If spinal stenosis is
the main cause of your neck pain, then the spinal canal must be made larger and
any bone spurs pressing on the nerves must be removed. One way that this is
done is with a complete laminectomy (lam-in-eck-toe-mee). Laminectomy means
"remove the lamina". The lamina is the back side of the spinal canal
and forms the roof over the spinal cord. Removing the lamina gives more room
for the nerves and lets the surgeon remove any bone spurs from around the
nerves. A laminectomy reduces the pressure on the spinal cord and relieves the
irritation and inflammation of the spinal nerves.
In the cervical
spine, removing the lamina completely may cause problems with the stability of
the facet joints between each vertebra. If the joints are damaged during the
laminectomy, the spine may begin to tilt forward, causing problems later. One
way that spine surgeons try to prevent this problem is to not actually remove
the lamina. Instead, they simply cut one side of the lamina and fold it back
slightly. The other side of the lamina opens like a hinge. This makes the
spinal canal larger giving the spinal cord more room. The cut area of the
lamina eventually heals to keep the spine from tilting forward.
The traditional way
of treating a herniated disc is to perform a laminotomy and discectomy. The
term laminotomy means "make an opening in the lamina," and the term
discectomy means "remove the disc."
This procedure is
performed through an incision down the center of the back over the area of the
herniated disc. The muscles are moved to the side so that the surgeon can see
the back of the vertebrae. X-rays may be required during surgery to make sure
the correct vertebra is located. The doctor cuts a small opening through the
lamina bone on the back of the spinal column. This procedure, called
"laminotomy," is used to give the doctor room to see and work inside
the spinal canal. View animation of laminotomy.
The nerve roots are
moved out of the way. Upon locating the problem disc, the surgeon removes it,
easing pressure and irritation on the nerves of the spine. Small instruments
that fit inside the disc are used to remove as much of the nucleus as possible.
This prevents the remaining disc material from herniating in the future. View
animation of discectomy. The muscles of the back are returned to their normal
position around the spine. The skin incision is repaired with sutures or metal
staples.
Microdiscectomy
Improvements have
been made in the tools available to the spinal surgeon for performing a
laminotomy and discectomy. Microdiscectomy is essentially the same as
traditional discectomy, but this newer approach has several advantages. A much
smaller incision is need when performing a microdiscectomy. There is less
damage to nearby parts of the spine. Patients tend to recover faster.
A small incision is
made in the back just above the area where the disc is herniated. Muscles are
moved aside to see the vertebrae. The surgeon positions a microscope in the
small incision. The remainder of the surgery is performed like the traditional
method.
Endoscopic
Discectomy
Many surgical
procedures have been revolutionized by the use of special TV cameras. The
procedure is still the same, but even smaller incisions (1/4 inch) are made to
insert a special magnified TV camera into the spinal canal so that the surgeon
can actually see the disc material. Through these tiny incisions, the camera
and several other surgical instruments are inserted. Rather than looking
through a microscope, the doctor watches the TV screen while working with
specially designed instruments to remove the disc material.
Torn cartilages of
the knee are now routinely removed with an arthroscope, and gallbladders are
routinely removed with a laproscope. These small scopes give doctors a method
of doing surgery with smaller incisions and with less risk to the nearby
tissues. The same approach is evolving with spine surgery. Endoscopy of the
spine is still in experimental stages and is not yet widely used. It might
eventually give doctors a way to remove a disc with even less risk of injury
than microdiscectomy.
A
laminotomy of the spine is used to treat the following conditions:
This surgical
procedure is carried out in two steps beginning with the laminotomy.
Once this is accomplished, the second procedure, the micro discectomy, is
performed. A high powered stereoscopic microscope is used to provide
illumination and magnification to allow the nerve and surrounding structures to
be visualized clearly through an incision less than one inch long. The nerve
root is carefully protected with a specialized retractor, and protruding disc
fragments, along with any remaining loose or degenerated disc material, are
then removed with a small grasping device.
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