Print out instructions for spine surgery below.

LUMBAR LAMINECTOMY AND FUSION

Most likely, the pain in your back or legs, or both, ultimately led you to seek help. You have been diagnosed as having lumbar spinal stenosis and will require lumbar laminectomy. The condition of spinal stenosis results in the narrowing of the spinal canal in which your nerves are contained. This narrowing or stenosis and the pressure on the nerves can result in pain, numbness and or weakness of one or both legs. These symptoms are usually aggravated by walking and/or standing.

Often patients who have spinal stenosis also have a condition called spondylolisthesis, or slippage, of one vertebral body over another. This also results in nerve compression and associated pain and other symptoms. The degree of "slippage" may cause spinal instability that would require a fusion operation to be done at the time your stenosis is surgically addressed.

Spinal stenosis, as pictured, can be caused by a variety of reasons, including age, repetitive stress, arthritis, thickening of the ligaments and a build up of calcium.  Some people are born with a narrow canal which can become symptomatic with age and stress.

The Lumbar Laminectomy procedure is designed to relieve this compression from the nerves. Generally, with the nerves decompressed symptoms will improve. The surgeon reaches the lumbar spine through a small incision in the lower back. Pressure is relieved by partial or complete removal of the back portion of the vertebrae called the lamina. The lamina is bone that covers the spinal nerves or cord. This bony removal generally does not affect the mobility or stability of your spine.

Spondylolisthesis can be congential or as a result of degenerative changes, but can likewise be seen secondary to trauma to the lumbar spine, or in those patients who are post-laminectomy. The levels most commonly involved are L4-5 and/or L5-S1. Risk factors for these changes to the spinal column include prior spinal or abdominal surgery, obesity, prior trauma or repetitive injury, and cigarette smoking.

Patients with spondylolisthesis typically present with a long and slowly progressive history of low-back and diffuse bilateral leg pain that increases with ambulating. Patients will commonly say that the distance they are able to walk has become shorter and shorter.  If the condition is left untreated, it may simply become too painful for the patient to walk, and they may then resort to the use of a wheelchair or other assistive device.

Testing before your Surgery

· On the day of your office visit, you will receive a prescription for pre-surgical testing to detect any abnormalities. These tests can be done up to one month prior to your surgery date. The results must be reviewed by the neurosurgeon's office no later than three working days before your surgery date. The prescription allows Passavant Hospital or any certified laboratory approved by your insurance company, to do the tests and forward the results to the neurosurgeon's office for review.

· You will also receive a medical clearance form to be completed by your primary care physician.  This form should be completed no more than thirty (30) days prior to your surgery and faxed to our office at 412-630-7644.

∙ If you see any medical specialists, such as a cardiologist or endocrinologist, please notify our office. Sometimes it is necessary for these physicians to provide clearance prior to your operation

∙ If you need pain medications or have any questions before your surgery, please contact our office at 1-877-635-5234.

The Procedure and its Benefits

Lumbar laminectomy with fusion takes about two to four hours. The fusion is generally achieved with pedicle screws, rods and bone.

The risks involved with this type of surgery are: Infection, excess bleeding, damage to dural nerve root, bladder and bowel dysfunction, cerebrospinal fluid leak, no relief of symptoms, excess scarring, increased neurological dysfunction, anesthetic complications, complications related to hospital stay and/or positioning, intra-abdominal injury, vascular injury, nerve root injury secondary to malplacement or displacement of screws, hardware failure, screw fracture and/or death.

After surgery, minor discomfort from your incision is common but temporary. This can be relieved with mild pain medications. Following the procedure, you may experience persistent numbness, weakness and pain, but these symptoms are generally temporary and gradually go away.

Members of the health-care team

You will meet a number of health professionals during this time. Their goal is to help you recover and return you to your prior activities. A brief description of each of these professionals follows:

Neurosurgeon. You have already met this person, who will perform the surgery and direct your care afterward. Please feel comfortable asking questions of your surgeon - communication is an essential key toward recovery.

Nurse. A nurse will obtain information and assess your condition both in the surgeon's office and in the hospital. The office nurse will evaluate you before you see the surgeon and again with the surgeon at the time of your visit. The office nurse will help explain the procedure, answer questions and arrange your surgery. The hospital nurse will assess you in the hospital, and help you before, during and after your surgery. The nurse also will answer questions from you and your family.

Physician assistant. The physician assistant (PA) has been trained to perform many tasks done by a physician. The PA may perform your history and physical examination and review the surgical procedure. The PA can answer questions and will follow you in the hospital after surgery, along with your physician. The PA will review your discharge instructions on the day after your procedure and facilitate your discharge planning.

The day of surgery

One to two days prior to surgery you will be contacted by a nurse in the surgical department at Passavant hospital, who will review your health and medication history. If you have not received a call by 3:00 pm, the day before your surgery, please call 412-367-6567. Please be prepared and have a list of questions and your medications by the phone.  The nurse will tell you what time you need to arrive at the hospital for your operation.

You will be thinking of many things on the day of your surgery, and it is only natural to be overwhelmed and possibly confused about what to do. This information and other information provided can help you become familiar with the process involved with your hospitalization and surgery. We hope that these help to answer your questions and reassure you about your procedure.

Arrival at Passavant Hospital

Plan to arrive at Passavant Hospital on the first floor and take the main elevator to the second floor.

· Eating or drinking after midnight the night before surgery is NOT permitted unless otherwise instructed.

· You will be visited by a nurse and/or PA, who will perform a preoperative assessment.

· Results from your laboratory work will be reviewed again.

· If you have a family doctor clearance letter, it will be collected.

· You will meet with the anesthesiologist who will review the risks of general anesthesia and answer your questions about the anesthetic.

· Your back will be scrubbed by the nurse in preparation for surgery, and you will go to the bathroom.

· An intravenous (IV) line will be inserted, and you will be given antibiotics and fluids.

· Your family should wait in the surgical waiting room (located on the second floor outside the Operating Rooms).

Operating Room

Second Floor, Passavant Hospital

∙ You will meet with a nurse and nurse anesthetist who will take you back to the operating room.

∙ You will be asked to review your name, date of birth and procedure outside of the operating room and again when you enter the operating room.

· You will be in surgery for about two to four hours.

· After surgery, you will be taken to the Recovery Room.

Recovery Room

Outside Operating Room

· Your vital signs will be checked frequently, the surgical dressing will be checked and your symptoms will be assessed.

· You will receive pain medication.

· Your IV fluids will continue.

· You will not be allowed to eat or drink.

· An anesthesiologist will discharge you from the Recovery Room after you are completely awake, which usually takes one to two hours.

· You then will be taken to the Patient Unit located in Passavant Hospital

∙ Your family will be informed as to which Unit you will go to.

Patient Unit

Passavant Hospital

· The nursing staff will assess you on arrival to the floor and monitor your progress.

· Your IV line will be removed after you drink fluids.

· You will be asked to take deep breaths to prevent pneumonia and do ankle and calf exercises to prevent blood clot complications. Pain medications are available; you should ask for this if you need it.

· You will be assisted out of bed the first time you get up. Then, you are encouraged to walk on your own in your room and the halls. You will see physical and occupational therapy, and they will help you with walking.

· A drain is usually placed in the wound after surgery in order to drain excess fluids. This will be removed in one or two days.  The operative dressing will remain in place until the drain is removed by the PA.

∙ If you already have your brace, this can be worn the first night after surgery. If you need a brace it will be fitted and custom made for you to wear the following day.

∙ You will be encouraged to ask the staff any question.

Discharge

· Patients who have had lumbar fusion are discharged two to four days after surgery. Your nurse and PA will discuss your discharge instructions. Please prepare questions to ask at this time.

∙ Patients who also require a fusion will be asked to wear a supportive brace for up to three months and obtain monthly X-rays. Prior to discharge, you will receive a prescription for an x-ray to obtain prior to your first postoperative appointment.

· You will be given a discharge instruction sheet that will include restrictions, activities, physical therapy, medications and care of the incision.

· Remember to arrange your transportation home prior to this day. You will not be allowed to drive yourself home. If you anticipate a problem with your travel arrangements, please notify the staff prior to your surgery. The discharge time is before 11 am.

Discharge Instructions

· A follow-up appointment will be given to you on your day of discharge.  If the time or location is not convenient, please call 1-877-635-5234 to reschedule.

· Until you are seen in follow-up, you should limit your activities.  You may walk as much as you would like.  However, you should avoid lifting more than five pounds, bending at the waist, twisting or sitting for more than 30 minutes. 

· You may not drive until you are seen in follow-up.

· Your lumbar brace should be worn when you are sitting or out of bed unless you are instructed differently at discharge.

· The dressing should be changed daily with dry gauze and tape.  You will be given supplies when you are discharged. 

· You will be given prescriptions for a pain medication, muscle relaxant and antibiotic.  Take these medications as instructed.  Make sure to ask questions at your discharge time.

· You should call our office immediately if you experience any of the following:  fevers, chills, night sweats, swelling at the incision, redness or drainage from the incision, new weakness or pain in your arms or legs.

∙ After your operation, if you have any questions regarding your incision or symptoms that you may be experiencing, please contact our office at 1-877-635-5234.

If you have specific questions that are not addressed in these materials, please call your neurosurgeon 1-877-635-5234

DISCLAIMER: Every effort has been made by the author(s) to provide accurate, up-to-date information. However, the medical knowledge base is dynamic and errors can occur. By using the information contained herein, the viewer willingly assumes all risks in connection with such use. Neither the author nor UPMC shall be held responsible for errors, omissions in information herein nor liable for any special, consequential, or exemplary damages resulting, in whole or in part, from any viewer(s)' use of or reliance upon, this material.

CLINICAL DISCLAIMER:  Clinical information is provided for educational purposes and not as a medical or professional service. Person(s) who are not medical professionals should have clinical information reviewed and interpreted or applied only by the appropriate health professional(s).

© 2008 Tri-State Neurosurgical Associates - UPMC

Last Updated: May 22, 2008