Lumbar Laminectomy And Fusion

Lumbar laminectomy is a surgical procedure to remove bony pressure on the spinal canal and spinal nerves to relieve buttock, hip, and leg pain. Occasionally disc material needs to be removed. If there is instability of your spine you may require a posterior fusion of the spine. This procedure involves taking either bone graft (from your pelvis or spine), or synthetic bone graft and packing it around the spine to create a solid bony fusion across the unstable segments. Usually titanium screws and rods are placed to increase the stability. Sometimes the lumbar disc is removed and replaced with a plastic cage filled with bone graft (TLIF).

If You Have Decided to Have Surgery:

Call Dr. Jeffords’ staff to schedule your surgery date and the date for your pre-operative visit.
At your pre-operative consultation Dr. Jeffords or his P.A. will discuss the procedure with you, answer any questions you may have, and have you sign a consent form for surgery.
You will be given prescriptions for pain medicine and instructions for post-operative care.
Your pre-operative evaluation at the hospital will be scheduled on the same day as your pre-operative consultation. You will have a chest X-ray, EKG, and bloodwork performed.
If you take aspirin or anti-inflammatories, STOP these medications at least 7 days before your surgery.
If you are a smoker you should make every effort to stop smoking as soon as you can before surgery (at least 2 weeks prior to surgery). You should not smoke for at least 6 weeks after surgery.
You will check into the hospital the morning of surgery.

Surgical Procedure:

Your anesthesiologist will bring you to the operating room and put you to sleep for the operation.
There are usually two nurses in the room and a surgical assistant that assists Dr. Jeffords with the operation.
An incision is made in middle of your lower back. The length depends on the number of levels to be decompressed.
After carefully moving the muscle tissue, a retractor is placed to expose the back of the spine.
Bone and ligament that are causing pressure on the spinal canal are removed. This is the laminectomy portion of the procedure.
If a discectomy is performed, the pinched nerve is gently moved to the side and the bulging or herniated disc material is removed from underneath the nerve.
For the fusion, bone graft is packed around the bone of the spine to create the fusion
Bone that was removed from the spine may be used, or bone may be taken from your pelvis.
Synthetic bone graft may be used instead of, or in addition to, your own bone.
Sometimes a TLIF is performed, where the entire disc is removed and replaced with a plastic cage filled with bone graft.
If screws and rods are used they are placed into the bone and tightened.
A drainage tube may be placed under the muscles before closing the incision to keep any blood or drainage from collecting beneath the incision. This is usually removed on the 1st or 2nd day after surgery depending on the amount of drainage.
The incision is closed with resorbable stitches that are placed beneath the skin.
The surgery will take approximately 2–4 hours or more, depending on the number of levels.

After Surgery:

You will be taken to the recovery room (PACU) and stay there for about 1-1 ½ hours. Afterwards you will be taken to your hospital room where you can visit with your family.
Dr. Jeffords will speak to your family while you are in the recovery room.
You will be given a PCA pain-pump which is a machine that you are able to control to help alleviate any post-surgical pain. The following morning you will be switched from the PCA to oral pain pills.
The nurses will get you out of bed shortly after surgery and the physical therapists will work with you to ensure that you are strong enough to walk and climb stairs.
You may be asked to wear a brace whenever you are out of bed for the first 6-12 weeks.
The surgical dressing will be changed and the small drain removed either the 1st or 2nd morning after surgery. This dressing will stay on until you see Dr. Jeffords in the office two weeks after surgery. You may shower over the dressing.
The hospital stay is usually 1-2 days if fusion is not done and 3-4 days if a fusion is performed.
You will be able to ride in a car or plane upon leaving the hospital.

After Going Home:

You will be given pain medication and a muscle relaxant to help control post-operative pain and spasms. Make sure you do not drive or operate heavy machinery while on the medication.
You may drive once you are off of your medications (generally at about 2-4 weeks).
You can expect to return to sedentary office or desk work approximately 2-4 weeks after surgery.
If you perform manual labor that requires heavy lifting or frequent bending or climbing, you should wait 6 months before returning to this activity. You can return to moderate duty at 6 weeks.
X-rays will be taken at each of your post-op visits at 2 weeks, 6 weeks, 3 months, and 6 months.
The fusion is usually seen to be solid by the six month visit.
Sports activities such as golf or tennis may be resumed at 6 months if the fusion is solid.