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The traditional type of surgery for lumbar spinal ste-
nosis is a decompressive
Laminectomy,
which relieves
pressure on the spinal cord or the spinal nerve roots.
Laminectomy removes the entire Lamina or bony shelf
to create space for nerves.
Laminectomy Large Section of Bone Removed
When indicated , Dr Pazmino prefers to maintain the
lamina’s integrity. In order to do this he performs a
Hemilaminotomy
on the side that needs to be decom-
pressed.
Hemilaminotomy
Bone Window Removed
This can be performed bilaterally as well
Hemi
=Half
Lamin
=Lamina
otomy
=Partial Removal
This procedures removes small windows within
the lamina preserving its overall structural integ-
rity and limiting long term instability.
Foramen / Foramina
(for-ray-men)
The foramen is the bony tunnel where the nerve lives
as it exits the spine. It is teardrop shaped. In the pho-
tos above you can see a healthy nerve within its fora-
men and on the photo on the right you can see the
scarring and withering which has happened to a nerve
within its stenosed and tightened foramen.
A
Foraminotomy
means opening up the foramen in
order to create more room for the nerves as it exits
the spine.
Therefore the entire procedure Dr. Pazmiño performs
is called a
Hemilaminotomy and Foraminotomy
is
aimed at removing all excess bony and ligament over-
growth to give the neural elements an environment
where they can start to heal.
Our procedures are performed in a Microscopic
minimally invasive manner. Dr. Pazmiño prefers
to perform the procedure with the use of a surgical
microscope to enhance visualization and this allows
him to perform the procedure in a minimally invasive
manner.
Minimally Invasive
approximately 1.5cm per level decompressed. Next
Dr. Pazmiño places a small retractor to move the mus-
cles of the back away from the bone. In fact it is the
muscles themselves that hurt after spine surgery. The
retractors cause a muscle sprain, this is what patients
feel when they wake up after surgery.Afterwards we
treat this exactly like a sprained muscle with ice, heat,
and pain medicines.
Outcomes
How do you define quality of life? How do you
measure a good outcome? Dr. Pazmiño’s research
has specifically focused on assessing patient out-
comes. He has studied how patients perform after
surgical procedures and has presented his results
at national and international Orthopaedic and
Neurosurgical conferences. Specifically he has
studies how long it takes patients to return to work,
sports, sex, and driving after surgery. Dr. Pazmiño
has studied how long patients remain in the hospi-
tal after surgery, how long they take medications
afterwards and how much weight they lose after a
procedure.
In general, Dr. Pazmiño’s research has shown over
90% of people are satisfied with the results of sur-
gery for spinal stenosis. They have described their
outcomes as good or excellent. For people with
severe symptoms, surgery usually reduces leg pain
and improves walking ability. But symptoms may
return after several years. Just under 10% of people
who have had surgery need to have surgery again
for adjacent levels, or may require a fusion if insta-
bility develops or becomes symptomatic.
Our procedures have provided excellent results in
patients with intractable pain and functional limita-
tions. For more information on our research please
feel free to ask Dr. Pazmiño or refer to our website
www. spinecal .com.
Foramen Healthy Stenotic
Foramen Foramen
The majority of our procedures
can be performend in a minimally
manner. For this procedure Dr.
Pazmiño makes a small incision