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Lumbar discectomy/laminectomy

When the spinal canal in the lower back narrows it is known as lumbar spinal stenosis. You may suffer pain, weakness and even tingling in the leg. A lumbar laminectory procedure could give you relief from the condition.
 

On this page you can find everything you need to know about the condition and the procedure. If you are well informed you can make a better decision about the surgery.

What is lumbar spinal stenosis?

The spinal cord runs from the brain down the spinal canal, which is protected by a ‘tunnel’ made from the row of vertebrae which run down the spine. These are arched in shape – hence the tunnel reference – and are linked together by facet joints and kept apart by spongy discs. The nerves and blood vessels belonging to the spinal cord enter the spinal canal below the vertebrae. The nerves are the sole means of communication between the brain and the muscles regarding movement; they inform you of sensations such as touch and pain from the skin.

As we get older there is a natural narrowing of the spinal canal; this is due to the general deterioration of the facet joints, the broadening of the ligaments and the bulging of discs. In addition, some individuals are born with narrower canals. Both spinal arthritis and other bone defects can cause a narrowing of the spinal canal. A narrow canal means less space for the nerves and the blood vessels, which results in nerves that work less efficiently. This is particularly noticeable if you have been standing for a long time or exercising. This condition can cause tingling in the leg or pain which can make walking difficult.

The symptoms can usually be alleviated by sitting down or bending forward.

Why have surgery?

Less pain and better mobility are the two most common benefits of surgery. The procedure limits the chances of the symptoms getting worse.

Alternative possibilities

Not everyone needs surgery but those with chronic symptoms that seem to be getting worse are often considered as candidates.


Figure 1 
Copyright © 2014 EIDO Healthcare Limited

a) Cross section showing a normal spinal canal
b) A disc bulge pressing the nerves within the spine

 

The repercussion of not having surgery

While some patients’ symptoms improve over time, most sufferers see their condition worsen. Surgery is often recommended if this is the case.

The procedure

The operation will last between one and three hours. An MRI scan confirms the site of the necessary surgery. 

An anaesthetist will discuss your anaesthetic options with you and advise on the most appropriate type for your individual circumstances. You should be aware that antibiotics may be administered during the procedure to protect against infection.

The surgeon will make a cut in the centre of your lower back and part your muscles to access the spine. The removal of bone and ligament tissue will ensure there is room for both the nerves and the blood vessels to work properly.


Figure 1
Copyright © 2014 EIDO Healthcare Limited

Bone and ligament removed
a) Top view
b) Cross-section

 

Closure will be with either stitches or clips. The surgeon may insert a tube known as a drain to aid healing. This can be removed in a day or two

Get ready for your operation by following this simple advice:

  • Quit smoking several months before the operation. Not only will it reduce risks of post-operation problems but is generally better for your health. Nicotine can cause surgical wounds to heal more slowly or not at all, which could lead to scarring and chronic pain.
  • Lose or maintain a healthy weight. If you are carrying excess weight there is greater risk of post-surgical problems.
  • Take regular exercise. You will be generally healthier and more ready for the operation, but it will also help you recover better. Before undertaking any exercise check the suitability with your doctor.

Protect yourself against wound infection by:

  • Refraining from waxing or shaving in the incision area for at least one week before the operation.
  • Bath or shower on either the day before or the day of the operation.
  • Keep warm. Make sure you let the healthcare team know if you feel cold before or during the operation.

How long should be allowed for recovery?

  • Walking will be encouraged the day after the surgery.
  • You will need to keep the wound dry for a period of four to five days after surgery. The medical team will advise about when dressings should be changed and when stitches or clips should be removed.
  • In most cases you are discharged from hospital after two or three days. A longer stay may be necessary, but this is the decision of your surgeon and depends on your progress.

Back to normal

  • Remember to heed the advice of your medical team to ensure that you reduce all risks of blood clot formation. This includes taking any medicines prescribed and wearing special stockings if necessary.
  • Back strengthening exercise routines given by your physiotherapist should be carried out to ensure good recovery and also to reduce the risk of encountering similar problems again.
  • Do not return to normal activities until instructed. Make sure you do not lift heavy weights or twist your back whilst you are recovering. Pay attention to your posture when sat down or upright. Exercise regularly as this will ensure your back heals well. However, do get direction from your consultant on the sort of exercises you should do.
  • Avoid driving until your back is sufficiently healed, to ensure you are in complete control of the vehicle. Check with your consultant and check your insurance policy for any clauses regarding surgery before you begin again.

The future

  • The percentage of those making a good recovery from this procedure is high (85%). They return to normal activities fairly soon after surgery.
  • Any leg pain should be relieved but you may still suffer from occasional backache due to natural spinal deterioration. Chronic back pain may be due to instability, which may mean that you need spinal fusion surgery.
  • Spinal stenosis can return either in the same place or somewhere else. The risk of needing further surgery is just 4 in 100.

To summarise

Lumbar spinal stenosis is the medical term for the narrowing of the spinal canal and refers to pain or weakness in the legs. Surgery will prevent these symptoms from worsening and is a relatively safe and effective treatment for the problem.
 

Acknowledgements: EIDO Healthcare Limited

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