While no area in spinal surgery seems to exist without controversy, laminectomies continue to be one of the most controversial. By definition, a laminectomy is a surgical procedure in which a portion of a vertebra is removed to relieve pressure on the spinal cord on the nerve roots that emerge from the spinal canal. The procedure is often used to treat spinal stenosis, a progressive narrowing of the opening in the spinal canal.
According to the American Academy of Orthopedic Surgeons, there are approximately 200,000 laminectomies performed every year. An estimated 20% -30% are reported to be unsuccessful, with a reoperation rate of 10%-25%. Even though these statistics include surgeries for a wide variety of conditions in addition to stenosis, it is easy to see that the problems of "failed back surgery" are enormous.
There is nothing more distressing to the physician or the patient than to be faced with this unhappy dilemma. There are over l5 billion dollars spent on low back care every year in this country. We can no longer afford anything less than a good outcome. Can the failed back surgery syndrome be avoided? What is going wrong? Why are there so many failed back surgeries? Is it the patient's fault? Is it the surgeon's fault? Or is it just the natural history of the disease? There are biologic variables doctors cannot control such as bone healing, cartilage degeneration, and patient behavior, all of which can affect outcome.
Should patients with stenosis who are experiencing failed open back surgery give up? No. Patients with stenosis should consider the following:
Diagnosis
The physician must determine that the symptoms are caused by spinal stenosis. Conditions that can cause similar symptoms include a slipped (herniated) intervertebral disc, spinal tumors, and disorders of the blood flow (circulatory disorders). Spinal stenosis causes back and leg pain. The leg pain is usually worse when the patient is standing or walking. Some forms of spinal stenosis are less painful when the patient is riding an exercise bike because the forward tilt of the body changes the pressure in the spinal column. Doppler scanning can trace the flow of blood to determine whether the pain is caused by circulatory problems. X-ray images, computed tomography scans (CT scans), and magnetic resonance imaging (MRI) scans can reveal any narrowing of the spinal canal. Electromyography, nerve conduction velocity, or evoked potential studies can locate problems in the muscles indicating areas of spinal cord compression.
How Stenosis is Diagnosed
Before making a diagnosis of stenosis, it is important for the doctor to rule out other conditions that may have similar symptoms. In order to do this, most doctors use a combination of tools, including:
History: The doctor will begin by asking the patient to describe any symptoms he or she is having and how the symptoms have changed over time. The doctor will also need to know how the patient has been treating these symptoms including what medications the patient has tried.
Physical Examination: The doctor will then examine the patient by checking for any limitations of movement in the spine, problems with balance and signs of pain. The doctor will also look for any loss of extremity reflexes, muscle weakness, sensory loss, or abnormal reflexes which may suggest spinal cord involvement.
Tests
After examining the patient, the doctor can use a variety of tests to look at the inside of the body. Examples of these tests include:
X-rays - these tests can show the structure of the vertebrae and the outlines of joints and can detect calcification.
MRI (magnetic resonance imaging) - this test gives a three-dimensional view of parts of the back and can show the spinal cord, nerve roots, and surrounding spaces, as well as enlargement, degeneration, tumors or infection.
Computerized axial tomography (CAT scan) - this test shows the shape and size of the spinal canal, its contents and structures surrounding it. It shows bone better than nerve tissue.
Myelogram - a liquid dye is injected into the spinal column and appears white against bone on an x-ray film. A myelogram can show pressure on the spinal cord or nerves from herniated discs, bone spurs or tumors.
Bone scan - This test uses injected radioactive material that attaches itself to bone. A bone scan can detect fractures, tumors, infections, and arthritis, but may not tell one disorder from another. Therefore, a bone scan is usually performed along with other tests.
Treatment
Mild cases of spinal stenosis may be treated with rest, nonsteroidal anti-inflammatory drugs (such as aspirin), and muscle relaxants. Spinal stenosis can be a progressive disease, however, and the source of pressure may have to be surgically removed.
Surgical Treatment
In many cases, non-surgical treatments do not treat the conditions that cause spinal stenosis, however they might temporarily relieve pain. Severe cases of stenosis often require surgery. The goal of the surgery is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing, trimming, or realigning involved parts that are contributing to the pressure.
The most common surgery in the lumbar spine to treat stenosis is the laminectomy. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. Various devices (like screws or rods) may be used to enhance fusion and support unstable areas of the spine.
A laminectomy is considered open back surgery. Many people have endured the long recovery process of such a procedure, only to learn that the outcome is poor. Not only is this a physically painful experience, it is also very difficult to deal with emotionally.
With advances in science and technology, there are alternatives. A proven alternative for helping to alleviate the pain of a failed laminectomy is The Bonati Procedures(sm).
The Bonati Procedures are advanced spine surgeries developed and perfected by The Bonati Institute(sm). The procedures employ the smallest incision possible to correct problems of the lumbar, cervical and thoracic spine with patented instrumentation and methods. The Bonati Procedures are performed sequentially as outpatient surgeries with the patient under local anesthesia and alert and able to communicate with the surgeon throughout the procedure. The result of this approach is far less trauma to the muscles and tissues, minimal blood loss and faster recovery. The Bonati Procedures are performed only at The Bonati Institute.
Consider all options
Before you agree to undergo any back surgery, consider getting a second opinion from a qualified spine specialist.
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