Dr. Said Elshihabi, MD

Depending on the region of pain and affected vertebrae, surgeons will likely perform one of three types of lamina procedure: laminectomy, hemilaminectomy, and laminotomy. These procedures can be performed on any part of the spine.

Laminectomy is the most common lamina procedure. During a laminectomy, the surgeon removes all or part of the lamina to create space in the spinal canal. An incision is made on the back and the back muscles are pulled away to access the spine. The surgeon slices parts of the lamina bone and other ligaments and bone spurs causing compression. Laminectomy is frequently performed on the lower back (lumbar laminectomy) and upper spine and neck (cervical laminectomy).

A hemilaminectomy, also known as a partial laminectomy, is less invasive than laminectomy and is accomplished by a small cut in the lower spine. The surgeon uses a surgical tool called a retractor to hold open the tissue surrounding the cut. A section of the lamina is removed from only one side of the lamina. The entire procedure lasts for about an hour.

During a laminotomy, the surgeon creates a hole in the lamina and removes a small piece of lamina bone. After making a minor incision in the back, surgeons use a burr (medical drill) to create the hole, relieving spinal canal pressure. Laminotomy is frequently the preferred procedure for spinal stenosis as it is less harmful to the muscles surrounding the spine.

Following lamina surgery, patients can expect a few days of hospital stay and a recovery lasting a few weeks to a few months. Recovery may last longer if patients also receive a spinal fusion (surgery to join two or more vertebrae) or other spinal surgeries in addition to a lamina procedure. Heavy lifting, bending, stretching, and other physical activity are strongly discouraged during the recovery period following a lamina procedure. Eventually, many patients begin to experience reduced back pain and improved quality of life.

To determine if spinal cord stimulation may benefit someone, they will first undergo a trial period. During this period, a temporary electrode lead is placed subcutaneously above the spinal cord, and it is connected to an external stimulator that they will carry with them. The procedure is typically completed within an hour, and patients may return home the same day. After a few days or weeks, the trial stimulator will be assessed for effectiveness. If the trial is unsuccessful, patients may undergo a second trial period, or the leads will be removed, and other treatment options will be considered. If, instead, a patient's pain is relieved during the trial, they will undergo surgery for implantation of a permanent stimulator and leads.

The components of a spinal cord stimulation system include the stimulator, the leads, and the wire that connects the two. Implantation of permanent leads may be percutaneous (through the skin) or involve a surgical incision. The spinal cord stimulator is implanted subcutaneously in the abdomen or buttock. The stimulator is battery-powered and may be rechargeable. If the battery is not rechargeable, it will last around 2-5 years, and a patient will need surgery to replace it.Their doctor will program the neurostimulator following the procedure.

After spinal cord stimulator surgery, patients may be released from the hospital the same day or the next one. In the weeks following the operation, patients will need to work with their doctors to find the optimal settings for their neurostimulator. Activities such as driving, twisting, bending, raising one's arms, sleeping on one's stomach, or lifting heavy objects should be limited.

There are several different types of spinal fusion surgery available, mostly depending on where a patient's pain is located and whether his or her surgeon will perform the procedure through the back, front, or side. In general, a fusion is performed by packing the vertebrae to be fused with grafted bone. This bone may be taken from the patient's hip, may be donated from a cadaver, or it may be a manufactured synthetic material. The bone is placed along the vertebrae, and sometimes, the disc that lies in between the vertebrae is removed and replaced with grafted bone. The bone material will grow and cement the two vertebrae together. After the bone graft is placed, the vertebrae are sometimes held in place with rods, screws, plates, or cages, depending on the weakness of the spine and needs of the graft.

Spinal fusion is a significant surgery and can take three to four hours or more. Recovery is typically two to four days in the hospital. After surgery, it is important to remember that the fusion takes time to grow from the bone graft. So, the actual fusion is not complete for several months. Patients will probably feel somewhat better right away, but it may take a while to feel the full effects of the fusion as the bone grows into place. In the meantime, doctors might have patients wear a brace to protect their spine and keep it properly aligned.

Spinal fusion is not used for all kinds of back pain. Changing the way the spine moves can lead to strain on the other joints in the back, and fusion is only performed when the benefits outweigh the risks. Some spine disorders that are treated with fusion include:

• Curvature disorders, such as scoliosis and kyphosis
• Degenerative disc disease
• Spondylolisthesis, a disorder that causes vertebrae to slip over each other
• Significant spinal fractures that cause instability
• Weakened spine due to infection or tumor
• Some cases of spinal stenosis, a narrowing of the spinal column
• Chronic lower back pain (although the use of fusion to treat this is controversial)

Regardless of the diagnosis, there is always a possibility of 'failure' with spinal fusion, or of the surgery not fully solving the pain. This is more likely when fusion is used primarily to treat pain instead of structural problems. Patients can improve their chances of a successful outcome by stopping smoking, maintaining a healthy weight, moving their body every day, and following their doctor's instructions for any physical therapy that they are prescribed.