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LUMBAR MICRODECOMPRESSION
Normal Room for Nerve Roots
The lumbar spine consists of the bony vertebrae, discs, nerve roots and other structures.
The vertebrae, which stack up to create the spinal column, surround and protect the spinal cord and, in the lumbar spine, the nerve roots (called the cauda equina). The discs are located between each vertebra. They allow motion between vertebrae, act as shock absorbers, and distribute the stress and strain placed on the spine.
Normal Spine Bones
The lumbar spine consists of the bony vertebrae, discs, nerve roots and other structures.
The vertebrae, which stack up to create the spinal column, surround and protect the spinal cord and, in the lumbar spine, the nerve roots (called the cauda equina). The nerve roots travel out small bony windows (foramenae). The discs are located between each vertebra. Discs consist of a fibrous outer layer (annulus) surrounding a gelatinous center (nucleus). They allow motion between vertebrae, act as shock absorbers, and distribute the stress and strain placed on the spine.
Treatment Options for Spinal Stenosis
Conservative Management: With time, inflammation around the nerve roots can go away on its own. Steroid injections may help relieve the pain and some of the inflammation around the nerve roots. If these attempts at conservative care do not relieve symptoms or if there is progressive neurological damage however; surgery may be necessary.
Microdecompression: is an operation to remove pressure on a nerve caused by spinal stenosis. This surgery involves a vertical incision one to two inches in length along the midline of the back. The doctor uses a microscope to see and protect the nerve roots, and safely remove the portions of tissue and bone which press on the nerve roots. Removing the tissues pressing on the nerve allows the nerve to begin to heal.
The reason to do this surgery is to relieve the leg pain or weakness caused by the pressure on the nerve roots. The success rate of relieving leg pain is very high, approximately 90%. The success rate of relieving chronic back pain present prior to surgery is much less predictable.
The length of the operation is typically short (60-90 minutes), but depends on the number of spinal levels operated upon, whether or not previous surgery has been performed and the severity of the pressure on the nerve roots. Blood loss is minimal so no blood donations are necessary before the operation. Hospitalization is brief and while some patients may go home the day of surgery, most patients go home the day after surgery.
Risks of Surgery
Surgery and anaesthesia involve stresses to many organs and tissues in the body. Incisions and handling tissues during surgery can result in many problems. The benefits of surgery must be carefully weighed against these risks. Some more common or serious problems are listed here.
Recurrent Fracture: The aging process continues, and arthritic changes may still occur. However, regrowth of bone spurs is likely to take a long time, so we do not anticipate the same area being pressed on. As arthritis progresses in the whole body, other areas of the spine may need surgery in the future, but having every area “cleaned out” now is not indicated. Surgery is only indicated on those areas which are currently causing symptoms of nerve root compression.
Spinal Nerve Root Injury: Permanent spinal nerve root injury is extremely rare. It is not unusual, however to experience minor temporary tingling, numbness, weakness or pain which resolves over several weeks. All precautions will be taken but rarely, more serious nerve root injuries may occur, effecting walking, balance, bowel or bladder functions.
Dural Tear: Leakage of spinal fluid can occur due to a tear in the tissue (called the “dura”) holding the spinal fluid and containing the nerves. On rare occasions additional surgery may be needed.
Infection: Infection is always a post-operative risk and occurs in approximately 0.5% of lumbar microdecompression patients. Infections may be superficial or deep into the bone. You are given antibiotics before and after the surgery to help prevent this complication. Please follow the instructions for wound care to help prevent infection.
Other complications: Other possible complications include blood clots, pneumonia and complications related to the general anesthesia.
Activities and Exercise / Rehabilitation
Adequate rehabilitation is crucial for a successful result. Many patients with spinal injuries have suffered from spinal pain for some time. This may result in considerable weakening of the spinal muscles due to lack of exercise, so you should return to your normal activities slowly.
The primary form of rehabilitation after surgery is an aggressive walking program. You should start immediately after discharge, walking more and more each day. In general, we recommend two to three episodes of exercise per day. The average patient can be walking 15 minutes twice a day by their first postoperative visit and 30–40 minutes twice a day by six weeks after surgery. Walk more if you are so inclined!
Expectations
Patients routinely experience a dramatic reduction in their leg pain. If the nerve has been irritated for a long time before surgery, then a more gradual reduction of the leg pain is to be expected. As the nerve heals, you may experience tingling or a warm feeling. Numbness in the leg/foot experienced before surgery is often the symptom which takes the longest to resolve.
Back pain associated with the incision is largely improved within two to three weeks. Increased pain with prolonged sitting and driving is also expected.
Wound Care
At your first post-operative visit we will inspect your wound and remove any stitches as necessary.
Do not soak your wound!
Do not soak your wound. No bathtub, swimming, or hot tub, etc. until you have received permission from your physician. Do not remove any “butterfly” bandages right next to your skin. These are designed to get wet and fall off in the shower over time.
- If you have a clear plastic bandage over your wound, you may shower right away. You may remove the clear plastic on arrival home, and then you may shower as listed below.
- If you have no clear plastic, but instead have a gauze dressing, you may not shower until 72 hours after your surgery and only if your bandage does not have wet drainage on it.
Medications
Prescribed narcotic pain medication may cause some constipation. To help with this:
- Increase your fluid and fiber intake (fruits, vegetables, whole grains)
- Walk as much as possible
If you need a refill on your pain medication, please have your pharmacy fax the refill request to our office @(949) 988-7800 and please allow up to 48 hours for the request to be processed. Refills on pain medication will not be filled after hours or on weekends or holidays. Be aware of how much pain medication you have, & obtain refills before you run out.
Activity Limitations
Avoid twisting your neck to the extremes, and avoid forced bending of your neck either forward or backward. Gentle range of motion of the neck is OK. Do not drive until you have received permission from your physician.
Treatment
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Call the spine center if you are experiencing the following:
- Difficulty breathing
- Temperature greater than 101.5°F (38.5° C)
- Changes in or difficulty with balance while walking
- Increased weakness or numbness to your arms or legs
- Increased or unusual pain not relieved by pain medication
- Increased redness, swelling, bleeding, or other drainage at your incision site
Dr. Jamie Gottlieb
ABOUT
Dr. Gottlieb, or simply Jamie as most of his patients come to know him, is not your typical doctor. His daily attire of scrubs and cowboy boots is the first indication of his demeanor to most people. You will not find suits and ties in this office. You won’t hear doctor Gottlieb talk in medical jargon when going over your concerns or diagnosis. He speaks in simple straightforward language and will develop an easy to understand plan of care to address your individual needs.
Nonoperative conservative care is the first step and often all that is required to improve your quality of life.
If surgery is needed, Jamie is well versed in traditional, minimally invasive and motion preservation techniques.
