I'm in need of a cleaning out of the little hole where the spinal nerve comes out in my low back. I think the surgeon said around L4. I saw a video on You-Tube how this is done. Is it done the same way for everyone? After I saw what they did, I'm not sure I really want to have this done after all.

As the younger generation fondly say, you may be a victim of "TMI" -- too much information. No matter how you look at it, spinal surgery is not pretty. In order to decompress the opening around the spinal nerve (called the foramen, it is often necessary to remove a portion of the bone from around the nerve.

Getting to the bone means cutting down through the skin, connective tissue, muscle, and other soft tissues surrounding the bone. Then the protective bone around the foramen (the lamina) is cut and removed. Removing the lamina is called a laminectomy.

There are other ways to approach the problem of too much pressure on the nerve. Another procedure used is called a laminoplasty. The surgeon cuts through the bone and creates a hinged-gate that allows the bone to swing away from the nerve. The advantage of this procedure is that it saves the bone so it can still be used to support and stabilize the spine.

Surgery to decompress the spinal nerve has improved over the years. Surgeons have moved from always using an open incision and cutting through all the soft tissues to get to the bone now to a minimally invasive (MI) approach. Small cuts are made leaving the muscles and tendons intact. Better tools, real-time X-rays, and more advanced techniques have reduced the amount of blood lost and time in the hospital. There are fewer complications and better results overall.

Before watching any more videos, check with your surgeon and find out how he or she is planning to do your procedure. Ask about potential negative effects, complications, or problems that can arise. And check to see what kind of results the surgeon has been getting with other patients. You may be pleasantly surprised and motivated once again to follow-through with your own treatment.

Reference: 

Carl Lauryssen, MD. Technical Advances in Minimally Invasive Surgery. In Spine. Supplement to December 15, 2010. Vol. 35. No.26S. Pp. S287-S293.

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