Lumbar Laminectomy
Reverend John Dennis* a 76 years old, very active Lutheran Minister who, per his own words, “can run circles around most people 20 year younger than me.”  But all of that that changed in May 2002.  He began to have severe low back pain and left leg pain to the point he was seen in the emergency room because the pain was so bad.  He was seen by Dr. Maroon in June 2002 and was found to have weakness of the left foot and difficulty walking any distance.  “I told Dr. Maroon I didn’t care whether I lived or died because I couldn’t take the pain much longer,” said the Reverend.

A MRI was done and showed a large herniated disc along with spinal stenosis at the L4-5 levels.  “I had the surgery on July 8th and was home by the 9th,” said the Reverend, “I was back to the church in one week and preaching a sermon two weeks after surgery.”  “My pain was immediately gone and the strength is back in my foot, and I am able to ride a stationary bike without a problem.   Overall, I feel this was a great success and I am back to myself again.”

* Reverend John Dennis has signed a released to permit the release of this personal information. We will not disclose any information unless the parties involved agree in writing. Reverend John Dennis chose to permit this information because of his gratitude to Dr. Maroon and his staff.

Lumbar Laminectomy

History:

Caroline Lollini* is an active 85 year old who since June of 2000 has been unable to enjoy her favorite sport due to low back pain.  Golf has been her avid past time for many years and she had played on a regular basis until it became difficult for her to walk.  “I was just it too much pain”, states Mrs. Lollini, “I knew there must be something wrong”.  She first saw her PCP and she was then referred to a neurologist.  “He told me I was too old to have surgery even though I have no major illnesses”, relates Mrs. Lollini, “he sent me to physical therapy which I think made things worse.”

Discussion:

Mrs. Lollini’s symptoms of back pain and difficulty walking are very common with lumbar stenosis.  This condition may improve with physical therapy but as Mrs. Lollini observed, in some people the activities of physical therapy can make people feel worse.  The fact that Mrs. Lollini is 85 years old, however, is not a good reason not to consider a surgical option.  Biological aging varies from person to person and a 40 year old may be physiologically as old as an 80 year old. And the opposite is also true.  Mrs. Lollini’s general health was excellent, as per her PCP, and therefore was referred to Dr. Maroon after her symptoms worsen with physical therapy.

Evaluation and Operation:

Dr. Maroon evaluated Mrs. Lollini in December 2000 and a MRI was done confirming the diagnosis of lumbar spinal stenosis at the L4-5 levels. Following a review of the risks and benefits of the surgery she underwent an L4-5 lumbar laminectomy on February 7, 2001, by Dr. Maroon, at Presbyterian University Hospital.

Recovery:

Mrs. Lollini was walking in her hospital room the night after surgery and walking in the halls the next day.   “I did not require any pain medication after surgery, which is somewhat unusual, and in fact I had to ask my Nurse if the surgery was over because I had no pain”, relates Mrs. Lollini. She was discharged home two days after surgery and was cleared to resume her daily activities after her follow-up appointment on March 9, 2001.  “This summer I played almost 40 rounds of golf”, states Mrs. Lollini, “I have no more back or leg pain and I can walk as far as a need to.”  “The worse thing about this is the delay I had to endure to get this surgery because people thought I was too old.  I have a good mental attitude and I think this helps a great deal.”

Discussion:

Mrs. Lollini’s recovery is not unusual, and many people have a similar experience.  The fact is that we are living longer and fuller lives and that the age of a person is less of a factor when considering who would benefit from surgery.  Careful patient selection and review of all medical risk factors is still the primary objective in order to help assure a good outcome.  Mrs. Lollini is certainly a good example of the fact that old age may not be a reason to continue to suffer.

*Mrs. Lollini has signed a released to permit the release of this personal information.  We will not disclose any information unless the parties involved agree in writing.  Mrs. Lollini chose to permit this information because of his gratitude to Dr. Maroon and his staff.

Lumbar Laminectomy

History

Mr. Bruno Sammartino* is a national and internationally known superstar in the world of profession wrestling who has enjoyed a remarkable career and generally good health. Mr. Sammartino, however, states for the last 10 years he has had progressive back pain.  “The pain in my back was bad but I was still able to jog and carry on with most activities”, stated Mr. Sammartino, “but once I began to get numbness into my legs I had difficulty walking and then even standing for any period of time.” “I couldn’t even walk to my own mailbox.”

These symptoms persisted and he underwent a MRI, brain scan, carotid blood vessel tests and electrical nerve tests. He then was evaluated by both orthopedic and neurosurgical spine specialists.  “Everyone said something different and I was told that no surgery could help and if I had surgery I would then need a fusion to stabilize my spine.

He was subsequently evaluated by Dr. Maroon and found to also have diminished vibration sensation and abnormal reflexes of his legs. The MRI’s revealed severe lumbar stenosis or narrowing of the lumbar spinal canal at L2, L3, and L4.  Following a discussion of the risks and benefits of surgery he agreed to have a lumbar laminectomy at those levels on 8/20/01.

Discussion:  Mr. Sammartino’s evaluation and duration of symptoms are not uncommon with the condition of spinal stenosis.  This condition is sometimes called the “great imitator” because it tends to have the same symptoms of many other diseases.  Brain problems such as vascular disease, Diabetes, Parkinson’s Disease and Multiple Sclerosis, all may have similar symptoms of leg numbness and the inability to walk for any distance. The lengthy evaluation process of brain scans and other non-spinal tests often are done to “rule-out” these conditions, but may also delay the discovery of the actual problem.  Before sophisticated MRI’s and CT-scans the condition of spinal stenosis was a common reason people over 60 years were confined to wheelchairs.

Mr. Sammartino also expressed concern that he had received such different options prior to seeing Dr. Maroon.  His experience of having been told that there was no surgery that could help him made him feel “hopeless”.  “I didn’t know how I could make it”, stated Sammartino, “I was falling and couldn’t walk more than 60 feet.” The next surgeon stated that he needed and operation but most likely he would then need more surgery to fuse his spine with metal rods.  “I thought I needed surgery but I was reluctant to sign on for possibly two operations”, related Mr. Sammartino. Sometimes a second operation is needed to stabilize the spine after a laminectomy.  This is call a lumbar fusion and is generally done with pedicle screws and rods alone with placement of bone to allow the fusion to occur.  This operation, however, is only rarely needed (<5%) and if required is generally very effective and safe.  But like most risks of any operation the laminectomy’s benefits greatly outweigh the risks.
Surgery and Hospitalization

Mr. Sammartino underwent the operation without complication and was discharged the two days after the surgery. “My leg symptoms were immediately better when I woke up in the room, but I had a fair amount of incisional pain”, stated Mr. Sammartino.  He required several pain pills but didn’t require any more after discharge.  When he was discharged he was asked not to do any strenuous activities, including driving himself for two weeks, and to start walking again. He would follow-up appointment with Dr. Maroon in four weeks.

Discussion:  His relief of leg symptoms is common after this type of operation and is shared by most patients. Back or incisional pain is also common due to the fact that a deep incision is required to do the laminectomy. The big back muscles can respond with pain and spasm that is why some people stay one or two days in the hospital.  But because this is temporary pain, during the healing process, these symptoms rapidly improve and are usually treated with mild pain pills or anti-muscle spasm pills.
Recovery

Mr. Sammartino was recently seen back by Dr. Maroon on 09/25/01. “He examination after surgery is now normal”, states Dr. Maroon.  “And I will recommend progressive return to all activities at this time.”  He was recommended to start in a therapy program to strengthen his leg muscles and help his endurance. “He has stopped short of asking to return to the square-ring”, said Dr. Maroon.

“I am already walking 6 miles a day”, states Mr. Sammartino,  “I believe I have the endurance back that I once had 3 years ago and I am totally pain free and without any numbness in my legs”.  “My quality of life was rapidly worsening before the surgery and now I can get back to all the things I enjoy”. “I am very happy to have had surgery and I recommended it to anybody who needs it”.        Discussion

Mr. Sammartino’s results are usual of this operation. Each patient’s recovery differs and depends on many factors.  Age, sex, type and amount of disability and length of symptoms all play a role in the recovery process.  Mr. Sammartino’s lifelong history of athletics and conditioning certainly added to his rapid recovery.  Our goal in all cases is to allow the patient to resume all the activities they did prior to your injury.

*Mr. Bruno Sammartino has signed a released to permit the release of this personal information.  We will not disclose any information unless the parties involved agree in writing.  Mr. Sammartino chose to permit this information because of his gratitude to Dr. Maroon and his staff.