Although a large percentage of patients with herniated discs report significant pain relief after surgery, there is no guarantee that surgery will help. Lumbar laminotomy is a procedure often utilized to relieve leg pain and sciatica caused by a herniated disc.
It is performed through a small 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 may need to be stabilized.
Spinal fusion often is 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.
The patient must have disc degeneration in only one disc, between L4 and L5, or L5 and S1 the first sacral vertebra. The patient must have undergone at least six months of treatment, such as physical therapy, pain medication or wearing a back brace, without showing improvement. The patient must be in overall good health with no signs of infection, osteoporosis or arthritis. If there is degeneration affecting more than one disc or significant leg pain, the patient is not a candidate for this 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 removal of the disc herniation for the posterior approach.
Patients, who are a candidate for posterior surgery, frequently do not need surgical fusion. For anterior surgery, after the disc is removed, the spine needs to be stabilized. This is accomplished using a cervical plate, interbody device and screws instrumentation. In a select group of candidates, artificial cervical disc is an option vs.
The doctor will give specific instructions after surgery and usually prescribe pain medication. He or she will help determine when the patient 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 during a gradual return to normal activity, but pain is a warning signal that the patient might need to slow down.
The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets.
This information provided is an educational service and is not intended to serve as medical advice. S1 radiculopathy. Lesegue sign. SLR aggravated by forced ankle dorsiflexion. Bowstring sign. SLR aggravated by compression on popliteal fossa. Kernig test. Naffziger test. Milgram test. Trendelenburg gait. MRI without gadolinium. MRI with gadolinium. WC patients have less relief from symptoms and less improvement in quality of life with surgical treatment.
Complications of Surgery. Recurrent HNP. Chronic low back pain. Not completely understood but central sensitization may be a factor. Pain diagrams may be useful in identifying patients with an increased likelihood of pain sensitization, psychosocial load, and utilizing pain management resources.
Vascular catastrophe. Size of herniation decreases over time reabsorbed. Technique Guide. Orthobullets Team. Previous Next. Upgrade to PEAK. QID: L 5 Question Complexity. Question Importance. L 1 Question Complexity. L 3 Question Complexity. L 2 Question Complexity. L 4 Question Complexity. Orthobullets was not involved in the editorial process and does not have the ability to alter the question.
Sort by. All Videos 10 Podcasts 1. The David B. Login to View Community Videos. When this plateau is still unacceptably painful, the following treatments may be considered. It is important to determine whether the pain is more in the leg or more in the back.
Two non-surgical treatments that can be helpful: Epidural steroid injection ESI : The MRI may suggest that an injection of corticosteroid sometimes known as "cortisone" directly around the spinal nerves, may be helpful.
This is a special procedure. ESIs are very safe, but the decision to have one should only be made after a discussion with the physician. A selective nerve root block SNRB is an injection which treats only one nerve. Frequently, epidurals and selective nerve root blocks are done with X-ray control to make sure the medicine is placed exactly where it is needed.
Herniated Disc Patients With Back Pain Predominating: There are three main treatments for patients who have back pain rather than sciatica: Exercise: The mainstay of treatment for back pain is a good self directed home exercise program to increase abdominal strength, back muscle strength, and flexibility.
There are many theories on which exercises are best. A physical therapist trained in back care will develop a personalized program with the patient over a one to three week period. Good abdominal strength is the key to a healthy back, therefore it is important for the patient to continue these exercises indefinitely.
It is important for the patient to give them a full three to four week trial since it takes this length of time for them to become fully effective. There are many types, and each individual can probably find one or two that work well.
Bracing: If symptoms persist over a long period of time, and exercise and NSAIDs have not improved the condition, a brace may be worn to provide additional support to the painful disc.
When used with a good abdominal strengthening program, a brace may allow some people to be more active with less pain. Patients should choose a brace that is comfortable enough to wear for several hours at a time for the more strenuous activities.
Click to Enlarge The indications for surgery include: Intense leg pain. The MRI shows a ruptured disc compressing a nerve which is consistent with the distribution of the leg pain. Testing the nerve by stretching it "nerve root tension signal" reproduces the leg pain. There are no factors that would make surgery a risk for the patient.
Progressive worsening of nerve function, such as any loss of bowel or bladder function. A general anesthetic is used, and once asleep,the patient is placed in the prone or kneeling position on a specially padded frame. A small incision is made directly over the disc, and a microscope is then used to find the compressed nerve and move it aside so that the ruptured portion of the disc can be seen and removed. The space around the nerve is then thoroughly examined to make sure no small pieces of disc material might still compress the nerve.
Finally, antibiotic solutions are washed through the disc and incision to reduce the chances of infection. An absorbable suture is used to close the incision so that there are no stitches to be removed later. Most people form some scar tissue in the area of a surgery, but for unknown reasons, some individuals form an extraordinary amount of scar which surrounds and irritates the nerve.
It can form along the spinal nerve inside the spinal canal, or where the nerve exits the spine. The bacteria can come from the skin around the incision, the air in the operating room, or the bacteria that circulate in the bloodstream. The steps taken in the operating room to avoid infection are many. A dose of intravenous antibiotics right before surgery reduces the risk of infection even more.
Persistent drainage from the wound days after surgery usually means an infection is present. The patient might also have fever or chills, but this is not a reliable indication of an infection. Antibiotics are usually successful, but sometimes it is necessary to return to the operating room to wash out the incision.
An infection does not usually cause the operation to fail, but may slow the healing process. Sometimes scar tissue forms between this sac and the ruptured disc. A hole can develop in the dura when the surgeon is looking for or removing the ruptured disc, allowing spinal fluid to leak out. When a spinal fluid leak is encountered, the hole is immediately repaired.
Sometimes artificial blood clot is added to form a seal around the repair. Usually the patient is kept flat for 24 hours to allow the hole to heal before resuming a normal recovery. Just moving the nerve to get at the disc behind it might cause this fragile nerve to be damaged.
Fortunately, this is very rare, as is other surgical damage to the nerve. Bleeding rare : Blood loss is a rare complication. People whose blood does not clot blood normally are at increased risk. The large blood vessels in front of the spine may be damaged while removing disc material from within the disc. This is extremely rare perhaps one in ten thousand cases and requires emergency abdominal surgery to repair the bleeding vessel.
Even after six weeks the disc continues to be prone to injury. This is why the maximum weight a patient should lift is pounds for six weeks after surgery. Abdominal strengthening exercises are recommended for life, since strong stomach muscles are good insurance against recurring disc problems.
Patients are usually seen by the surgeon at two, six and ten weeks after surgery. A daily walking program should begin as soon as possible after surgery. At first it may be limited to a short distance, but it should be the main form of therapy for the first 6 weeks. During this time, anything weighing more than a gallon of milk should not be lifted.
By the end of the second week, strength and endurance should be improving. David C. John H. Accredited Business.
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