of your surgery.

Lumbar Laminectomy with or without fusion: A Patient’s Guide to Surgery 

Our goal is to return you to optimum health following surgery and send you home the day of or day after your operation.

The following information should help you understand what will be involved with the surgery. This guide is not intended to take the place of the neurosurgical team’s explanation, but is designed to answer some common questions and make you familiar with common terms and procedures related to a Lumbar Laminectomy surgery.

Testing and therapy before Surgery:

Our goal is to return you to your activities prior to your surgery. Conservative therapy or non-surgical treatment is often used before surgery. Occasionally, conservative therapy may relieve the symptoms associated with a herniated disk or stenosis and eliminate the need for surgery. Because conservative therapies such as bed rest, medications, traction and physical therapy have not been effective for you; your neurosurgeon has recommended Lumbar Laminectomy and possible Fusion.

Diagnostic tests such as lumbar computed tomography (CT), magnetic resonance imaging (MRI) and myelograms indicate the level degree of herniation, bone spurs or spine compression and allow your neurosurgeon to precisely perform the procedure. One or more of these tests may be necessary to accurately diagnose the problem.

The Procedure and its Benefits:

Lumbar Laminectomy takes about one to two hours to perform. Your incision will be dependent of the amount of surgery required on your spine. Generally, you will be walking the day of surgery and can be discharged the day after your operation. Please arrange your transportation home in advance.

The risks involved with this type of surgery will be reviewed prior to surgery by your neurosurgeon in his office and the anesthesiologist the day of surgery.

After surgery, minor discomfort from your incision is common but temporary. This can be relieved with mild pain medication. Following the procedure, you may experience persistent numbness, weakness and pain along the path of the nerve that was decompressed, but these symptoms are generally temporary and gradually go away.

Discharge instructions, pain and muscle relaxant prescriptions will be provided to you in an informational packet and review with you prior to discharge. Your activities will be limited until you come for your postoperative follow-up visit.  You will be asked to obtain a lumbar spine x-ray prior to your follow-up visit if you also had a fusion done at the same time as your laminectomy.

Members of the health-care team:

You will meet a number of health professionals during this time. Their goal is to help you recover and return you to your prior activities. A brief description of each of these professionals follows:

Neurosurgeon. You have already met this person, who will perform the surgery and direct your care afterward. Please feel comfortable asking questions of your surgeon – communication is an essential key toward recovery.

Nurse. A nurse will assess your condition both in the surgeon’s office and in the hospital. The office nurse will evaluate you before you see the surgeon and again with the surgeon at the time of your visit. The office nurse will help explain the procedure, answer questions and arrange your surgery. The hospital nurse will assess you in the hospital, and help you before, during and after your surgery. The nurse also will answer questions from you and your family.

Physician assistant.- The physician assistant (PA) has -been trained to perform many tasks done by a physician. The PA may perform your history and physical examination and review the surgical procedure. The PA can answer questions and will follow you in the hospital after surgery, along with your physician. The PA will review your discharge instructions on the day after your procedure and facilitate your discharge planning.

The day of surgery:

Several days prior to surgery you will be contacted by the Same Day Surgery Unit’s Nurse, who will review your health and medication history. If you have not received a call by 5:00 pm, the day before your surgery (see numbers above). Please be prepared and have a list of questions and your medications by the phone.

You will be thinking of many things on the day of your surgery, and it is only natural to be overwhelmed and possibly confused about what to do. This information and other information provided can help you become familiar with the process involved with your hospitalization and surgery. We hope that these help to answer your questions and reassure you about your procedure.

Arrival at the Hospital

Plan to arrive at the Hospital follow overhead signs to Admitting. Eating or drinking after midnight the night before surgery is NOT permitted unless otherwise instructed.

You will be visited by a nurse and/or PA, who will perform a preoperative assessment.

·Results from your laboratory work will be reviewed again. If you have a family doctor clearance letter, it will be collected. You will go to the bathroom. Your family should wait in the Surgical waiting room. You will be held in the Pre-operative Holding Area located next to the Operating Rooms.

Holding Area

Here, you will see your neurosurgeon and/or his representative and also discuss anesthesia related concerns and risks with your anesthesiologist.  An intravenous, (IV) line will be inserted, and you will be given antibiotics and fluids.

Operating Room

You will be in surgery for about one to two hours. You will receive a general anesthetic, which means, you will be asleep during the procedure. After surgery, you will be taken to the Recovery Room.

Recovery Room

Your vital signs will be checked frequently, the surgical dressing will be checked and your symptoms will be assessed.;

• You may receive pain medication.
• Your IV fluids will continue.
• You will not be allowed to eat or drink.

An anesthesiologist will discharge you from the Recovery Room after you are completely awake, which usually takes one to two hours. You then either be sent back to Sameday Holding to be discharged later in the day or taken to the Patient Unit located in the hospital. Your family will be informed as to which Unit you will go to.

Patient Unit

The nursing staff will assess you on arrival to the floor and monitor your progress.

Your IV line will be removed after you drink fluids and you will be asked to take deep breaths to prevent pneumonia and do ankle and calf exercises to prevent blood clot complications. Pain medications are available; you should ask for this if you need it.

You will be assisted out of bed the first time you get up. Then, you are encouraged to walk on your own in your room and the halls. The nursing staff will remove the operative dressing the morning after surgery and allow you to shower with a plastic dressing covering this area.

Discharge

Patients who have had Lumbar Laminectomy are discharged generally the day after surgery. Your nurse and PA will discuss your discharge instructions. Please prepare questions to ask at this time.

You will be given a discharge instruction sheet that will include restrictions, activities, physical therapy, medications and care of the incision. Remember to arrange your transportation home prior to this day. You will not be allowed to drive yourself home. If you anticipate a problem with your arrangements to go home, please notify the staff the day of surgery. The discharge time is before 11 am.

Most of the information you will need about your stay is in the brochure you will received at your neurosurgeon’s office. Pertinent telephone numbers, directions, maps, lodging and parking information are highlighted in the handbooks

Your discharge instructions will help you become familiar with any limitations you will have after surgery.

Disclaimer

If you have specific questions that are not addressed in these materials, please call your neurosurgeon. 

Call, toll-free, at 888-234-4357 to learn more.