IntroductionA Lumbar Interspinous or Interlaminar Spacer is an implant used to stabilize the spine following a decompression. In some cases, this technology is used in place of a traditional spinal fusion.
This procedure commonly is used to treat a lumbar spinal stenosis and lumbar spondylolisthesis.
At present, there are several different interspinous devices available. This intended to be a less invasive approach to stabilize the spine and maintain pressure off the spinal nerve while allowing natural motion.
This procedure can be performed on an outpatient basis for many patients.
As with any surgical procedure, there are potential risks and benefits that should be discussed and considered.
Description of ProcedureThis surgery is performed under general anesthesia. Once you are comfortable and asleep, you will be positioned on your stomach. Live x-ray is used to localize the area of your incision.
A small incision will be made along the midline of your low back. Using specialized retractors, the surgeon will develop a plane through layers of muscle that will allow access to the affected area. Once the correct level is confirmed, using a high speed drill and cutting instruments,, small fragments of bone and ligament will be removed to uncover (decompress) the individual nerve root(s).
Following the decompression, the surgeon will select the appropriate size interspinous or interlaminar device and place it along the backside of the spine. X-rays are used to confirm correct placement.
Any muscles that were split at the beginning of the procedure are sewn back together and the skin is closed with either dissolving sutures or skin staples. The advantage of this less invasive approach is that it can alleviate radiating pain into the leg(s) while providing mechanical stability to minimize or prevent the development of instability without the need to fuse bones together. The device can easily be removed if necessary.
This procedure can be performed on an outpatient basis for most patients.
No. Dr. Shim does not prescribed a brace after this type of surgery.
The interspinous devices are made up metal alloys consisting of mostly titanium, aluminum and vanadium.
While everyone’s pain tolerances and conditions differ, most recover from this type of surgery with a 4 to 6 week time period.
This depends on the type of work you perform and the duties involved. Dr. Shim will discuss this with you during your first post-operative follow-up visit. In general, most patients can return to a sit down type job with no lifting required within 2 weeks after surgery. Those patients who have heavier duty occupations requiring lifting, pushing, pulling, and overhead activity can expect to be out 4-6 weeks.
Most patients can return to driving 10-14 after this procedure. If you are taking narcotic pain medication, you should not drive a motor vehicle.
Your incision may be closed with either dissolving sutures or skin staples. A Silverlon will be placed over the incision. This dressing should remain on until the time of your first post-operative visit with Dr. Shim. If it begins to fall off, please contact the office.
As a normal part of the post-operative period, we encourage you to get up and walk shortly after your surgery. You may walk as much as you can tolerate.
Most patients do not require physical therapy after this type of procedure. Dr. Shim will provide you with some basic exercises to begin following your first post-operative visit. For those patients who had significant weakness before surgery or are having persistent back stiffness after surgery, therapy may be recommended.
Staples will be removed approximately 12-14 days after surgery. If you have dissolving sutures, nothing will need to be removed.
Yes, you may resume sexual activities as soon as you feel up to it. This may be a few days or even a week after you come home from the hospital. You should avoid positions which cause increased back discomfort.
Most patients are free to travel after their initial post-operative visit 12 –14 days after surgery. Patients who may have been experiencing any problems during this time may be encouraged to wait a little longer before traveling. Keep in mind, you will not be able to carry any luggage greater than approximately 10 –15 pounds for the first 4 weeks after surgery. For international patients who are considering this surgery, please see our program schedule for returning home.
You will need to avoid taking a bath or submerging in water for approximately 3 weeks after surgery.
One of the benefits of the Silverlon dressing is that you may get it wet. You may begin showering the second day after your surgery. We recommend that you turn your front side to the showerhead so that your dressing does not get saturated.
Since the device is made out of titanium, it is possible to set the detectors off. You will be provided with a card showing that you have a medical implant. You will need to present this during the security screening process.
Most patients will be able to walk upstairs after surgery. You should limit the amount of times you go up and down the stairs during your first few days home. We encourage you to use a handrail if one is available.
Yes, in approximately 3 weeks after surgery. Your incision will need to be completely healed before you swim.
Everyone’s pain tolerances and conditions do vary. In general, many patients experience some relief of their leg symptoms immediately after surgery. It is not uncommon to have back pain, soreness, stiffness, and incisional discomfort for several weeks beyond surgery. For some patients, the pain level may decline slowly over weeks or even months after surgery.
Several reasons for this. First, you were given medications to help relax you and your pain during the surgery along with the anesthesia. This combination of medications may stay in your system for a day or two after surgery. Secondly, as you start feeling better, most patients become a bit more active, this can lead to increased discomfort initially.
A sore throat can result from anesthesia in some cases. You received an endo-tracheal intubation (“tube”) into your throat to help you breath during the procedure. This may have irritated the lining of your throat. This soreness and even some difficulty swallowing tends to resolve within a few weeks after surgery.
If you experience any fevers over 101.5 degrees, any wound drainage, swelling or redness around your surgical incision, increasing pain, tingling or numbness that you did not have before surgery, difficulty swallowing, difficulty walking, severe headaches, difficulty urinating or weakness, call your doctor.
You can lift up to 5 lbs. after surgery until your first post-operative visit. After 12 – 14 days you will be able to lift more. Heavy lifting is usually not recommended before 6 weeks after surgery.
RisksSome of the risks and complications associated with this procedure include:
- Wound infection
- Nerve injury
- Loss of bowel or bladder function
- Blood clots
- Numbness (temporary or permanent)
- Scarring of the nerve(s)
- Fracture of bone
- Mechanical failure or dislodgement of device
- Incomplete relief of symptoms
- Risks associated with anesthesia
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