Lumbar
Laminectomy - Decompressive
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The "Aging" Spine
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| The
Body's Aging Process |
Your
body goes through many changes as you get older. You
may not see or hear as well as you did when you were
younger. We recognize that this is a natural process,
and we learn to accept it or make adjustments for it,
such as getting glasses or a hearing aid.
As
your spine ages, it also goes through some natural
changes. In a condition often referred to as the
Degenerative (or "Aging") Spine, the gelatin-like
centers of your discs begin to dry out, causing them
to become compressed or "flattened" (Fig.
5). This, in turn, causes the vertebrae to"settle." It's
one of the reasons most people actually become shorter
as they grow older.
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| The
Slowly Closing Window |
As
your discs begin to "compress" and your vertebrae begin
to "settle", the window-like openings of the foramen become
smaller and smaller (Figs. 5,above & 6,below).
Eventually, the opening can become so small that the
nerve is "pinched" against a vertebra. It's similar to
laying your hand on a window sill. As long as the window
is open, there is no problem. However, if someone slowly
closes the window, there will be a point at which your
hand begins to feel the pressure. The more the window
is closed, the greater the pressure and the greater the
pain you will feel. |
| The
Loss of Your Spine's "Shock Absorbers" |
At
the same time, your aging discs are drying out and losing
their ability to act as effective "shock absorbers." Your
vertebrae begin to bounce against one another and this
jarring action actually causes the bone matter of the
vertebrae to grow. This results in the formation of bone
spurs. The jagged edges of this new growth can cause
both the spinal canal and the foramen to become even
smaller. When this happens, the result is often the pinching
of the cauda equina and/or a spinal nerve root. |
| Symptoms |
When
a spinal nerve is pinched by a narrowing of the foramen,
the condition is referred to as lateral recess stenosis.
Symptoms include intense pain, numbness and/or weakness
in one leg. When the cauda equina becomes compressed
by a narrowing of the spinal canal, the condition is
referred to as lumbar canal stenosis and the pain,
numbness and/or weakness appears in both legs. |
| Individual
Preferences |
If
the aging of the spine is a natural process
and happens to everyone, why does one person end up
with lateral recess stenosis or lumbar canal
stenosis while his/her neighbor is seemingly unaffected?
The answer is that everyone's spine is unique.
Some people are born with discs which are naturally
more"plump" than others. Some have wide foraminal or
spinal canal openings, while others have narrow ones.
These factors as well as your weight, posture and level
of physical activity help to determine who will be
adversely affected by the aging process.
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| Treatment Options
| Because
the aging of the spinal discs is a natural and irreversible
process, treatment options for lateral recess stenosis
or lumbar canal stenosis are limited to the following:
- Taking
Medication: For some, medication may help
to ease the pain in the affected area and thereby
provide relief.
- Using
Physical Therapy: For those with only limited
pinching of the spinal nerves, measures such
as physical therapy or gentle exercise may provide
relief
- Having
Surgery: For those with severe compression
of the cauda equina and/or spinal nerves, a decompressive
lumbar laminectomy often is the recommended
treatment.
When
Surgery is NOT an Option:
The
severity of your symptoms (pain, weakness, numbness)
and your general health and physical condition will
play an important part in determining when surgery
is not an option for you. In general, surgery is
not an option when:
- you
do not have leg symptoms;
- your
back and leg symptoms are not caused by a pinched
nerve;
- there
is a medical reason which prevents you from having
surgery;
- medication
which reduces swelling or relieves pain would provide
you with adequate relief; or
- physical
measures would improve your condition.
When
Surgery IS an Option:
A decompressive
lumbar laminectomy is usually recommended only
when specific conditions are met. In general, surgery
is recommended when a spinal nerve root(s) is pinched
and you have:
- leg
pain which limits your normal daily activities;
or
- weakness
in your leg(s) or feet; or
- numbness
in your legs; or
- difficulty
in walking or standing.
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The
Risks of Having Surgery:
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Some
of the more common risks of having any surgery include
excessive bleeding, infection, or a negative reaction
to anesthesia. Certain unforeseen circumstances could
even lead to death. Clinical experience and scientific
calculation indicate that these risks are low, but
surgery is still a human effort. You should feel free
to ask any questions you have about your specific risk
factors.
Since
a decompressive lumbar laminectomy involves surgery
in and around the spine, further nerve damage is
a possibility. In some cases, the nerve is
already so damaged that the surgical procedure
required to simply take the pressure off the nerve
could be the "straw that breaks the camel's back." The
end result could be numbness, paralysis or a loss
of bowel and bladder control.
The
Risks of Not Having Surgery
Without
surgery, simple everyday activities also could lead
to further nerve damage. The consequences could be
much the same as those associated with surgery, including
numbness, paralysis or a loss of bowel and bladder
control.
The
Benefits of Having Surgery
You
can think of surgery as the first step in
the healing and recovery process. It can help relieve
pressure on your spinal nerve(s) and, thereby, help
relieve your leg symptoms. It also may help you begin
the process of regaining more normal function in
your legs.
Your
Chances for Success
Your
level of healing will be determined by your age,
your general health and the severity of the damage
to your spinal nerve(s). Your attitude and your willingness
to work at recovery also will play an important
part in your recovery process.
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| Making Your
Decision |
 When you consider your
options, keep in mind the impact your condition has on
your way of life and carefully weigh the risks and benefits
of having surgery against the risks and benefits of not
having surgery. The decision is yours! |
| If You Decide
to Have Surgery |
Approach
your surgery with a positive mental attitude and with
full confidence that you have made the right decision.
While the surgeon concentrates on finding and removing
the cause of your pinched nerve, you must concentrate
on the recovery process. Cooperate fully with your
surgeon and focus on the improvements you will make
in the future - not on the problems of the past.
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Related links:
Lumbar
Laminectomy - Decompressive -page 1
Lumbar Laminectomy
- Decompressive -page 3
Lumbar Laminectomy
- Decompressive - page 4
Back FAQ's
Pre-surgery FAQ's |
