Client Access | Home | Careers at AAMC | AAD Imaging | Contact 
1-800-MD-NURSE2001 Medical Parkway
Annapolis, Maryland 21401
|
Client Access | Home | Careers at AAMC | AAD Imaging | Contact |
443-481-4000 1-800-MD-NURSE 2001 Medical Parkway Annapolis, Maryland 21401 |
|
|
AAMC Spine Center
|
|||||||
|
|||||||
Frequently Asked Questions About Lumbar Laminectomy Q. What is wrong with my back? A. You have a “pinched nerve.” This can be produced by one or more herniated discs and/or areas of arthritis in your back. The discs are rubbery shock absorbers between the vertebrae, and are close to nerves that originate in the spine and then travel down to the legs. If the disc is damaged, part of it may bulge (herniate) or even burst free into the spinal canal, putting pressure on the nerve and causing leg pain, numbness or weakness. Bone spurs associated with arthritis may do the same thing. Q. What is required to fix it ?A. The discs or bone spurs pressing on your nerve must be removed. This is done by making an incision (usually two or three inches long) in the middle of your lower back, moving the muscles covering your spine to the side, and making a small window into your spinal canal. The nerve is exposed, moved aside and protected, and the protruding disc or bone spur is then removed. This decompresses the nerve and, in most cases, leads to rapid improvement in nerve pain, numbness and/or weakness. Sometimes the abnormality may be more extensive, extending over several disc segments, requiring a longer incision for decompression. Q. Who is a candidate for lumbar laminectomy and when is it necessary?A. The primary reason for this operation is pain that is intolerable to the patient. Sometimes increasing nerve dysfunction (particularly weakness) or loss of bowel or bladder control may make the surgery necessary even if pain is not severe. In most cases, nerve dysfunction is not severe and pain can be controlled by non-surgical means. If this doesn’t happen, and if the pain and subsequent disability become intolerable, surgery is a reliable way to solve the problem. Since the patient is the one feeling the pain, the patient is usually the one who decides when he or she is ready for surgery. Q. Who performs this surgery?A. Both orthopedists and neurosurgeons are trained in spinal surgery and both specialists may perform this surgery. It is important that your surgeon specialize in this type of procedure. Q. Is my entire disc removed? A. No, only the ruptured part and any other obviously abnormal disc material is removed. This generally amounts to no more than 10-15 percent of the entire disc. Q. How long wil I be in the hospital? A. Laminectomy patients are usually out of bed within an hour or two after their operation, and some can go home on the day of surgery. The remainder almost always go home the next morning. Q. Wil I need a transfusion? A. Transfusions are rarely needed after this kind of surgery. We do not recommend preoperative donation of your own blood. | Q. What can I do after surgery? A. Once your nurse says it is okay, you may get up and move around as soon as you feel like it, and may drive short distances when you feel able. You should avoid bending, lifting and twisting for six weeks to allow for healing of the surgical area. Q. When can I go back to work? A. That depends on the kind of work you do, and how long you have to drive to get there. Surgical patients can return to sedentary (desk) jobs that they can reach with a drive of 15 minutes, or less, whenever they feel comfortable (usually two or three weeks). You should not drive long distances (30 minutes or more) for about one month after surgery. If your job requires physical labor, you should consult your surgeon. Q. What is the likelihood that I will be relieved of my pain? A. Ninety to ninety-five percent of patients get relief of their leg pain. Some patients (about 15 percent) will continue to have noticeable back pain in some situations and may require additional treatment. Q. Could I be paralyzed? A. The chances of neurologic injury with spine surgery are very low and the possibility of catastrophic injury such as paralysis, impotence or loss of bowel or bladder control are highly unlikely. Injury to a nerve root with isolated numbness and/or weakness in the leg is possible. Q. What other risks are there? A. There are general risks with any type of surgery. These include, but are not limited to, the possibility of wound infection, uncontrollable bleeding, collections of blood clots in the wound or in the veins of the leg, abdominal problems, pulmonary embolism (a blood clot to the lungs) or heart attack. The chances of any of these happening, particularly to a healthy patient, are low. Rarely, death may occur during or after any surgical procedure. Q. Will my back be normal after surgery? A. Though you may have excellent relief of pain, a disc is never completely normal after it has herniated, and if your problem has been caused by arthritis, the arthritis cannot be cured even if the bone spurs have been removed and the nerves decompressed. You may have more back pain than a normal person would have, and there is an increased risk of re-herniation of the damaged disc. However, most people can resume almost all of their normal activities after recovering from surgery. Q. What should I do after surgery? A. You should resume low-impact activities as soon as possible, starting with walking. Try to walk a little farther each day, building up to a brisk three-mile walk each day by six weeks after surgery. Once your sutures are removed you may swim, which is very back-friendly. By two or three weeks after surgery you may try more vigorous activities such as an exercise bike or treadmill. Talk to your surgeon about aerobics and jogging. Physical activity is good for you, if done properly. Q. What shouldn’t I do after surgery? A. In general, you should limit heavy lifting, bending, twisting and high impact physical activities, including contact sports. Consult your surgeon for details. Q. Could this ever happen to me again? A. Unfortunately, yes. As mentioned above, only part of the disc is removed and there is no way to make the disc normal again, so recurrent herniations do occasionally occur. Also, adjacent discs may be abnormal, too, and could rupture in the future. Q. Should I avoid vigorous physical activity? A. No. Exercise is good for you! You should get some sort of vigorous, low-impact aerobic exercise at least three times a week. Walking either outside or on a treadmill, using an exercise bike and swimming are all examples of exercise that is appropriate for spine patients. If exercise is causing pain, stop and consult your doctor before continuing. Frequently Asked Questions About Lumbar Fusion Q. What is wrong with my back? A. You have one or more damaged discs and/or areas of arthritis in your back. This produces pain, and may produce abnormal motion, or misalignment of your spine. Discs are rubbery shock absorbers between the vertebrae and are close to nerves that travel down to the legs. If the disc is damaged, part of it may bulge or even burst free into the spinal canal, putting pressure on the nerve and causing leg pain, numbness or weakness. Q. What is required to fix it ? A. Your condition requires both a nerve decompression (freeing the nerves from pressure) and a spinal fusion. In this case, both nerve decompression and spinal fusion would be done. Q. What is spinal fusion? A. A fusion is a bony bridge between at least two other bones; in this case, two vertebrae in your spine. The vertebrae are the blocks of bone that make up the bony part of the spine, like a child’s building blocks stacked on top of each other to make a tower. Normally, each vertebra moves within certain limits in relationship to its neighbors. In spinal disease, the movement may become excessive and painful, or the vertebrae may become unstable and move out of alignment, putting pressure on the spinal nerves. In cases like this, surgeons try to build bony bridges between the vertebrae using pieces of bone called bone graft. The bone graft may be obtained from the patient, (usually from the pelvis), or from a bone bank. There are advantages and disadvantages to either source. The bone graft is either laid next to the vertebrae or actually placed between the vertebral bodies (the rubbery disc that normally lies between the vertebrae must be removed). In either case, the bone graft has to heal and fuse to the adjacent bones before the fusion becomes solid. Spine surgeons often use screws and rods to protect the bone graft and stabilize the spine while the fusion heals. Q. How is the operation performed ? A. A four-to five-inch incision is made in the middle of the lower back. Muscles supporting the spine are pushed aside temporarily. The spinal nerve is exposed, moved aside and protected, and the ruptured disc or bone spur is removed to loosen the nerve. The fusion is performed as described above. The wound is then closed and dressings are applied. The operation typically takes a minimum of three hours and may be longer, depending on the complexity of the problem. Sometimes the spinal fusion is performed with an anterior approach. In this case, the surgeon would make a four-to five-inch incision in the lower abdomen, gently move the internal organs aside, and proceed with the surgery as described above. Q. Who is a candidate for lumbar fusion & when is it necessary? A. When the back and nerve problems cannot be corrected in a more simple procedure and the pain persists at an unacceptable level, it is necessary to do a fusion. Some of the conditions which require spinal fusion are discussed in the answer to “What is Spinal Fusion?” Q. Who performs this sugery? A. Both orthopedists and neurosurgeons who specialize in spine surgery may perform this procedure, either individually or as a team. Q. Could I be paralyzed? A. The chances of neurologic injury with spine surgery are very low, and the possibility of catastrophic injury such as paralysis, impotence or loss of bowel or bladder control are highly unlikely. Injury to a nerve root with isolated numbness and/or weakness in the leg is possible. Q. Are there other risks nvolved? A. There are general risks with any type of surgery. These include, but are not limited to, the possibility of wound infection, uncontrollable bleeding, collections of blood clots in the wound or in the veins of the leg, abdominal problems, pulmonary embolism (a blood clot to the lungs), or heart attack. The chances of any of these happening, particularly to a healthy patient, are low. Rarely, death may occur during or after any surgical procedure. Q. What are my chances of being relieved of my pain? A. More then 90 percent of patients get relief of their nerve symptoms or leg pain. Relief of back pain is less predictable, occurring about 75 percent of the time. Q. Will my back be normal after surgery? A. No. Even if you have excellent relief of pain, the spine is not completely normal after a fusion. Stiffening one segment of the spine with the fusion may put additional strain on other areas. Other discs may have started to wear out. Even if they aren’t causing you pain now, they may do so in the future. For these reasons, you may have more back pain than a normal person would have. However, most people can resume almost all of their normal activities after their fusion has healed. Q. How long will I be in the hospital? A. The hospital stay is generally one to three days. Q. What s hould n’t I do after su rgery? A. Generally, you should avoid bending, lifting and twisting for six to nine months. Even if screws or rods are used, 6 to 12 months are required for the fusion to heal completely. You must protect your spine during this time. Your surgeon will usually prescribe a brace for you to wear for part of this time. If you are a smoker, you definitely should not smoke until your fusion is completely solid since smoking interferes with bone healing. Q. What can I do after surgery? A. You should get up and move around frequently as soon as your nurse or physical therapist says that it's ok. If you are feeling well enough, you may begin driving in four weeks with your back brace on. Q. When can I return to work? A. This should be discussed individually with your surgeon. Generally, patients may return to sedentary jobs whenever they are comfortable, which is usually within three to six weeks. If you drive more than 30 minutes to get to work, your surgeon may want you to wait longer. It takes much longer to get back to work that requires strenuous physical activity due to the increased stress these activities play on the healing bone. Q. Could happen to me again? A. Unfortunately, yes. A fusion may add stress to the levels above and below the fusion. If the fusion doesn’t heal solidly, even with plates and screws, your symptoms may reoccur and additional surgery may be needed. Q. Should I avoid vigouiously physical activity? A. No. Exercise is good for you! You should get some sort of vigorous, low-impact aerobic exercise at least three times a week. Walking either outside or on a treadmill, using an exercise bike and swimming are all examples of exercise that is appropriate for spine patients. You may start these activities when cleared by your surgeon. Frequently Asked Questions About Cervical Laminectomy and Cervical Discectomy Q. What is wrong with my neck? A. You have a “pinched nerve.” This can be produced by a ruptured disc or by bone spurs. Discs are rubbery shock absorbers between the vertebrae, and are close to the nerves that travel down to the arms. If the disc is damaged, part of it may bulge or even burst free into the spinal canal, putting pressure on the nerve and causing arm pain, numbness, or weakness. Bone spurs, usually the result of arthritis, can also put pressure on nerves. Occasionally, pressure from bone spurs or a ruptured disc may affect the spinal cord and cause abnormalities in the legs or lower parts of the body. Q. What is required to fix the problem? A. In most cases, a small (three-to four-inch) incision is made in the posterior part of the neck. Muscles supporting the spine are pushed aside temporarily and a small “window” is made into the spinal canal. The spinal nerve is protected and the ruptured part of the disc or the bone spur is removed. If bone spurs and arthritis are the cause of your problem, you may require a bigger incision and more bone may have to be removed. Q. When is this operation necessary? A. In almost all cases, the major reason for spine surgery is pain that is intolerable to the patient. Often non-surgical measures can control the pain satisfactorily. However, if the pain persists at an unacceptable level, if you cannot function because of pain, or if weakness or other neurologic problems develop, then surgery may be necessary to relieve the problem. Q. Who performs this surgery? A. Both orthopedists and neurosurgeons are trained in spinal surgery. It is important that your surgeon specialize in this type of procedure. Q. How long will I be in the hospital? A. Most patients stay 24 hours. Complications may require longer stays. Q. Will I need a blood transfusion? A. There is usually very little blood loss with this operation and transfusions are almost never necessary. Q. What can I do aft er surgery? A. You should try to get up and move around as much as your symptoms allow. You may walk as much as you like. Q. When can I go back to work? A. That depends on what kind of work you do and how far you have to drive. It can be as little as two weeks, but may be longer if your job involves manual labor or if you have to drive more than 30 minutes to get there. Q. What are my chances of pain relief? A. Ninety to ninety-five percent of patients get relief of their nerve symptoms or arm pain. Neck and shoulder pain are less predictably relieved by disc surgery. Up to 15 percent of patients may have some neck and shoulder aching after surgery; this percentage may be higher in patients who have a substantial amount of neck and shoulder pain before surgery. Other conditions such as fibromyalgia may also produce continued pain even after successful disc surgery. Q. Will my neck be normal after surgery? A. No. Even if you have excellent relief of pain, the disc has still been damaged. However, most people can resume almost all of their normal activities after disc surgery. People who do heavy work generally take longer to recover and may not be able to do everything they could do before their injury. Q. Could I be paralyzed? A. The chances of neurologic injury with disc surgery are very low and the possibility of catastrophic injury such as paralysis is highly unlikely, though not impossible. Injury to a nerve root with isolated numbness and/or weakness in the arm is possible. Q. What other risks are there? A. There are general risks with any type of surgery. These include, but are not limited to, the possibility of wound infection, uncontrollable bleeding, collection of blood clots in the wound or in the veins of the leg, pulmonary embolism (movement of a blood clot to the lung), heart attack, stroke and death. The chances of any of these events happening, particularly to a generally healthy patient, are low. Q. Is my entire disc removed? A. No, only the ruptured part and any other obviously abnormal disc material is removed. This generally amounts to no more than 10-15 percent of the whole disc. Q. Could this ever happen to me again? A. Unfortunately, yes. As mentioned above, only part of the disc is removed and there is no way to make the remaining disc normal again, so recurrent herniations do occasionally occur. Adjacent discs may be or may become abnormal too, and could rupture in the future. Q. Should I avoid vigorous physical activity? A. No. Exercise is good for you. You should get some sort of vigorous, low-impact aerobic exercise at least three times a week. Walking either outside or on a treadmill and using an exercise bike are examples of the type of exercise that is appropriate for spine patients. However, all of the exercise you choose should be pain-free. If any exercise causes pain, you should consult your physician before continuing. Frequently Asked Questions About Cervical Fusion Q. What is wrong with my neck? A. You have one or more damaged discs in your neck. Discs are rubbery shock absorbers between the vertebrae and are close to the nerves that travel out to the arms. If the disc is damaged, part of it may bulge or even burst free into the spinal canal, putting pressure on the nerves and causing arm pain, numbness, weakness and/or pain in the neck or shoulder area. Occasionally, this pressure may affect the spinal cord and cause abnormalities in the legs or lower parts of the body. Bone spurs, usually the result of arthritis, can also put pressure on nerves or the spinal cord. Loss of the normal “shock-absorber” function, or arthritis around the damaged disc, can also produce pain around the neck or shoulders with neck movement or awkward positions. Q. What is required to fix the problem? A. The best approach to your problem is to remove the damaged disc and bone spurs from the front, or anterior part, of the neck and to perform a fusion between the adjacent vertebral bodies. Certain conditions require the surgeon to perform the fusion using a posterior approach instead. Q. What is spinal fusion? A. A fusion is a bony bridge between at least two other bones, in this case two vertebrae in your spine. The vertebrae are the blocks of bone that make up the bony part of the spine, much like a child’s building blocks stacked on top of each other make a tower. Normally, each vertebrae moves within certain limits in relationship to its neighbors. In spinal disease, the movement may become excessive and painful, or the vertebrae may become unstable and misaligned, putting pressure on the spinal nerves. In cases like this, surgeons build bony bridges between the vertebrae using pieces of bone which are called bone grafts. The bone graft is obtained from a bone bank. The graft is then laid between the vertebrae. The bone graft has to heal and unite with adjacent bones before the fusion becomes solid. Spine surgeons often use plates to protect the bone graft and stabilize the spine during the healing period, attaching them to the spine using screws. Q. How is the operation performed? A. An incision, usually about two inches in length, is made across the front of the neck. The trachea (windpipe), esophagus (food pipe) and other tissues are temporarily pushed aside and the abnormal disc or discs are removed completely. The bone graft is then placed to fuse the vertebrae. In most cases it takes between six to nine months to create the solid bony bridge between the two vertebrae which eliminates movement between them. For fusions involving more than one level, or in the case of unusual spinal instability, internal plates and screws may be used to improve stability and conditions for bone healing. Q. When is this operation necessary? A. In most cases, the major indication for spine surgery is pain. Weakness, numbness, clumsiness, and gait instability may also be an indication for surgery. Often nonsurgical measures can control the pain satisfactorily. If the pain persists and interferes with daily activities or if other neurologic problems develop, then surgery may be necessary to relieve the problem. In most cases, the patient makes the final decision about surgery because of pain. If neurologic damage is occurring, your doctors may strongly recommend that you proceed with the operation. Q. How long will I be in the hospital? A. Most patients leave in 24 hours; however, combination anterior/posterior cervical fusion patients will be in the hospital for two days. Q. Will I need a blood transfusion? A. Rarely does a patient need a transfusion. Only in rare tumor or unusual reconstruction cases are transfusions typically needed. Q. What can I do after surgery? A. You should try to walk and take care of yourself as much as possible. You should try to exercise each day. You may perform other low-impact activities not requiring lifting or neck movement as allowed by your brace. If a brace is not required, you may drive when allowed by your surgeon. Q. What shouldn’t I do after surgery? A. You should avoid lifting heavy objects and all overhead lifting. Twisting, repetitive bending and tilting your head back to look overhead are also stressful to the neck. If you are a smoker, you should not smoke until your fusion is completely solid. Smoking interferes with bone healing. Q. Will I need to wear a neck brace? A. Most patients will wear some type of neck brace after this surgery. The type of brace and length of time you need to wear the brace will be determined by your surgeon. Q. When can I go back to work? A. That depends on the type of work you do. If a brace is required, you will not be able to drive until you no longer need the brace. For sedentary jobs, work may resume when you feel comfortable and can get to work. For jobs that require more strenuous physical exertion, a longer healing time may be required. Your surgeon will discuss this with you. Q. What are the chances of pain relief? A. Eighty to 95 percent of patients obtain relief from their arm pain. Relief of neck pain is less predictable, usually in the range of 65-75 percent. Q. Will my neck be normal after surgery? A. No. While most patients have excellent relief of arm pain after surgery, your neck will not be completely normal. While most patients with a one- or two-level fusion will not notice significant loss of motion, the stiffened segment of your spine puts additional stresses on adjacent discs, which may already be abnormal to some extent. These other discs may cause symptoms. Although most patients can resume most of their normal activities after healing, you should take care of your neck. Your surgeon can discuss this with you in detail. Q. Could I be paralyzed? A. The chance of neurologic injury with spinal surgery is low, but not impossible. Injury to a nerve root with isolated numbness and/or weakness in the arm is possible. Fewer than one in 1,000 cases may result in complete or partial paralysis. Q. What other risks are there? A. The risks of this operation include, but are not limited to, anesthesia, wound infection, uncontrollable bleeding, collection of blood clots in the wound or in the veins of the leg, pulmonary embolism (movement of a blood clot to the lungs) and heart attack. The chances of these complications occurring are 2-3 percent of the cases. Death rarely occurs during or after any surgical procedure. Q. Could I have dificulty swallowing? A. Most patients report mild discomfort with swallowing for a few days after surgery. Occasionally, swallowing difficulties may be more significant and last for longer periods. Rarely, it may be necessary to place a feeding tube until swallowing returns to normal. If swallowing difficulty persists, notify your physician. Q. Will my voice be affected? A. Some patients may be hoarse after anterior cervical spine surgery. Usually, this goes away within a few days or weeks. Rarely, the hoarseness may be persistent for a longer period of time or even be permanent. Q. Is the entire disc removed? A. Yes. Q. Could this happen to me again? A. Unfortunately, yes. Similar conditions that led to the disc damage being treated now may have already started in one or more of the other discs in your neck. A small percentage of fusions do not heal normally, which may require additional surgery. The chance of this happening increases if fusion is attempted at more than one level. This is why spine plates are sometimes used for multi-level fusions. Over more than 90 percent of patients do well. Less than 10 percent have some recurring problems. Q. Should I avoid physical activity? A. No. Exercise is good for you. You should get some sort of vigorous, low-impact aerobic exercise at least three times a week. Walking either outside or on a treadmill, using an exercise bike, and swimming are examples of the types of exercises that are appropriate for spine patients. All exercise should be pain-free. If any exercise causes pain, you should consult your physician before continuing. (See section x for approved activities). Q. Who performs this surgery? A. Both orthopedists and neurosurgeons are trained to do spinal surgery. It is important that your surgeon specialize in this type of procedure. |  
|
||||||
AAMCAbout Us
|
