A Healthy Lumbar Spine

In a healthy lumbar spine, all the parts work together.

 - Disks are soft pads of tissue that act as shock absorbers between the vertebrae.  The firm, fibrous outer layer of a disk is called the annulus.  The soft center of the disk is called the Nucleus.

 - The spinal canal is a tunnel formed within the stacked vertebrae.  The opening between the vertebrae on either side of the spinal canal is called the foramen.

 - Nerves run through the spinal canal.  They branch out from the spinal canal through the foramen on each side.

 - The lamina is the arched part of each vertebra that forms the back of the spinal canal.  Facet joints are the joints where the vertebrae meet.

A painful lumbar spine

Low back pain can be caused by problems with any part of the lumbar spine.  A disk can herniate (push out) and press on a nerve.  Vertebrae can rub against each other or slip out of place.  This can irritate facet joints and nerves.  It can also lead to stenosis, a narrowing of the spinal canal or foramen. 

Pressure from a disk

Constant wear and tear on a disk can cause it to weaken and push outward.  Part of the disk may then press on nearby nerves.  There two common types of herniated discs:

 - Contained means the soft nucleus is protruding outward.

 - Extruded means the firm annulus has torn leading the soft center squeeze through.

Pressure from bone

With age, a disk may thin and wear out.  Vertebrae above and below the disk may then begin to touch.  This can put pressure on nerves.  It can also cause bone spurs (growths) to form where the bones rub together.  Stenosis results when bone spurs narrow the foramen or spinal canal.  This also puts pressure on nerves. 

An unstable spine

In some cases, vertebrae become unstable and slip forward.  This is called spondylolisthesis.  Slipping vertebrae can irritate nerves and joints.  They can also worsen stenosis.

Types of surgery: decompression

Decompression is a type of surgery that takes pressure off of a nerve.  This can be done by removing bone from the vertebrae.  It can also be done by removing a portion of the disk.  Sometimes, a combination of procedures are used.

Laminotomy

A laminotomy removes a portion of the lamina -- the bone at the back of the spinal canal.  The small opening that is created is sometimes enough to take pressure off a nerve.  But in most cases, part of a disk or bone spur that is pressing a nerve is also removed.

Laminectomy

A laminectomy removes the entire lamina.  This helps relieve pressure when a disk bulges into a nerve.  If needed, your surgeon can also remove any part of a disk or bone spur that presses on a nerve.

Diskectomy

A diskectomy removes a portion of the damaged disk.  Your surgeon may use a surgical microscope during the procedure (microdiskectomy).  In most cases, a laminotomy must first be done to expose the disk.  Then any part of the disk that presses on the nerve can be removed.  Disk matter that is loose or may cause problems in the future is also removed.  After surgery, there is usually enough disk remaining to cushion the vertebrae.

Types of surgery: fusion

Spinal fusion is a type of surgery used to make spine more stable.  It can also help ease the lower back and leg pain.  During the surgery, two or more vertebrae are locked together (fused) using a bone graft.  This keeps the bones from shifting and pressing on nerves.

The fusion procedure

Fusion surgery can be done using several methods.  Talk with your doctor if you have questions about steps of your procedure.

 - Part of a disk may be removed from between the vertebrae to be fused.

 - Bone graft is packed between the vertebrae.  In time the graft and nearby bone grow into a solid unit.

 - Too keep the spine steady, metal supports may be used along with the bone graft.  The supports are left in place after surgery.

 - The incision is closed with stitches or staples.

Understanding bone grafts

Grafts are very small pieces of material used to bone “cement" vertebrae together.  Grafts can come from your own body, a bone bank, or artificial sources.  In some cases, bone protein (BMP) may be used.

Recovering in the hospital

After surgery, you'll be moved to the PACU (post anesthesia care unit).  This is sometimes called the recovery room.  You'll stay there until you're fully awake -- often a few hours.  Then you'll be moved to your hospital room.  The likes of your stay depends on what type of surgery you had in how well you’re healing.

Right after surgery

When you wake up from surgery, you may feel groggy, thirsty, or cold.  Your throat may also be sore.  For a few days, you may also have:

 - Tubes to drain the incision.

 - An IV to give you fluids and medication.

 - A catheter (tube) to drain your bladder.

 - Boots or special stockings on your legs to help prevent blood clots.

Controlling pain

You'll likely have some discomfort after surgery.  Your nurse may give you pain medication.  Or you may have a PCA (patient controlled analgesia) pump.  The pump lets you give yourself small amounts of pain medication.  Some pain is normal, even with medication.  But if you feel very uncomfortable, tell your nurse.

Getting up and moving

Soon after surgery, you'll be encouraged to get up and walk.  This helps keep your blood bowels moving.  It also keeps fluids from building up in your lungs.  To help you move, you may be given a brace to support your spine.  You may also see a physical therapist.  He or she will teach you ways to protect your spine while moving.

When to call your doctor

Call your doctor if you have any of these symptoms:

 - Increasing pain, redness, or drainage from your incision

 - A fever over 100°F (37.7°C)

 - New pain, weakness, or numbness in your legs

 - A severe headache

 - Loss of bladder or bowel control

 

HOW HAS YOUR LIFE BEEN AFFECTED

Take a look at how your cervical spine problem has affected your life by answering the following questions.  This self-assessment may help you decide if the benefits of treating your neck problem outweigh the risks and inconvenience of surgery.

Physical effects

Do you miss work because of your pain?

Does your neck pain shoot down your arm?

Does your arm or hand feel number weak?

Do you have headaches, or pain between your shoulder blades?

Social effects

Are you unable to join in family activities because of your pain?

Does your pain force you to spend time alone, away from friends and family?

When you're with other people, do you find yourself distracted by your discomfort and unable to enjoy yourself?

Emotional effects

Does your pain make you feel frustrated or depressed?

Are you afraid of losing your job to do too much time off?

Do you ever feel that other people think your pain isn't real?

Do you feel that you have no control over your life?

 

UNDERSTANDING YOUR SURGERY

During surgery, your surgeon may remove all or part of the disk (diskectomy).  To reach the cervical spine, he or she may make an incision in the front (anterior) or the back (posterior) of your neck.  With the anterior approach, the neck may be made more stable with the fusion (joining) of the vertebrae.  With the posterior approach, bone may be removed to enable your surgeon to reach the disk.

Through the front: anterior approach

your surgeon will make the horizontal or vertical incision (about 1 to 3 in. long) on either side of your neck.  To reach the disk, soft tissue is moved aside.  All or part of the disk that is irritating the nerve is a removed.  Your surgeon may remove bone spurs.  The vertebrae may then be prepared for fusion.

Through the back: posterior approach

Your surgeon will make an incision (about 2 to 4 in. long) in the middle of the back of your neck.  Then he or she may remove the bone to reach the problem area.  The surgeon then removes the damaged portion of the disk.

Adding stability: fusion

After removing a disk from the front, your surgeon may fuse the vertebrae above and below it.  This limits movement, helping to relieve pressure and pain.  First, the surgeon enlarges the space between the vertebrae.  The surgeon then plugs the space with a cylinder or wedge-shaped bone graft.  Metal plates may be added.  As you heal, the graft and vertebrae grow together.  After fusion, your ability to bend your neck may be slightly restricted.

Removing bone

To reach the disk from the back, your surgeon may enlarge the foramina or remove a portion of the lamina.  To help relieve pressure on the nerves or spinal cord, bone spurs may also be removed.