Herniated Disc: Spine Surgery and Prevention Tips

Lumbar laminotomy is a procedure often utilized to relieve leg pain and sciatica caused by a herniated disc. It is performed through an incision down the center of the back over the area of the herniated disc. During this procedure, a portion of the lamina may be removed. Once the incision is made through the skin, the muscles are moved to the side so that the surgeon can see the back of the vertebrae. A small opening is made between the two vertebrae to gain access to the herniated disc. After the disc is removed through a discectomy, the spine must be stabilized. Spinal fusion is often performed in conjunction with a laminotomy. In more involved cases, a laminectomy may be performed.

In artificial disc surgery, an incision is made through the abdomen and the affected disc is removed and replaced. Only a small percentage of patients are candidates for artificial disc surgery. You must have disc degeneration in only one disc, between L4 and L5, or L5 and S1 (the first sacral vertebra). You must have undergone at least six months of treatment, such as physical therapy, pain medication, or wearing a back brace, without showing improvement. You must be in overall good health with no signs of infection, osteoporosis or arthritis. If you have degeneration affecting more than one disc, or significant leg pain, you are not a candidate for this surgery.

Cervical Spine Surgery
The medical decision to perform the operation from the front of the neck (anterior) or the back of the neck (posterior) is influenced by the exact location of the herniated disc, as well as the experience and preference of the surgeon. A portion of the lamina may be removed through a laminotomy, followed by a discectomy. After the disc is removed, the spine often needs to be stabilized. This is accomplished using a cervical plate and screws (instrumentation) and often, spinal fusion.

Postsurgery
Your doctor will give you specific instructions postsurgery and usually prescribe pain medication. Your doctor will help determine when you can resume normal activities such as returning to work, driving and exercising. Some patients may benefit from supervised rehabilitation or physical therapy after surgery. Discomfort is expected while you gradually return to normal activity, but pain is a warning signal that you might need to slow down.

Prevention Tips
Once you have recovered from surgery and have checked with your doctor, you may resume moderate exercise. The following tips may be helpful in preventing low back pain and herniated discs.

• Do crunches and other abdominal-muscle strengthening exercises to provide more spine stability. Swimming, stationary bicycling and brisk walking are good aerobic exercises that generally do not put extra stress on your back.

• Use correct lifting and moving techniques, such as squatting to lift a heavy object. Don't bend and lift. Get help if an object is too heavy or awkward.

• Maintain correct posture when you're sitting and standing.

• If you smoke, quit. Smoking is a risk factor for arthrosclerosis (hardening of the arteries), which can cause lower back pain and degenerative disc disorders.

• Avoid stressful situations if possible, as this can cause muscle tension.

• Maintain a healthy weight. Extra weight, especially around the midsection, can put strain on your lower back.

NeurosurgeryToday.org
September, 2005

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