Laminectomies and Fiber Optic Procedures

Pain expert Dr. Scott Fishman answers questions about back pain:

Q: He has explained that there is a compressed nerve in my spine. He wants to do surgery called a "laminectomy." Can you explain this procedure and how it will help my pain?

A: There are many types of back surgeries and some of them will help pain. Because there are many causes of back pain related to the spine, there are also many different approaches doctors take to relieve the pain. Most back surgery is performed because there is a specific problem in the spine that results in what are called "neurological signs." These signs include objective symptoms such as numbness or weakness in the arms, back or legs. Major back surgery may help these neurological signs and the pain, but this type of surgery is usually performed more to stop the progression of neurological problems and is usually not performed solely to relieve pain. Sometimes, the specific neurological problem can be relieved from the surgery, but the pain is not relieved and persists after recovery from the surgery itself.

To understand a laminectomy, one must also understand an important part of the spinal vertebrae called a "lamina." The lamina is a small part of the spine that runs across the back. It is an area that intersects with nerves as the nerves exit from the spine out to the body. By removing this small area of the spine, which is referred to as a "laminectomy," surgeons are able to "decompress" or release pressure on the nerve as it exits the spine. A laminectomy is an approach to relieving a special type of nerve pain called "radiculopathy," which means the pain is due to the root of the nerve, (the segment of the nerve as it leaves the spinal cord and enters the body). In other words, a laminectomy procedure surgically relieves obstruction on the nerve where the nerve is located. It is always hoped that this procedure will help improve the neurologic symptoms, such as numbness or weakness and also alleviate pain.

Other surgical techniques that can help relieve entrapped nerves or nerve roots are also available. These include surgeries called "foraminotomies" that relieve pressure on the area of the channel that the nerves run in called the "foramina." Surgical intervention on spinal discs can also help with relieving neurological symptoms and pain. These types of surgeries are called "discectomies."

Any of these surgeries can be performed by any number of techniques. These techniques include what are called "open procedures" meaning a major surgery with a substantial skin incision and general anesthesia. Some of these procedures can now be done with less invasive surgical technology. Less invasive techniques offer the advantage of smaller skin incisions, less time spent in the hospital and possibly a shorter recovery period overall.

One of these less invasive procedures that is undergoing a lot of research these days is called a "microdiscectomy." Surgeons insert a very small fiber-optic scope into the problem spinal area to visualize the disc and repair it with a far smaller skin incision than the usual approach. Fiber-optic surgery has been very commonly used for knee problems (called "Arthroscopy") and similar types of surgeries are also now being done for gall bladder problems (called "Fiber-optic Cholecystectomy). There has not been a long history with these less invasive procedures in the back, but they raise great hope for more effective and improved short- and long-term outcomes for patients in pain.

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