What to look for
Injury, wear and tear and the normal aging process can all result in low back pain, keeping you from doing your work, participating in physical activities and enjoying life to the fullest. If low back pain does not respond to conservative methods of treatment, your physician may recommend surgery. A number of procedures can be performed alone or in combination depending on your specific condition.
Laminectomy/Laminotomy
 Spinal surgery usually involves either a laminotomy or laminectomy. First, the surgeon will make an incision in the midline of the back. Next, a "window" is made in the lamina, the portion of the vertebrae that forms the roof of the spinal canal. Bone is removed to relieve pressure on the nerve and to allow the surgeon access to the spinal canal.
 A laminotomy removes a portion of the lamina and is performed when the surgeon needs access to a small part of the spinal canal.
A laminectomy removes the entire lamina and is performed to create more room for the nerves and allows the surgeon greater access to the spinal canal. The bone removed does not grow back.
Discectomy
 With access to the nerve and disc areas gained through the laminotomy or laminectomy, further corrections can be made. The surgeon uses small instruments to remove the damaged disc material that is pressing on a nerve root.
Fusion
For patients with instability, a spinal fusion may be recommended. A spinal fusion involves placing bone grafts between vertebrae. Frequently only two lumbar vertebrae are fused. However, multiple vertebrae may be included. Bone grafts may be taken from the pelvic bone and placed in a hollow, porous implant that is placed between two vertebrae or the bone is placed along side the vertebrae on the transverse processes. As the body heals, the bone graft and the vertebrae grow into one unit or become fused. This stabilizes the vertebrae reducing pain caused by too much movement between vertebrae.
Before Surgery
Before performing surgery, your physician will study your back by means of X-ray or other tests such as magnetic resonance imaging (MRI), myelography or a CT scan. Testing will help the physician determine what procedure will be best for you. Your doctor will discuss whether your procedure will be performed on an outpatient basis or if a hospital stay will be required; fully explain the procedure; and explain the risks and benefits of surgery.
To prepare yourself for surgery, you may be asked to do a number of things. You may be asked to lose weight if you are overweight. If you smoke, it is important for you to stop several weeks prior to surgery. If you are taking aspirin or certain anti-inflammatory medications, inform your surgeon; you may need to stop taking these two weeks before surgery.
What to Expect After Surgery
You will be monitored as you recover from your procedure and you will be given medication to relieve pain. As you prepare to go home, you will be given instructions about physical therapy and a prescription for pain medication. You will also be instructed about follow up visits to your physician.
Your active role in your recovery will continue once you are home by following your rehabilitation plan. Call your doctor if you have any of the following:
- new pain, weakness or numbness that begins after you return home
- fever, headache or extreme fatigue
- bladder or bowel problems
Recuperation will depend on the type of procedure performed and varies with each patient. Ask your doctor when it is safe to resume regular activities, including house work, returning to work, and athletic activities.
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