113 - Lumbar spine surgery

Summary

Lumbar surgery in adults can be divided into three general levels of complexity and associated morbidity. The simplest and most common disorder is the herniated lumbar disk. Lumbar stenosis can affect multiple motion segments that will require decompression via a laminectomy. A lumbar diagnosis requiring fusion with or without decompression represents an incremental technical and physiologic event. With the recent advances in spinal instrumentation and biotechnology of bone graft substitutes, an anterior lumbar fusion procedure may be a viable substitute for some posterior fusion operations with less blood loss and faster recovery.

Patients with a lumbar disk herniation present with radiculopathy in a dermatomal pattern and may exhibit motor weakness or reflex changes which correspond to the anatomic level of neural compression. The host is typically a young adult in good health. Axial back pain is not a predominant symptom of this condition and is generally unimproved with a diskectomy. If the symptoms produced by lumbar disk herniation fail to respond to appropriate non-operative therapy, laminotomy and diskectomy are indicated. Patients are placed either prone or in the knee–chest position on a specially designed operating table; the latter position affords decompression of the abdominal cavity and the epidural veins. The procedure is performed with either loupe magnification or the surgical microscope through a posterior midline incision measuring 2.5 to 5 centimeters. The operative level is confirmed radiographically to prevent harming an otherwise normal intervertebral disk. Blood loss is minimal and the total anesthetic time is usually 1 to 2 hours.