Lumbar surgery involves surgery of the lumbar spine stretching from L1 to S1 levels. The indications for lumbar spine surgery – It’s only recommended when non-surgical treatments haven’t helped.
Lumbar spine surgery is comprised of two types of surgeries –
Lumbar decompression is carried out to eliminate the pain resulting because of the nerve root pinching. This can arise due to pressure on the nerve root post a lumbar herniated disc or lumbar spinal stenosis (1). Decompression surgery involves – Microdiscectomy wherein disc material impinging the nerve is removed; thus relieving the nerve of the pressure. And in Laminectomy a small piece of the vertebra causing stenosis is removed (1). Foraminotomy is considered when the protruded disc and /or bony spur compresses the nerve root. The procedure aids in the increasing the diameter of the foramen thus relieving the nerve compression. Similarly, Laminotomy is a part of lumbar Minimal Access Spine Technology (MAST) procedure for easy accessibility of the disc material. Facetectomy; complete or partial elimination of the facet joint, is performed to decompress the nerve root or to approach the disc space (5).
Neurological complications such as altered bladder and bowel function and increasing neurological deficits such as reduced / loss of motor power or sensory deficit in the lower limbs justifies lumbar discectomy. Surgery should also be contemplated in cases where there has been no significant improvement in the lower limb radiculopathy following an adequate conservative management (3)
The surgery is also performed in cases of spinal injuries such as fracture or a swelling and metastasis of tumor from other organs of the body.
In order to reduce the pain occurring at a painful motion segment in the lumbar back, a bone graft is used which helps in relieving the pain arising from the joint. It is carried out in cases of pain and disability arising due to lumbar spondyloarthropathy with disc disease and spondylolisthesis.
Instrumentation are the Spine specific implants that are often used in conjunction with fusion surgery. Devices used as Instrumentation are plates, rods, screws, and interbody devices. They stabilize the spine until the fusion heals solid (5).
There are bright chances (Up to three in every four people) that the pain reduces substantially post operatively with the improvement in neurological aspects such as sensory and motor functions of the lower limbs (4).
Complications – For every case, a thorough preoperative evaluation (analyze cardiac, respiratory, hematologic, mental status, nutrition status, bone density, alcohol and tobacco use), needs to be done so as to minimise the possible complications. The significant development in the field of anesthesia and invention of newer techniques in surgery have drastically reduced intraoperative and perioperative complications (2).
There can be intraoperative excessive blood loss (58.3%) in posterior fusion, instrumentation and osteotomies as a corrective surgery for adult scoliotic or kyphotic deformities. The aim should be to reduce surgical time, as extended surgical time beyond 4 hours is related to increased risk for developing superficial and deep wound infections (2). Other complications can be neurological deficit, deep vein thrombosis and pulmonary embolism.