Journal of Surgery and Anesthesia

Steps involved in the Pocedure of Lumbar Decompression Surgery

Yabu Hori^* Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
^*Correspondence: Yabu Hori, Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan, Email:

Received: 07-Oct-2022, Manuscript No. JSA-22-19166; Editor assigned: 10-Oct-2022, Pre QC No. JSA-22-19166(PQ); Reviewed: 01-Nov-2022, QC No. JSA-22-19166; Revised: 08-Nov-2022, Manuscript No. JSA-22-19166(R); Published: 15-Nov-2022, DOI: 10.35248/2684-1606.22.06.193

Description

Except in the rare case of cauda equina syndrome or rapidly worsening neurologic impairments, decompression surgery for spinal stenosis is an optional procedure. Only patient determine whether surgery is the best course of action or not, even though consultant doctor may suggest many possibilities. Before choosing a choice, be sure to weigh all the advantages and hazards. Decompression simply alleviates some of the symptoms; it does not treat spinal stenosis or get rid of arthritis. Unfortunately, as the ageing process that results in stenosis continues, the symptoms could return. Spine surgery can be carried out by an orthopaedic or neurosurgeon. Many spine surgeons focus on complex spine surgery as their area of expertise. Inquire about surgeon's training, particularly if patient situation is complicated or if the patient had multiple spinal surgeries.

The process consists of several steps. Usually, the treatment takes one to three hours.

Step 1: Get the patient ready

On the operating table, patient will be lying on back while receiving anesthesia. When patient fall asleep, patient will be supported by pillows on chest and sides as the patient roll over onto stomach. Cleansing and preparation are done at the area where the incision will be made. The hip region will be prepared for a bone graft if a fusion is intended and patient have to choose the use of his or her own bone. A hip incision is not required if donor bone is being used.

Step 2: Make an incision

Over the relevant vertebrae, a skin incision is created down the center back. The number of laminectomies that will be performed determines how long the incision will be. The lamina of each vertebra can be seen when the powerful back muscles are divided down the middle and moved to either side.

Step 3: Laminectomy or laminotomy

An X-ray is done once the bone has been made visible to confirm the proper vertebra.

Laminectomy: The bony spinous process is removed by the surgeon. After that, a drill or bone-biting instruments are used to remove the bony lamina. The ligamentum flavum, which joins the laminae of the vertebra above with those of the vertebra below, has thickened. For each afflicted vertebra, this is done once again.

Laminotomy: In certain circumstances, the surgeon might not wish to completely remove the protecting bone lamina. Compression may be alleviated via a tiny hole in the lamina above and below the spinal nerve. Laminotomy can be performed on one side (unilaterally) or both sides (bilaterally), as well as on different levels of the vertebrae.

Step 4: Release the spinal cord from compression

The dura mater, which serves as the spinal cord's protective sheath, can be seen once the lamina and ligamentum flavum have been removed. In order to remove bone spurs and thicker ligament, the surgeon might carefully withdraw the sac that surrounds the spinal cord and nerve root. To give the nerve roots more space, the facet joints directly above them may be undercut or shortened .This procedure, known as a foraminotomy, widens the neural foramen (where the spinal nerves exit the spinal canal). A discectomy will be carried out by the surgeon if a herniated disc is the source of compression.

Step 5: Fusion (If needed)

A fusion may be performed if we have laminectomies to several vertebrae or spinal instability. With the aid of a bone graft and hardware such plates, rods, hooks, pedicle screws, or cages, two vertebrae are fused together. The bone graft's objective is to fuse the vertebrae above and below into a single piece of bone. Fusion can be produced in a variety of ways. The posterolateral fusion is the kind of fusion that occurs most frequently. To provide room for the bone graft to grow, the topmost layer of bone on the transverse processes is removed with a drill. The posterolateral bed is covered with bone graft that has been removed from the top of our hip. Metal rods and screws that are placed into the vertebrae by the surgeon may be used to strengthen the fusion. The bone transplant is covered by the back muscles to keep it in place.

Step 6: Completion

With sutures or staples, the incisions in the muscle and skin are joined.