Lumbar spinal stenosis is performed for the patients, who have reduced ability of participation in the day to day activities to unacceptable levels. This surgery can be done in different procedures like laminectomy, foraminotomy or discectomy. Lumbar laminectomy or foraminotomy is considered to opt, when there is a rapid progression of neurologic impairment is found.
Need for the Surgery
This surgery is to be chosen only if the non-operative treatments found no help to relieve the symptoms and the following symptoms are experienced by the candidate.
- Severe pain felt at the calf, shoulder, hands, arms, lower back and thigh
- When the pain is steady and deep
- Pain occurring, while performing certain activities, like moving the body in a particular direction or particular way
- Muscle weakness
- Numbness and tingling
Foraminotomy surgery is performed to widen the opening or expand in the back, where spinal canal is left by the nerve roots. So, it takes of the pressure present over the spinal column, by the nerve. It is performed if the candidate has narrow opening of the nerve. It is usually performed at any level that is related to the spine.
Before the Procedure
Doctor discusses the procedure that is going to be conducted and will inquire about medical history of the candidate. Other medicine has to be stopped before two weeks of the surgery, as it may lead to hardening the process of blood clot. If the patient has heart diseases, diabetes or other medical complications, regular doctor has to be consulted. Physical therapist also has to be met to know what exercises to be done before the surgery is performed.
General anesthesia is given to the candidate, so that the patient is asleep and there would be no pain. The patient is laid down and facing down on the operating table. A small incision is made for the cut at the center or middle part of the spine back. The length of the spinal column has to be operated determines the length of the incision. Then the ligaments, muscles and skin are to be moved to one side. A surgical microscope may be used for this to view inside the back. Some of the bone has to be shaved or cut away for opening the open part of the nerve root. Then the disk fragments, if found any, are removed. Bones present in the back part of the vertebrae also have to be removed to create enough room. Then the spinal fusion process is conducted. It is required to be done to ensure that the spinal column becomes stable, post surgery. The tissues and muscles are then put back into their places. The incision would then be closed.
After the Procedure
After the surgery is completed, soft neck collar has to be used. Most of the patients are able to get up and able to sit after or before 2 hours of the surgery. The neck has to be moved very carefully. The patient is usually relieved the next day of the surgery. Driving takes one or two weeks and be able to perform light activities after four weeks.
Risks that are associated with the anesthesia are, breathing problems, reactions to the prescribed medicine.
Risks that are particular to the foraminotomy are,
- Partial relief to the pain post surgery
- No relief to the pain post surgery
- Infection to the vertebral bones or wound
- Return to the same back pain to be felt in the future
Foraminotomy done for the spinal foraminal stenonis would relieve the patient partially or completely to the symptoms experienced before the surgery. However, there are possible future spine problems. When foraminotomy is done with spinal fusion, problems can be occurred with the spinal column, just below and above the fusion. When additional procedures are performed along with the foraminotomy, probability of complications or problems are more in the future.
Cost of Lumbar Laminectomy and Foraminotomy Procedure
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