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Lumbar laminotomy is a procedure often utilized to relieve
leg pain and sciatica caused by a herniated disc (sometimes written as herniated disk). It is performed through an
incision down the center of the back over the area of the herniated disc. During
this herniated disc surgical 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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