If nonsurgical measures fail to relieve symptoms of spinal stenosis, a surgical procedure called laminectomy also referred to as decompression can be done. A portion of the vertebra called the lamina is removed, along with any bone spurs or ligaments that may be causing the narrowing.
The procedure makes more room for the nerves, thus relieving symptoms. Some people have spinal stenosis plus instability in the spine, and this is where spinal fusion has a role. Fusion surgery permanently joins fuses two vertebrae together. With spondylolisthesis, a vertebra has slipped forward or backward in relation to the adjacent vertebra. Scoliosis is a rotational curvature of the spine, which can occur in adults over time as a result of degeneration of disks.
These conditions can worsen symptoms of spinal stenosis. To maintain the benefit of the decompression, surgeons perform fusion to stabilize the spine. This prevents further slippage or curvature in that location. A study published in the New England Journal of Medicine found that people with back and leg pain from spinal stenosis who also had spondylolisthesis did better with decompression plus fusion than with decompression alone.
This continues to be studied. To find out if you are a candidate for this surgery, a set of imaging studies will be done. These include an X-ray of the spine while standing to look at the position of the bones and magnetic resonance imaging MRI to get a more detailed image of the nerves and soft tissues. The surgery involves inserting a small amount of bone bone graft in the space between the two vertebrae to stimulate them to grow together, much the way the two ends of a broken bone heal back together.
The bone graft often is taken from bone that was removed during the laminectomy. Because it takes six months to one year for the vertebral bones to completely fuse, the surgeon also places screws and rods to hold the vertebrae together. Rarely did surgery deliver as much benefit as it hoped. Over the past twenty years of my career, advances in our ability to diagnose and treat spinal disease have expanded dramatically. With the latest techniques, we are now able to get people back to work and back to life after spine surgery very reliably.
In order to answer these and other questions related to work after surgery, we conducted a research study through the Sonoran Spine Research and Education Foundation. The purpose of our study was to define the expectations for returning to work for different kinds of spine surgery, from minimal lumbar diskectomy to major spinal reconstruction and fusion of several vertebrae.
Based on our experience, our hypothesis or expected finding from this study was that the majority of patients, who were working before surgery, went back to work after surgery and were able to stay in the work force for an extended period of time.
Study of Workers - We studied patients, all adults between age 19 and age 60, who were working full time prior to their lumbar surgery. Some had to stop working before surgery due to pain, but they had the capability to work and hoped to get back to work following surgery. Excluded from the study were patients who were retired, students, the unemployed, and any patients involved in a worker's compensation claim or litigation of any sort for instance someone involved in a car accident who was suing the driver of the other car.
The average age of these patients was We broke down the type of work performed into sedentary patients medium work patients heavy work 23 patients and work type unknown 10 patients. The diagnoses for this group of patients included disc herniation, recurrent disc herniation, spinal deformity such as scoliosis or kyphosis, shifting or unstable vertebra such as spondylolisthesis, arthritic conditions involving nerve compression, and patients requiring revision spine surgery for prior failed surgical attempts.
All patients were asked to fill out questionnaires before surgery and at regular intervals after surgery regarding how they felt and how well they were doing. The average patient was questioned four years after their surgery. They were all asked to rank their pain on a scale of 1 to 10 as to severity, asked about their need for pain medication, and asked about their physical fitness and function.
Results from surgery If the results are ignored and the surgical choice is made off of the MRI findings, then a discogram does not serve any useful purpose. Deciding on Surgery for Degenerative Disc Disease. Getting an Accurate Back Pain Diagnosis. Diagnosing Lumbar Degenerative Disc Disease. Lumbar Spinal Fusion Surgery.
Treatment for Degenerative Disc Disease Video. You are here Treatment Spinal Fusion. Indications for Spinal Fusion share pin it Newsletters. Peer Reviewed. It is especially critical to select the right patients for a lumbar spine fusion surgery for two reasons: Lumbar spine fusion is an extensive surgery and the healing process takes a long time about 3 to 6 months, and up to 18 months The spine fusion forever changes the biomechanics of the back and is thought to increase the stress placed on the other non-fused joints in the lower spine and possibly lead to degeneration of the adjacent levels of the spine.
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