Lumbar Surgeries

Lecture 3

Which 6 surgeries are associated with Disc Disease?

1. Discectomy

2. Posterior lumbar interbody fusion (PLIF)

3. Transforaminal lumbar interbody fusion (TLIF)

4. Lateral lumbar interbody fusion (LLIF)

5. Anterior lumbar interbody fusion (ALIF)

6. Artificial disc replacement

Which 5 surgeries are associated with Spinal Stenosis and Spondys?

1. Laminectomy

2. Posterolateral fusion

3. Posterior lumbar interbody fusion (PLIF)

4. Transforaminal lumbar interbody fusion (TLIF)

5. Lateral lumbar interbody fusion (LLIF)

List the indications for lumbar decompression.

• symptoms of neurogenic claudication

• back pain is not primary complaint

• central/lateral recess stenosis is predominant over foraminal

• low disc height

• no spondylolisthesis

• no instability in flex or ext

• failed conservative management (6 weeks)

List the contraindications of lumbar decompression.

• sx may create instability

• disc protrusion without radiculopathy/pain

• pyogenic discitis or other infection

• herniation due to spondylolisthesis

List the relative contraindications of lumbar decompression.

• smoking

• HTN

• psychiatric disorders

• hyperlipidemia

• other comorbidities

What is the most common procedure for pts with back and leg pain?

Discectomy

What are the indications for receiving a discectomy?

• unilateral radicular leg pain with correlating disc herniation

• failed 6-8 weeks of PT

• severe or worsening motor deficit

What are the 3 subtypes of discectomies?

1. Classic - midline incision, laminectomy, bulge removed

2. Percutaneous - fluoroscopy used, no bone removed while removing bulge

3. Microdiscectomy - microscope used

When would a microdiscectomy not be an option?

• back and leg pain is not linked to a herniated disc

• minimal leg symptoms

• all sx is contraindicated

• PT works

When would a microdiscectomy be indicated?

• bowel or bladder dysfunction

• leg weakness/numbness

• leg pain limits activity

• ruptured disc is pinching off spinal nerves

Do herniated discs heal on their own?

Herniated discs get better with time

• most spontaneous regression occurs within the first year

• does not occur in all cases

When is a laminectomy indicated?

• PT failure and intolerable pain

• neurological deficits that severely impede activity

How successful is laminectomy at treating neurogenic claudication?

85-95% effective

What kind of things can contribute to lumbar instability?

• infections/tumors of the vertebral column

• scoliosis

• spondylolisthesis

• disc degeneration or herniation

• spondylolysis or spondylosis (nondisplaced lumbar fx or age-related degeneration)

What is the deciding factor in whether or not a pt receives a lumbar fusion?

severity of pain and loss of function

What is a major risk related to receiving lumbar fusion surgery?

fusing a segment of the spine could just lead to more degeneration/dysfunction in other segments

What kind of patients are good candidates for lumbar fusion?

• those who failed PT

• those whose back pain limits their function

• disc space is determined to be the pain generator

What patient-controlled factor is associated with negative surgical outcomes?

smoking