The Purpose of this Information
This information is being provided to you in order to prepare you to make decisions about your own health care. If you should ultimately decide that surgery is the best treatment option for you, this section will help you understand what happens during a decompressive lumbar laminectomy and will help you prepare for your role in the healing and recovery process. Read it thoroughly and answer the questions before making your final decision about your treatment options.
The Health Care Team’s Role
The duty of your health care team is to:
- evaluate your condition
- establish a diagnosis
- present the various treatment options
- offer a specific treatment recommendation
- provide you with the information you need to make a decision; and then
support you in the decision you make.
The Patient’s Responsibilities
You are the only one who can decide to have surgery. It is important that you take ownership of this decision, recognizing the limitations your particular physical condition places on the potential success of each of the treatment options.
If you choose to have surgery, your physical condition and your mental attitude will determine your body’s ability to heal. You must approach your surgery with confidence, a positive attitude, and a thorough understanding of the anticipated outcome. You should have realistic goals – and work steadily to achieve those goals.
The decision to have or not to have surgery includes weighing the risks and benefits involved. You will make the final decision, so ask questions about anything you do not understand.
Since medical care is tailored to each person’s needs and differences, not all information presented here will apply to the patient’s treatment or its outcome. Seek the advice of your physician and other members of the health care team for specific information about the patient’s medical condition.
Anatomy of the Lumbar Spine
The Spinal Column and Vertebra
Your spinal column consists of 24 separate bones, called vertebrae, plus the five fused bones of the sacrum and the four fused bones of the coccyx (often referred to as the “tail bone”) (Fig. 1). The vertebrae are stacked one on top of another and can be divided into:
- the cervical (neck) spine: the top seven vertebrae;
- the thoracic (chest) spine: the middle 12 vertebrae; and
- the lumbar (lower back) spine: the bottom five vertebrae.
Support for the Vertebral (Spinal) Column
Attached to the vertebrae are muscles, tendons and a group of strong bands, called ligaments. Together, they support the spinal column and help to protect its delicate nerves.
The Role of the Vertebral (Spinal) Column
Your spinal column enables you to walk upright. It is the central support for your upper body and carries the weight of your head, chest and arms. The vertebrae in the lumbar (or lower back) portion of your spine carry the majority of this weight. The constant pressure from this weight, even when you are simply sitting in a chair, is what usually leads to problems associated with the lower back.
The Role of the Invertebral Discs
The bony vertebrae of your spinal column are separated from one another by pads of tough cartilage, called intervertebral discs (Fig. 2,above). These discs act like shock absorbers during activity, preventing the individual vertebra from rubbing against one another. Healthy discs, with their gelatin-like inner core, allow the spine to move freely and provide much of the flexibility found in a young person’s spine.
The Invertebral Disc Nucleus
The gelatin-like center of each intervertebral disc (called the nucleus) is surrounded by a tougher, fiber-like outer lining (called the annulus) (Fig. 3). As your body ages, the disc’s nucleus begins to “dry up” and stiffen, increasing the chances that the central bundle of nerves and/or a spinal nerve may eventually become pinched.
The Spinal Canal
The spinal cord, which begins at the base of the brain and runs within the spinal canal, ends in the lumbar spine area in a bundle of nerves known as the cauda equina (Fig. 3,above). The spinal canal runs through the center of the spinal column and protects the spinal cord and other delicate spinal nerves.
The Spinal Nerve Roots and the Foramen
At each vertebral level, a pair of spinal nerve roots branch off from the spinal cord or the cauda equina (Fig 3,above) and pass through an opening in the vertebra called the foramen (Figs. 3,above and 4). “Plump” and healthy discs help to cushion the vertebra and keep the opening of the foramen wide enough for the spinal nerve roots to pass through without being pinched.
The Body’s “Electrical” System
The spinal nerve roots are part of the body’s “electrical” system, carrying “current” (for sensation and movement) to specific parts of the body. These nerves are protected by an “insulated” covering in the same way a “live” electrical line is coated to prevent contact with the bare wire. When a nerve root is damaged, all or part of its protective coating may be rubbed off at the point of injury. Prior to surgery there is no way of telling how much of this “insulation” has been rubbed off or how much damage has been done to the nerve itself (the body’s “live electrical wire”).