Lumbar surgery refers to any type of surgery in the lumbar spine, or lower back, between one or more of the L1-S1 levels.
There are three general types of lumbar spine surgery that comprise the most common surgical procedures for the lower back:
This type of pain is usually referred to as a radiculopathy, or sciatica.
A decompression surgery involves removing a small portion of the bone over the nerve root and/or disc material from under the nerve root to relieve pinching of the nerve and provide more room for the nerve to heal. The most common types of decompression surgery are microdiscectomy and laminectomy.
This pressure is most commonly caused by bony overgrowths within the spinal canal, which can occur in people who have arthritis in their spines.
Laminectomy is generally used only when more-conservative treatments — such as medication, physical therapy or injections — have failed to relieve symptoms. Laminectomy may also be recommended if symptoms are severe or worsening dramatically.
Surgeons usually perform laminectomy using general anesthesia, so you’re unconscious during the procedure. The surgical team monitors your heart rate, blood pressure and blood oxygen throughout the procedure with a blood pressure cuff on your arm and heart-monitor leads attached to your chest. After you’re unconscious:
The surgeon makes an incision in your back over the affected vertebrae and moves the muscles away from your spine as needed. Small instruments are used to remove the appropriate lamina.
If laminectomy is being performed as part of surgical treatment for a herniated disk, the surgeon also removes the herniated portion of the disk and any pieces that have broken loose (diskectomy).
If one of your vertebrae has slipped over another or if you have curvature of the spine, spinal fusion may be necessary to stabilize your spine. During spinal fusion, the surgeon permanently connects two or more of your vertebrae together using bone grafts and, if necessary, metal rods and screws.
Depending on your condition and individual needs, the surgeon may use a minimally invasive incision and a special surgical microscope to perform the operation. The incision is closed using staples or stitches.
During the procedure, a small part of the bone over the nerve root and/or disc material under the nerve root is taken out.
A microdiscectomy (also called a microdecompression) is usually more effective for relieving leg pain (also known as radiculopathy, or sciatica) than lower back pain.
For leg pain, patients will normally feel pain relief almost immediately after a microdiscectomy. They will usually go home from the surgery with significant pain relief. For numbness, weakness, or other neurological symptoms in the leg and foot, it may take weeks or months for the nerve root to fully heal and any numbness or weakness to subside.
As general rule, microdiscectomy is considered a relatively reliable surgery for immediate, or nearly immediate, relief of sciatica from a lumbar herniated disc.
Minimally Invasive Microdiscectomy
There are two common options in an outpatient lumbar discectomy—microdiscectomy and endoscopic (or percutaneous) discectomy. A microdiscectomy is generally considered the gold standard for removing the herniated portion of a disc that is pressing on a nerve, as the procedure has a long history and many spine surgeons have extensive expertise in this approach.
While technically an open surgery, a microdiscectomy uses minimally invasive techniques and can be done with a relatively small incision and minimal tissue damage or disruption.
Some surgeons have now gained sufficient experience with endoscopic or minimally invasive techniques, which involve doing the surgery through tubes inserted into the operative area, rather than through an open incision.
There are also a few alternatives available to the above standard procedures, such as an X-STOP which is a possible option instead of a laminectomy for lumbar spinal stenosis.
A spinal fusion surgery involves using a bone graft to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. Spine surgery instrumentation (medical devices), bone graft procedures, and a bone stimulator are sometimes used along with spinal fusion.
Minimally Invasive Lumbar Fusion
Unlike a traditional surgical spinal fusion—sometimes called an open spinal fusion—the goal of a minimally invasive lumbar fusion is to minimize the size of the incision and the exposure of the spine, which lessens the amount of healing you have to do. MISS uses specialized instrumentation that allows the surgeon to avoid disrupting soft tissues (eg, muscles) in the spine, resulting in less pain. These procedures are typically safer, quicker, and promote a faster recovery than traditional spine surgery.
The potential benefits of minimally invasive spine surgery include:
Less blood loss
Lower risk of muscle and soft tissue damage
Lower risk of infection
Reduced postoperative pain
Reduced pain medication use
While MISS often focuses on the size of the incision, it’s really a larger concept of being minimally traumatic to the body and the muscles in the low back. The MISS technological advances have not only given spine surgeons a new way to perform lumbar fusion, but they’ve also enabled the surgery to be performed in an outpatient setting. You can now have your surgery performed in a comfortable atmosphere, and many patients return home same day—as opposed to the two to three-day hospital stay for a traditional fusion.
What Happens During an Outpatient Minimally Invasive Lumbar Fusion Surgery?
Simply put, a fusion procedure fuses (ie, joins) together two or more bones in your spine (eg, vertebral bodies). Bone graft is used to help stimulate fusion. Bone graft may be packed into the empty disc space (after micro-discectomy; surgical removal of an intervertebral disc), interbody device and/or instrumentation implanted to immediately stabilize one or more levels of the spine. Over time, the bones grow and heal together into a solid, which further stabilizes the spine.
Two common MISS fusion procedures are (1) transforaminal lumbar interbody fusion (TLIF) and (2) posterior lumbar interbody fusion (PLIF).
In a TLIF, you are positioned face-down on the operating table and the surgeon works from the side of the spine.
In a PLIF, the surgeon accesses your spine from the middle of the back.
Minimally invasive lumbar fusion has a host of benefits over traditional fusion—less blood loss, smaller incision, and quicker recovery time to name a few. But, not everyone is a candidate for a minimally invasive spinal fusion, particularly in an outpatient setting.
Surgical treatment of some low back (lumbar spine) conditions require a traditional open approach. Therefore, your particular diagnosis and other factors (eg, overall health) are important considerations in making the decision whether MISS is right for you. It is important to understand that if you have a serious health problem, such as cardiovascular disease, your surgeon may recommend you undergo the MISS procedure in the hospital, where other specialists (eg, cardiologists) are readily available.
As any spine fusion surgery, there is a risk of nonunion—that is, when bones don’t fuse as planned. Your surgeon will review all potential complications as a result of undergoing minimally invasive lumbar fusion with you prior to surgery.
Advances in technology and instrumentation have paved the way for the ever-growing effectiveness of minimally invasive lumbar spinal fusion. Minimally invasive procedures require smaller incisions with faster recovery, and patients who undergo MISS in an outpatient setting enjoy the additional benefits of being in a comfortable environment and going home the same day.
For more information on lumbar surgery please do not hesitate to get in touch with Mr Torrie through our appointments page.