Laminectomy, followed by discectomy and a spinal fusion procedure can successfully treat a ruptured disc. During a laminectomy for a ruptured disc a portion of the back bone is removed to allow the surgeon access to the spine and the disc space. The surgeon will carefully remove the disc material and relieve the pressure on the spinal nerves. Once the ruptured disc material has has been removed the surgeon can carry out a spinal fusion procedure if considered necessary. The successful fusion of the spine at the segment where the disc was removed can prevent excessive segment motion, maintain, or restore, the intervertebral height at that section and reduce the risk of pain from spinal instability.
Multiple Disc problems
In case of a ruptured disc, discectomy, laminectomy, and fusion are more likely where there is evidence of multiple sites of disc degeneration with disc rupture or bulging. Fusion across many levels following a laminectomy with discectomy is also a preferred option when other back surgeries may result in a worsening of the stenosis at one or more of these levels. Instead, the surgeon will remove the disc material where it is compressing spinal nerves and carry out a fusion procedure to reduce the risk of spinal slippage and curvature. Fusion may be in the form of an autograft, with bone taken from the patient’s hip and secured by rods and screws, or an allograft, where donor bone is utilized.
Laminectomy is a major back surgery and requires the cutting of muscle and ligaments to reach the back bone. There are possible complications surrounding the extent of structural tissue removed and its resulting effect on the stability of the spine. The rigidity after spinal fusion can cause pressure to be deferred onto the adjacent segments and lead to fracture or other problems at those levels. Recovery from laminectomy can be prolonged and surgeons favour more minor procedures where they will be as helpful. Patients are advised against using NSAIDs after a fusion procedure as these can increase the risk of pseudoarthrosis (non-union). Smoking is also a major risk factor for pseudoarthrosis, with some surgeons unwilling to operate on those who have failed to quite smoking prior to the back surgery. Smoking also increases the risk of degenerative disc disease and the rupture of a disc.
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