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LUMBAR DISC HERNIATION-HÉRNIA DE DISCO

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Published on Oct 18, 2008

-Hemilaminectomy is where only part of the Lamina and only a portion of the of the Facet Joint is removed to allow more room for the Lumbar Nerve. This nerve is usually compressed due to a progressive degeneration in the spine.
The most common reason to have this procedure is due to severe Sciatica, numbness or weakness in the leg. Most likely if symptoms are not too severe other things will be tried first, such as physical therapy, rest, and anti-inflamatory medications.
The cause of your symptoms, in the majority of cases, is a degenerative process in the Lumbar region of the spine whereby the Facet Joints enlarge, the ligament becomes thicker, and the disk bulges. When this happens, it reduces the space and compresses the nerves that supply sensation to the legs.
In the operating room you will be given a general anaesthetic and then positioned face down on a special frame. An incision is drawn on with a special pen and the area is cleansed with an antiseptic solution. You are then covered in drapes so that only the incision area is exposed. An incision is then made through the skin and down to the spinous process. The muscle is moved away from the Lamina and Facet Joint and a retractor is used to hold it out of the way. The level is checkd by Xray and the operating microscope is brought in. Using a special bone drill, part of the Lamina and the Facet Joint may be removed. This leave the ligament which is removed in order to expose the dura and the compressed nerves. The procedure may be needed on more than one nerve. It can also be done bilaterally leaving the spinous process intact.
Special attention is given to the nerves to make sure the nerve is completely decompressed. The openings under the Facet Joints that the nerve runs through are checked and decompressed if necessary. Once this has been completed and all bleeding stopped, the layers are then stitched back together in their normal positions. The skin is then closed with either dissolvable sutures, or staples.
You will wake up in the recovery room and after about 1 hour you will be moved to your room. The nurses will be continually checking your vital signs and leg strength monitoring for any signs of complications. During the first night the nurse will wake you for these observations. You will be given injections for pain which will be discussed before surgery. Sometimes you will have difficulty urinating and will require a catheter. You will be encouraged to get up and walk a little. The next day the IV in your arm will be removed after your next walk adn then you will be given oral analgesia. You could go home on this day, or the next depending on your comfort level.
It is important after the surgery to walk as much as possible. Prolonged rest in bed can produce hip pain and blood clots in the legs. Sometmies a couple of days after the surgery the discomfort in the legs may return. This is caused by swelling and will usually settle down with NSAIDs. If you have removeable sutures they will be removed 7 to 10 days post-operatively.
-HEMILAMINECTOMIA
-BY ED ZERATI
-http://www.zerati.com

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