LUMBAR SPINAL STENOSIS
is a guide to the upcoming operation on your low back. You have
a condition called lumbar spinal stenosis. "Lumbar"
refers to the lower part of your spine where you have problems.
to a narrowing of the spinal canal that has reached such a critical
level that the lower elements of the spinal cord are being compressed.
At rest or in bed, this usually does not cause discomfort. However,
when you walk, this compression of the spinal cord causes heaviness,
tiredness, or progressive pain in the legs to the point where you
need to sit down. The operation to relieve this is called a "minimally
invasive microsurgical bilateral laminotomy." During the operation,
with the use of the microscope, we use a natural opening to enter
into the spinal canal. We shave down calcium deposits to relieve
the pressure on the spinal cord.
is no special preparation for this procedure. You should eat nothing
after midnight before the procedure. If you take medications in
the morning, you should do so with a sip of water. If you take Insulin,
you should have a large glass of orange juice and take half your
normal dose of insulin.
When you come into the Operating Room, you will eventually be transported
to what is called the "Holding Area". You will meet the
nursing staff, the anesthesia staff, and have an intravenous placed.
From there you will be moved to the Operating Room and be given
a medication that will allow you to drift
off to sleep. The operation takes about 90 minutes,and you will
remember nothing of it.
After you are asleep,
you will be rolled gently onto your belly. An incision about the
length of your index finger will be made a few inches above your
buttocks. We are then looking at the back of your spine similar
to the picture of the back of the spine that we have included with
The operation is straightforward.
We use a natural opening in the spine (red arrow) to enter the spinal
canal. Specially designed instruments allow us to shave down calcium
deposits from inside the spinal canal to restore it to its normal
size. Given the minimally invasive nature of this procedure, we
usually don't put stitches in the skin. Paper strips called "Steri-Strips"
AFTER THE SURGERY:
When you awake, you will be in the Recovery Room. You can expect
anywhere from mild to very unpleasant pain in the back which is
the worst the night of the surgery, but eases off very quickly.
In a week or two it is mild and tolerable. Some patients can go
home the same day as the procedure, and some cannot. It is a decision
we make together, and is based on a number of issues such as your
recovery from anesthesia and the chance of internal bleeding the
night of the procedure. While we want you to be home as soon as
possible, we also want the procedure to be as safe as possible.
On returning home, the
only immediate difference you should feel is the discomfort in your
back. You should call my office to set up an appointment to see
me or my physician's assistant a week after the surgery to have
the incision checked, and make sure all is well. In regard to activity,
I recommend that you not drive for 3 days after returning home,
but then resume doing so as you feel better. In regard to the incision
itself, 48 hours after the procedure the skin has grown over it
and is waterproof. I suggest taking all dressings off for a shower
or a bath. When you are not in the shower or bath, I do recommend
that you have some form of light dressing on it that you can get
at any local CVS or Osco pharmacy.
RISKS OF OUTPATIENT
SURGERY: If your procedure is uneventful, one option will be
for you to go home a few hours after the procedure. During my years
of surgical training in the 1980s, the standard of care was to remain
in the hospital for several days after this operation. However,
as anesthesia has improved, and as the operation has become less
invasive under the microscope, many surgeons have begun performing
this as an outpatient. We have performed one and two level procedures
in this manner for several years without a single mishap at home
on the night of the surgery. However, like any medical decision,
there are benefits and risks.
The benefit is
the simple advantage of being in your own home and bed to recover
from the microsurgery. Any painkiller you might receive via an intravenous
in the hospital, you can take as easily by mouth at home. We have
become increasingly concerned about hospital-acquired infections.
There is a particularly dangerous strain called "MERSA"
that is resistant to many of our best antibiotics. The main risk
is internal bleeding or swelling after the operation with nerve
damage to the legs; however, in over 25 years of performing this
procedure, I have not caused a single case of this.
BENEFITS AND RISKS:
The benefit of the surgery is to make your legs feel well. After
a successful outcome, most people describe the sensation of having
"new legs." When they exert themselves, the heaviness,
pain, and tiredness do not appear as they did before. The operation
works most of the time, but not all the time. In my experience,
four out of five people will have an excellent result and feel much
improved thereafter. One out of five people will not notice any
significant change of any kind. It is important to know that this
operation is generally not effective for the relief of back pain.
In general, back pain is the result of arthritis and
tight muscles. This is something that a conservative approach with
medication and conservative therapy is often beneficial for.
In regard to risks, it
is a very safe procedure. I have not had a serious complication
in over 30 years of performing this operation. Given the narrowness
of the spinal canal, the possibility exists for a spinal injury
with weakness or paralysis of the legs. In the medical literature
the incidence of this is far under 1% and as mentioned above, I
personally have not caused that problem. The more reasonable concern
is infection and spinal fluid leakage. Infection is
a risk of all forms of surgery, and in this case it is approximately
1%. This is usually treated with antibiotics. The spinal cord is
covered by a membrane that can be very thin in these conditions.
If we find a small hole (pin sized) in the membrane as a result
of the procedure, spinal fluid can leak out through the skin. This
usually seals over quickly on its own without any need for treatment.
You will see me before
the operation to answer any questions. It is important to note that
if you have an uncomplicated hospital course, you will generally
see our physician's assistant in the days after the procedure. If
you wish to set up a time to meet with me, you may always call my
office and that is easily done. I will see you myself in the office
after the surgery to make sure all is well. I will try to call you
at home to make sure that all your questions have been answered.
We no longer have an answering service, and email is the best way
to contact me (email@example.com). This routes to my iPhone
immediately, and they are checked several times an hour. Unless
I am tied up in surgery, you can expect a response in that time