IntroductionA Lumbar Laminotomy and Discectomy is performed to remove pressure off of one or more nerve roots cause by a disc herniation or bone spurring.
This less invasive procedure commonly is used to treat lumbar disc protrusions, lumbar disc herniations, and some forms of spinal stenosis.
Lumbar Discectomy surgery has been shown to be successful with good to excellent results in up to 90% of patients with sciatica (leg pain) based on a single level disc herniation with appropriate patient selection. This surgery is much more predictable for alleviating leg pain than back pain. Despite a successful outcome from surgery, a small percentage will develop a recurrent disc herniation at the same level.
This procedure can be performed on an outpatient basis for most 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 overlying the affected area of your low back. The length of the incision will vary based on the number of levels involved. 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(s) are confirmed, the surgeon will use a high speed drill or other surgical instruments to create a small opening in the bone (laminotomy). This allows access to the affected nerve roots. A retractor is placed to protect the nerve while ruptured portion of dis (discectomy) and/or bone fragments are removed to decompress the nerve root.
The layers of muscle and skin are sewn back together with suture and steri-strips are applied over the incision.
Advantages of this less invasive approach include minimal muscle and soft tissue disruption which can lessen post-operative pain, reduce bleeding risk, and allow for faster recovery.
This procedure is performed on an outpatient basis at the surgery center or hospital.
No. Dr. Shim does not prescribed a brace after this type of surgery.
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 1-2 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 7-10 after this procedure. If you are taking narcotic pain medication, you should not drive a motor vehicle.
Your incision may be closed with dissolving sutures or staples. If you have dissolving sutures, you will find small white tapes “steri-strips” covering your wound. These steri-strips should be left alone and kept dry. A Silverlon will be placed over the steri-strips or staples. 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.
If you have staples, they will be removed approximately 12-14 days after surgery. If you have a smaller incision with dissolving sutures, there will be nothing to remove.
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.
A stool softener will be ordered for you while in the hospital. You may discontinue this after your first bowel movement or at your discretion.
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 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
- Cerebrospinal fluid leak from a Dural tear
- Loss of bowel or bladder function
- Blood clots
- Numbness (temporary or permanent)
- Scarring of the nerve(s)
- Recurrent disc herniation/protrusion
- Incomplete relief of symptoms
- Risks associated with anesthesia
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