Laminectomy
The term laminectomy is derived from lumber (lower spine), lamina (part of the spinal canal's bony structure) and -ectomy (removal). The operation is performed to relieve pressure on one or more spinal nerve roots. This pressure, often called nerve root compression or a "pinched nerve", is what often causes back and leg pain.
Nerve root compression is caused by:
Ruptured disc - Also called a protruded, slipped or herniated disc.
Spondylosis - Deterioration or "wear and tear" of multiple discs with bony spur formation and degenerative disc.
Scar tissue
Combination of the above factors
After the laminectomy I also had fusion and instrumentation done to give stability to the area of the spine that was affected. The big difference in my case was that I did not receive a bone graft from my hip, I received a donor graft from a cadaver.
Another type of spine surgery is spinal fusion. The diseased disc and lamina are first removed. Pieces of bone are removed from your hip (donor) and are placed along the spine and between the vertebrae. This is called bone grafting. When the bone heals, this is called a bone fusion and the vertebrae no longer move separately. This fusion takes three months to heal.
Indications for Spinal Fusion
When a disc ruptures, the hydraulic effect of the disc is disrupted. The facet joints (the joints between two vertebrae), muscles, and surrounding ligaments are required to take over the job of the disc. If the disc does not heal, it is said to be degenerative. A degenerative disc is not able to support the weight of the body and the space between vertebra narrows. When the space between two vertebra narrows, so do the holes (or foramen) that the nerves pass through. This causes the nerve to be pinched and results in leg and/or back pain. Over time the facet joints become arthritic, get larger, and develop bone spurs.
This is called spondylolisis and narrows the formen even further. Finally, as the facet joints become arthritic and lose their cartilage, they begin to slide on one another. This allows one vertebrae to “slip” on the other, narrowing the hole even more. This kind of slipping and narrowing is a dynamic process and is worse when sitting or riding in a car and is called spondylolisthesis.
When a nerve is pinched by a ruptured disc, the disc material can be removed to relieve pressure on the nerve (laminectomy and discectomy). When the disc is degenerative and the nerve is pinched by bone (from narrowing of the disc space and foramen, spondylolisis, and slipping or spondlylolisthesis), spinal fusion is indicated to relieve pressure on the nerve and keep the vertebra from slipping.
With the development of fusion cages, it is now much easier to relieve pressure on a pinched nerve, keep the vertebra from slipping, and getting the fusion to heal. The fusion cages can be put in from the back or from the front. We prefer to put our cages in from the back because, the nerves can be seen better and protected better during surgery and the holes (foramen) can be made bigger allowing the nerve more room.
In addition I also received what is called a BAK cage to help keep the space between the vertebra open.
BAK Cage
Extracted from Agusta Orthopedic Surgery
This surgical procedure is used when there is severe enough disc degeneration and narrowing that more space is needed between the bones of the spine. A small cylinder is placed between the bones of the spine to hold them apart. The cage has holes in it and the bone grows in and around it, holding it in place. This relieves the pressure on the nerves of the spine and patients are usually able to return to a more active lifestyle and control their back pain.
The purpose of a spinal fusion is to eliminate painful motion that occurs at that spinal segment.
There are many techniques used to fuse spinal segments. The main advantage touted in favor of the BAK cage is that it can be done through a limited exposure.
The BAK cage is typically inserted from the anterior or frontal approach via a laproscopic procedure. Thus it requires no large incision and tissue trauma can be limited. Recovery time is thereby minimized.
The BAK cage allows the patient to be up and about without a hard plastic brace. However, the BAK fusion cage depends on the bone healing from one vertebra through the cage to the other vertebra. It is imperative that the patient not smoke. Smoking decreases blood supply (because of the nicotine). Spinal fusions require a good blood supply to heal and the process can take up to 4 months.
Once the pinch on the nerve is removed, the patients legs feel better and stronger almost immediately. The patient will experience moderate back discomfort, however. A lumbar corset can be worn for support. The intense back pain resolves quickly (2-3 days), but the residual nagging back ache lasts up until the fusion is healed.
The procedure must still be considered experimental. It is not widely available. It is also technically demanding and takes a lot of experience to master the technique. At this time there is promise for the procedure, but one must be very cautious about pursuing the surgery, reviewing the credentials and experience of the surgeons
Total time I spent in surgery was about 9 hours start to finish. The only thing I remember was being wheeled from the prep area to the OR and asking them to take some pictures once they cracked me open. I mean how often do you really get to see your own spine through some media other then X-Ray?
In the prep room we did all the final prep for the surgery including signing a power of attorney should something go wrong and I would be unable to make my own decisions. They discussed the possibilities of complications from the surgery and the anesthesia (including death). Well it all may sound morbid they are issues that anyone having major surgery should consider.
When they finished throwing paperwork at me they started to put in the IV and EKG monitor leads. They also screwed little electric leads into my head and feet. I remember asking them what they were for and I think the answer was so they could see what nerves they were working on. After they finished I was wheeled into the OR.
The OR was the cleanest room I have ever been in. I remember seeing all the foam padding on the table and can only figure they used it to stabilize me into the position they would need. I also remember seeing the Makita drill boxes on the table and laughing to myself, after that I was out like a light.
I woke up in recovery shivering and shaking from coming out from under the anesthesia. They said that was a normal effect and then the warmest blanket I have ever had was put on me. They keep blankets in the warmer as the OR and Recovery rooms are kept very cold to hamper infectious organisms.
I remember my family coming in to see me but I was back out after that. I woke the next day in the ICU scratching the hell out of myself. Turns out that some people do not tolerate morphine well and the side effect is feeling itchy.
The rest of my stay in the hospital was about 5 day in the regular neuro ward doped up and watching the war on TV (my surgery was right after the war kicked off in Iraq). I do remember the nice nurse who helped me roll over and then packed a ton of ice on my back to keep the swelling down.
Anyway, just some memories from my surgery and hospital stay.
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