Know Your Neurosurgeon

Adult Procedures

Lumbar spine degenerative disease results in compression of lumbar nerve roots and may lead to pain, numbness, weakness and muscle wasting in the legs. It may result in problems urinating or incontinence of urine. If urinary symptoms occur, emergency treatment is required.

Causes
  • Lumbar disc prolapse
  • Lumbar canal stenosis
  • Spondylolisthesis



Lumbar Disc Prolapse

Almost all lumbar degenerative diseases result from dehydration of the lumbar disc. Depending on the rate, location and extent of dehydration, the disc may fragment and parts may “break-off” and cause compression of the adjacent nerve root. The disc may also “bulge” and compress the nerve root.

Lumbar Canal Stenosis

The spine may also wear and result in ligament thickening, joint bulge or bone spur formation. These will cause narrowing of the spinal canal at that level. The nerves in the lumbar region will be irritated by the tight canal and cause pain in the legs especially when you are walking or standing up. Interestingly, the pain usually improves when you sit or bend over.

Spondylolisthesis

Owing to degeneration of the lumbar spine, the vertebral column may sometimes present a “step” or a problem with alignment. This step may cause compression of the spinal nerve roots at that level. The same symptoms as lumbar canal stenosis may then result.

Possible Surgeries
  • Lumbar discectomy
  • Lumbar laminectomy
  • Lumbar spinal fusion or disc replacement



Lumbar Discectomy

The part of the disc that is causing the nerve compression is removed. This will give more space for the nerve root. The remaining “healthy” disc is kept intact so that the spine remains stable. The discectomy is usually performed after a small window of bone is drilled out to allow access to the disc site.

Lumbar Laminectomy

A greater amount of bone than in discectomy is removed from the back of the spine. This will decompress the entire spinal canal and free up many nerve roots. This procedure is the basis for all posterior lumbar spine surgery.

Spinal Fusion and Disc Replacement

Spinal fusion is used to stabilise an unstable spine. When the degeneration is severe or if there is a step in the spinal column, the decompression of the nerves may result in weakness or instability in the spine. Fusion requires “building” a construct connecting the various spinal levels with a combination of metallic screws, rods and polymer cages. Around this construct, biological “mortar” must be placed to secure the fusion. The metal construct itself is not strong enough to stabilize the spine. This mortar is usually in the form of the patient’s own bone or bone fragments which can be taken from the site of surgery or the hip bones.
 

Please discuss with your surgeon the risks and benefits of each option.

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