Lumbar spinal surgery

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Alternative names
Spinal surgery - lumbar

Definition

Lumbar spinal surgery is used to correct problems with the spinal bones (vertebrae), disks, or nerves of the lower back (lumbar spine).

See also spinal fusion and Spinal surgery - cervical.

Description

The spine consists of bones (vertebrae) separated by soft cushions (disks). Pressure on the nerves that branch off the spinal cord can produce pain, numbness, tingling, or weakness and may be caused by the following:

• Injured disks that bulge out (slipped disk) between the vertebrae
  
• Bone injuries (fractures)
  
• Narrowing of the space between vertebrae (spinal stenosis)
  
• Growths (tumors)
  
• Pockets of infection (abscesses)
  
• Pockets of blood (hematomas)

Patients with spinal pain in the neck or back are usually treated conservatively before surgery is considered. Bedrest, traction, anti-inflammatory medications (nonsteroid and steroid), physical therapy, braces, and exercise are often prescribed.

Maintaining good health, muscle strength, and body posture with appropriate rest and exercise help prevent unnecessary strain on the spine and muscles.

Lumbar spinal surgery is done while the patient is under general anesthesia (unconscious and pain-free). An incision is made over the troubled area. The bone that curves around and covers the spinal cord (lamina) is removed (laminectomy) and the tissue that is causing pressure on the nerve or spinal cord is removed.

The hole through which the nerve passes may be enlarged to prevent further pressure on the nerve. Sometimes, spinal fusion is necessary to stabilize the area.

Indications
Symptoms of lumbar spine problems include:

• Pain that extends (radiates) from the back to the buttocks or back of thigh
  
• Pain that interferes with daily activities
  
• Weakness of legs or feet
  
• Numbness of legs, feet, or toes
  
• Loss of bowel or bladder control

If you are experiencing numbness in your groin region and problems with urinary or bowel control, contact your health care provider immediately. This could indicate cauda equina syndrome, which must be addressed as soon as possible.

Risks
Risks for any anesthesia include the following:

• Reactions to medications
  
• Problems breathing

Risks for any surgery include the following:

• Bleeding
  
• Infection

Additional risks of spinal surgery include the following:

• Nerve damage leading to paralysis
  
• Blood clots
  
• Muscle weakness
  
• Loss of bowel or bladder control

Expectations after surgery
The outcome depends on the source of the problem or the extent of the injury but most patients do very well after surgery.

Convalescence

The length of hospital stay will vary according to the surgery performed, but can be as short as overnight for a simple discectomy, to up to a week if a spinal fusion is peformed.

You will be encouraged to walk the first or second day after surgery to reduce the risk of blood clots (Deep venous thrombosis).

Complete recovery takes about 5 weeks. Heavy work is not recommended until several months after surgery or not at all.

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