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PREPARATION: There is no special preparation for this procedure. You are to 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. THE PROCEDURE:
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, 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 bum. 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 this guide. The operation is straightforward. We remove the bone from the back of the spine to give the spinal cord the opportunity to expand and "breathe." We make sure the nerves are free. If there is any question about the spine being "weak" at the area of the surgery, we might perform a fusion in which the bones are sealed together and made stronger. Given the minimally invasive nature of this procedure, we usually don't put stitches in the skin. Paper strips called "Steri-Strips" are used. AFTER THE SURGERY: When you awake, you will be in the Recovery Room and, more likely than not, there will be a tube in your bladder (a Foley catheter) which will remain overnight so that you can rest comfortably without having to get up to go to the bathroom. 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 and in a week or two is very mild and tolerable. The day after
the surgery, you will begin to get up and around. I have found over
the years that this operation requires several days to recuperate
from. The average hospital stay is three days, and about a third
of our patients need to go to a rehabilitation facility for a few
days to regain full mobility such that they can return home. RISKS OF OUTPATIENT SURGERY: If we anticipate that your procedure will be a short and minor one, 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 and potentially fatal. The main risk is internal bleeding or swelling after the operation. In the lumbar spine after a microdiskectomy, this could result in weakness or paralysis of 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. In the operations that I have performed myself, I have not had a serious complication in over 25 years. Given the narrowness of the spinal canal, the possibility exists for a spinal injury with weakness or paralysis of the legs. To my knowledge, in the medical literature the incidence of this is 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 2%. This is usually treated with antibiotics. The spinal cord is covered by a membrane that can be very thin in these conditions. If there is a tiny tear in the membrane as a result of the procedure, the spinal fluid can leak out through the skin surface. I have to perform a surgery less than once a year or so to repair such a membrane leakage. It, in general, is rare and relatively easy to repair when it occurs.
You will see me before the operation, and on the same day afterwards to see how you are doing. It is important to note that if you have an uncomplicated hospital course, you will generally see my physician's assistant or the Neurosurgery residents who will perform the postoperative care. 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.
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Neurosurgery
Associates, Inc. email: questions@neurosurgery-associates.com Copyright ©2008 Neurosurgery Associates, Inc.
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This
is a guide to the upcoming operation on your low back. You have
a condition called lumbar spinal stenosis. "Lumbar"
refers to the part of your spine where you have problems. "Stenosis"
refers to a narrowing of the spinal canal that has reached such
a critical level that the spinal cord is being deprived of blood.
At rest or in bed, this usually does not cause discomfort. 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 "laminectomy."
This, in effect, makes an opening into the back of the spinal canal
to relieve the pressure on the spinal cord. It is similar to a napkin
ring tightly compressing a napkin. During the operation, the back
portion of the spine (the back half of the napkin ring) is removed
to let the spinal cord (napkin) expand to its normal size.
and
you will remember nothing of it. 
