Page 2 - Laminoplasty

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A lumbar fusion may be helpful in treating lumbar ste-
nosis, lumbar arthritis, lumbar degenerative or recurrent
herniated discs. Any excess or protruding bone, ligament
or disc may compress the nearby neural elements causing
leg pain or weakness. Back pain on the other hand can
arise from arthritis of the facet joints or degeneration of
the discs or shock absorbers between the vertebral bod-
ies. As the discs dry out and shrink, they lose their flexi-
bility and cushioning properties, which causes back pain.
This procedure can be performed from the front or back
of the body. If the fusion is done from the front, or anteri-
or, of lumbar spine the incision is done near or just below
the belly button anteriorly. For the lumbar procedures Dr.
Pazmiño uses a Vascular surgeon to perform the approach
and closure afterwards. This is because in order to insert
the spacer anteriorly the vessels near the front of the spine
need to be safeguarded and retracted as the disc is placed
in its final position. If the fusion is performed from the
back of the spine the incision is a straight line placed right
in the middle of the spine.
There is no spinal cord in the lumbar spine.
The spinal
cord actually ends where you can feel your last rib, just
before the lumbar spine begins. This means any surgery
performed in the lumbar spine will be a safe distance
away from your spinal cord so this significantly decreases
the risk for paralysis. Once Dr. Pazmiño approaches the
spine he first works on decompressing the nerves at the
level involved. In order to do this he removes the extra
bone and ligament surrounding the nerves 1mm at a time.
Posterior Fusion Interbody Fusion
After the nerves are completely decompressed Dr.
Pazmiño next performs the fusion in one of several
ways. The fusion can be performed posteriorly by
laying bone along the transverse processes and facet
joints. The fusion can be reinforced with screws and
rods, which hold the bones in place until the fusion
In some cases the disc height may be so collapsed
that Dr. Pazmiño may need to use special spacers
to recreate the normal disc height. After the disc is
removed, the space between the bony vertebrae is
empty and Dr. Pazmiño can use custom spacers to
place in between the vertebral bodies. Dr. Pazmiño
fills the spacers with bone graft or BMP which stimu-
lates bone to grow through the hollow spacer and
join or fuse the two vertebral bodies together.
Here are examples of some spacers below.
A lumbar fusion is an ongoing process. It is similar to
planting a seed and watching a tree grow afterwards.
After surgery your body will require time for the
vertebral bones to join or fuse to each other. Bones
are one of the most active organs in the body. They
require a blood supply, and a quiet stable environ-
ment to strengthen. These bones require approxi-
mately one year to completely fuse.
What are the results?
Lumbar fusion is successful in relieving Back and Leg
pains in lumbar patients. These products have been
approved by the FDA for single and multiple level use in
both the lumbar spine. Patients can notice improvements
for up to two years after their fusion procedure. The fusion
takes time to mature. It is stable by around 3-6 months
and solidly fused at one year.
What are my instructions after surgery?
After surgery, pain is managed with narcotic medica-
tion for a limited period (2 to 4 weeks). Hoarseness,
sore throat, or difficulty swallowing may occur in some
patients and should not be cause for alarm. These symp-
toms usually resolve in 1 to 4 weeks. For the first three
months do not use non-steroidal anti-inflammatory drugs
(NSAIDs) (e.g., aspirin; ibuprofen, Advil, Motrin, naprox-
en sodium, Aleve). Do not smoke. Smoking delays heal-
ing by increasing the risk of complications (e.g., infection)
and inhibits the bones’ ability to fuse. Do not lift anything
heavier than 5 pounds (e.g., gallon of milk). Dr. Pazmiño
requests all patients gradually return to your normal activ-
ities. Walking is encouraged; start with a short distance
and gradually increase to 1 to 2 miles daily. A physical
therapy program may be recommended by Dr. Pazmiño.
You may shower immediately after surgery. No tub baths,
hot tubs, or swimming pools for three weeks. Soon you
will be able to return to complete unrestricted activities.
Follow Dr. Pazmiño’s specific instructions. Call for your
follow up appointment in Dr. Pazmiño’ office which will
be 2-3 weeks after surgery. For further information feel
free to look us up online at
www. spinecal .com
Normal Stenosis Arthritis