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Lumbar Laminectomy

Lumbar Laminectomy Introduction

Back pain can grow progressively worse and more disabling, depending on the cause. At some point, your doctor may suggest surgery as one of the alternatives. The lumbar laminectomy may be one option. Despite medical breakthroughs, back pain has been a common problem through the centuries, often with no simple solutions.

  • Facts about back pain
    • Back pain results in more lost work productivity than any other medical condition. It is the second leading cause of missed workdays (behind the common cold).
    • Back pain is more common in men than women.
    • Back pain is more common among whites than among other racial groups.
    • Most back pain occurs among people 45-64 years of age.
    • A common cause of acute back pain is muscle strain. A common cause of chronic back pain is degeneration of the lumbar spine and lumbar disk disease.
    • Discussion of back pain has been found on Egyptian papyrus dating 3,500 years ago. Through the centuries, thousands of physicians have evaluated it and recommended treatments for it.
  • Back pain that can lead to surgery
    • The most common site of back pain is in the lower back.
    • A significant percentage of people who have back pain have a herniated disk with nerve pain transmitted down a lower extremity. This pain is called sciatica, because the problem once was believed to stem from pressure on the sciatic nerve. Sciatica causes pain to radiate through your buttocks into one or both legs.
    • A disk acts as a shock absorber for your spine. It is made up of a tough outer ring of cartilage with an inner sac filled with a jellylike substance. When a disk herniates, the jellylike nucleus pushes through the harder outer ring (annulus), putting pressure on the adjacent nerve root.
    • A herniated disk can cause varying degrees of pain and complications. The most serious complication is cauda equina syndrome, compression at the point where the roots of all the lumbar spinal nerves are located.
      • People may lose all nerve function below the area of compression, including loss of bowel and bladder control.
      • This condition is a true surgical emergency requiring immediate decompression of the entrapped nerves if you are to preserve bowel and bladder function. The longer the delay, the less recovery can be expected.
  • Surgery for back pain
    • As with other back pain, doctors first attempt conservative medical treatment for a herniated disc. If conservative treatment fails, surgery often produces gratifying relief.
    • Surgery may be considered for anyone with frequently recurring sciatica, usually if the pain interferes with your ability to work or do daily activities.
    • Doctors decide to perform surgery, however, only after they have tried a variety of treatments. Doctors usually reserve surgery for chronic sciatica. In general, most medical experts do not recommend considering surgery in acute sciatica. The decision to have surgery should be a joint decision you make with your doctor.
    • Another indication for surgery is a progressive loss of nerve function. For example, you may lose a certain reflex and later begin to lose strength gradually.
      • Far more commonly, people go to a doctor with an acute lack of nerve function.
      • Usually these function losses are minor and may come and go. They respond well to conservative medical treatment.
      • If the deficit is severe -- you cannot bend a knee or move a foot -- surgery is an option.
      • Many people may not regain full nerve function after surgery, however.
    • Men are twice as likely to need surgery as women.
    • The average age for surgery is 40-45 years.
    • More than 95% of disk operations are performed on the fourth and fifth lumbar vertebrae.
  • Types of surgery: Doctors perform three common surgeries on the back to relieve nerve root compression. These procedures are sometimes referred to as decompressive operations. They often are done in combination with each other.
    • Laminotomy -- Removal of part of the bony lamina above and below a nerve that is getting "pinched."
    • Laminectomy -- Removal of most of the bony arch, or lamina, of a vertebra (Laminectomy is most often done when back pain fails to improve with more conservative medical treatment.)
    • Discectomy -- Removal, or partial removal, of a spinal disk
Medically Reviewed by a Doctor on 8/4/2016

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The eMedicineHealth doctors ask about Lumbar Laminectomy:

Lumbar Laminectomy - Recovery

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Treatment of sciatica may incorporate medication and/or surgery.

Sciatica Treatment

The mainstay of treatment for sciatica is activity modification and pain medication. After diagnosing sciatica, the doctor will almost certainly prescribe or give medication for the pain.

If, despite doing everything one is instructed to do, the pain continues and the CT or MRI shows a problem with the disc or bone, back surgery may be recommended. Back surgery is generally performed for patients who have tried all other methods of treatment first.

Read What Your Physician is Reading on Medscape

Lumbar Degenerative Disk Disease »

Descriptions of treatment for low back pain (LBP) date to Hippocrates (460-370 BCE), who reported joint manipulation and use of traction.

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