Lumbar Spine Surgery
The lumbar spine
What is it?
The lumbar spine – or lower back – is made up of five vertebrae in the lower part of the spine, between the ribs and pelvis. The spinal cord ends at the top of the lumbar spine, and the remaining nerve roots (called the cauda equina) descend the remainder of the spinal canal.
The lower back performs important functions, such as:
- Supports and stabilizes the upper body
- Allows movement in the trunk
- Protects the spinal cord and cauda equina
- Controls leg movements
While the lumbar spine is sturdy and resilient, it is also subject to a high degree of stress and loads, which may cause various problems that result in pain. When this happens, Dr. Washington specializes in a number of different procedures that can provide relief.
Relieving pressure
Lumbar Microdiscectomy
This minimally invasive procedure is performed to relieve pressure on the spinal nerve column caused by a herniated lumbar (lower back) disc. The goal of the procedure is to decrease pain and allow you to regain normal movement and function.
A microdiscectomy is performed using a special microscope to view the disc and nerves. Using this microscope provides a larger view, which, in turn, allows the surgeon to make a smaller incision. The smaller the incision, the less damage is made to the surrounding tissue.
The goal of a microdiscectomy is to remove the disc material placing pressure on the nerves by the herniated disc. Since the procedure is done under general anesthesia, you’ll be unconscious during the entire procedure.
The Procedure
With the patient lying face down, an incision will be made directly over the affected disc. The damaged tissue will then be removed and the incision closed with sutures. Patients are typically discharged the same day or the morning after an overnight stay in the hospital.
Most patients will notice significant improvement in their pain levels and will benefit from physical therapy to help restore strength and flexibility and reduce recurring back pain or disc herniation.
Widening the spinal canal
Lumbar Laminectomy
A lumbar laminectomy is a minimally invasive surgical intervention performed to alleviate spinal nerve compression often caused by spinal stenosis or a herniated disc.
This procedure involves widening your spinal canal in the lumbar area, which is the lower back region. This is achieved by removing the lamina, a part of the vertebra that serves as a cover for your spinal canal. The result is relief from pressure on the spinal cord or nerves that is usually caused by bone spurs within the spinal canal. These bone spurs can narrow the space around your spinal cord and nerves, leading to pain, weakness, or numbness radiating down your arms or legs.
While many cases of spinal stenosis or disc herniation can be treated with rest, anti-inflammatory drugs, physical therapy, or a back brace, sometimes these methods might not be enough. If the symptoms worsen over time, that’s when Dr. Washington may recommend a laminectomy.
The Procedure
During the procedure, a small incision will be made right above the affected area of the back.
The lamina may be removed entirely or in parts, depending on the extent of the damage. Any bone spurs or debris are also removed, relieving the compression of the spinal cord and spinal nerves, thus improving symptoms.
TLIF, ALIF & DLIF
Lumbar Fusion
Lumbar fusion surgery is designed to permanently connect two or more vertebrae in your lower back (lumbar) to stop painful motion between the vertebrae by fusing them. Most commonly, this type of surgery is performed to alleviate the pain and disability caused by conditions such as degenerative disc disease or spondylolisthesis, although it can be used to strengthen a weak or unstable lumbar spine, fractures, scoliosis, or deformity.
There are many approaches to lumbar fusion, and all involve techniques designed to mimic the normal healing process of broken bones. During a lumbar spinal fusion, a bone graft, or bone-like material, is placed within the space between two lumbar vertebrae. Metal plates, screws, and rods may be used to hold the vertebrae together as they heal into one solid unit.
Dr. Washington performs three different lumbar fusion procedures:
Minimally Invasive TLIF
The TLIF (Transforaminal Lumbar Interbody Fusion) procedure has traditionally been performed as what is called an “open” technique, which requires making a larger incision as well as cutting and retracting muscle and tissue. Although effective, the traditional TLIF requires a long recovery period of several weeks or months.
Dr. Washington, however, specializes in performing a minimally invasive TLIF. Typically, two small incisions are made in the middle of your lower back. Using special surgical instruments, the entire TLIF procedure is performed through these small incisions.
By working through the small incisions instead of a traditional “open” incision, the amount of muscle and tissue needed to be cut or disrupted, as well as the amount of blood loss, can be significantly reduced. This typically translates to a shorter hospital stay and faster patient recovery times.
ALIF
The ALIF – or anterior lumbar interbody fusion – is a common spinal fusion technique performed through the front of the body (anterior approach). Interbody fusion refers to the removal of an intervertebral disc, which is then replaced with a spacer during the fusion process. A major advantage of anterior entry is that a larger and sturdier implant can be incorporated into the procedure.
Patients generally opt for ALIF surgery for a variety of reasons including:
- Reduction of back pain
- Stabilization of an unstable spine
- Medication reduction
- Prevention of deterioration
- Improved lower back and leg function
- Improved work and recreational capacity
- Improved quality of life
The recovery period for a spinal fusion procedure such as ALIF will vary depending on your body’s ability to heal and firmly fuse the vertebrae. Patients typically stay in the hospital for a few days after the surgery. During this time, there may be physical therapy or rehabilitation to help the patient with walking and stair climbing. Your surgeon may prescribe pain medication as needed. Typically, patients will be required to wear a brace and complete physical therapy.
Many patients who have ALIF surgery can return to normal activities in as little as six weeks. When to return to work will depend on the type of work you do, but typically ranges from two to six weeks after surgery. As with all surgical procedures, specific recovery time varies by patient.
DLIF
Direct Lateral Interbody Fusion, or DLIF, is a minimally invasive surgical procedure used to relieve leg or back pain caused by degenerative disc disease, recurrent disc herniation, radiculopathy, spinal stenosis, and spondylolisthesis (spinal instability). Unlike traditional anterior (front) or posterior (back) approaches to spine surgery, DLIF approaches the lumbar spine through the patient's side, which helps Dr. Washington minimize disruption to the surrounding soft tissues, nerves, and blood vessels.
During the DLIF procedure, the patient will receive general anesthesia to prepare for the surgery. A lateral incision is made along the patient’s side near the hip area. Muscles are retracted from the area using dilation tubes to provide access to the spine. After the damaged discs are removed, orthopedic devices will then be inserted to realign the empty disc space and provide space for the bone graft. The bone graft will be installed to lift pressure off the nerves and provide space for the bone graft to fuse the vertebrae.
Once installed, the incisions will be closed, with wounds being cleaned and bandaged. Recovery from DLIF can take up to a few weeks to a few months to recover, depending on the treatment’s extent.
This surgery may be performed as an inpatient or outpatient surgery. Dr. Washington will advise you on what option is best for you. The patient is often able to walk around the day of the surgery and able to return to normal activities after a few weeks.
