Surgical Options

Lumbar microdiscectomy

This surgery is performed for patients with lumbar radiculopathy from a disc herniation or foraminal stenosis. Patients are put to sleep with general anesthesia and turned prone. The level is localized through x ray and accessed through a small incision in the lower back measuring 1.5 inches in length. Using a microscope, a small amount of the lamina is removed and the disc space identified. The disc fragment is then removed, leaving the majority of the non herniated disc intact. The surgery takes approximately 45 minutes. Patients usually go home the same day.

Lumbar laminectomy

This surgery is performed for patients who have lumbar stenosis presenting with neurogenic claudication. MRI shows compression of the nerve roots centrally at one or multiple levels. During surgery, the lamina are removed as well as a small part of the facet joint to decompress the nerves and thecal sac. The surgery takes approximately 45 minutes. Patients usually go home the same day.

Lumbar foraminotomy

A lumbar foraminotomy is a surgical procedure designed to relieve nerve compression by enlarging the foramen, the passage where spinal nerves exit the spinal column. It is most commonly performed at the L3-4, L4-5, and L5-S1 levels. Most surgeons have seen success with this procedure for patients with lumbar foraminal stenosis, which can cause radiating leg pain, numbness, or weakness due to nerve compression.

This procedure is often recommended when conservative treatments such as physical therapy, medication, or injections have failed to provide relief. A lumbar foraminotomy removes bone or tissue pressing on the nerve, allowing for improved function and reduced pain without the need for spinal fusion. The surgery takes approximately 60 to 90 minutes. Patients usually go home the same day.

Lumbar laminectomy with interspinous device

Similar to a lumbar laminectomy, but the spinous process is preserved and the lamina is removed through a laminotomy rather than laminectomy. A device is placed between the spinous processes to prevent further movement and reduce the likelihood of recurrent stenosis. The surgery takes approximately 45 minutes. Patients usually go home the same day.

Lumbar fusion and decompression (TLIF)

Transforaminal lumbar interbody fusion, or TLIF, is a fusion procedure that decompresses the neural elements and stabilizes the level. This is the typical procedure for degenerative spondylolisthesis or instability with radicular symptoms. Most patients go home within a day or two of surgery.

Lateral lumbar fusion and decompression (XLIF)

Also known as XLIF, or extreme lateral interbody fusion, this is an approach to the spine through the lateral flank. It is most commonly used at the L2-3, L3-4, and sometimes L4-5 levels. Surgeons have seen success with this procedure for adjacent segment disease after a previous fusion. For instance, a patient undergoes a fusion at L4-5 and later develops stenosis at L3-4. Rather than extend the fusion, an XLIF can be performed in a short period of time with minimal surgical exposure, and the patient goes home the next day. The surgery takes approximately 60 minutes.

Lumbar tumor resection

Also known as a minimally invasive lateral approach, this technique removes tumors in the lumbar spine while preserving spinal stability. It is most commonly performed at the L2-3, L3-4, and sometimes L4-5 levels. Surgeons have seen success with this procedure for tumor removal with minimal disruption to surrounding muscles and structures.

In some cases this approach is beneficial for patients with adjacent segment disease after a previous fusion. If a patient undergoes a fusion at L4-5 and later develops stenosis or instability at L3-4, a lateral approach allows for targeted treatment without extending the fusion. This technique provides a shorter surgical time, minimal exposure, and allows the patient to return home the next day. The surgery takes approximately 60 minutes.

What to know after surgery

Do I go home the same day?

Most patients who undergo a one level or two level surgery go home the same day. If patients live too far away or live alone, we sometimes recommend an overnight stay. Patients who undergo a three level surgery usually stay overnight and go home the next day.

Wound care

The incision is usually one and a half to three inches long, placed vertically in the midline of the lower back. The incision is closed with subcuticular sutures that dissolve and do not need to be removed. We place steri strips over the incision and then cover with a dressing. You can shower the day after surgery, but the shower should be quick. You can remove the dressing on postoperative day two. Leave the steri strips on and your surgeon will remove them at your first postoperative visit.

Pain medications

No history of pain medications: If you have not taken pain medications in the past, you will be given a small dose that you take only if you need them. Try to use Tylenol or Motrin when possible. The sooner you stop taking narcotic pain medication, the better you will feel.

History of pain medications: If you have taken pain medications before surgery, we work with your pain management physician to cover your surgical pain. Once you recover from the surgical pain, usually two to four weeks, your pain management provider takes over.

Driving

Unless you do not feel well, you can begin driving 48 hours after surgery. If your surgeon does not think you should drive, they will tell you before you leave the hospital.

Work

Discuss with your surgeon before surgery. Depending on your occupation, some patients return to work within days after surgery. If your job requires physical labor, it may be six to twelve weeks before you can return to work.

Bathing and showers

The day after surgery you can shower. Shower as quickly as possible. Do not worry if the dressing is exposed to water. We do not recommend baths or hot tubs for the first four weeks after surgery.

Activity

Exercise

Walking is the only exercise recommended in the first four weeks after surgery. During your postoperative visits, discuss your exercise goals with your surgeon.

Sex

It is safe to start having sex in the days after surgery.

Postoperative visits

You will see your surgeon after surgery in seven days, one month, three months, and then one year. You should have x rays at each visit.