L5-S1 Laminectomy Surgery, What and Why?

I had a Lumbar Laminectomy Discectomy surgery.  From my understanding, this means lower back (lumbar), some of the Lamina bone is removed (Laminectomy) and some of the damaged disk is removed (discectomy).

Why Happened?

Starting in mid-February, I’ve had some off feelings in my legs.  I was getting swelling in my left knee, which is my “good” knee.  I checked with Dr. Behr, and it all looks good.  This has occasional flared up over the past few years, but it tends to resolve itself.

After a week or so, it was indeed better, but I woke with a horrible pain in my hip.  That was mid-March.  I’ve had pain in my hip a few times since my microfracture surgery, but I assume it is because of hip muscles that might be imbalanced.  Well, that didn’t get better quickly, so I went to see my Physical Therapist, Tassinari Physical Therapy.

Right away it was obvious that I was out of whack.  My walk was was off and it included very tight left hip-flexors, tight left abdomen, and a tight lower right back.  This caused my pelvis to twist.  In short, it wasn’t pretty.  This had likely been going on for some time and my body found a way around it.  There were obvious muscle problems, so we started there.

I made progress and kept details about what I was feeling.  Slowly, this pain shifted to sciatic nerve pain in my right leg.  I even noticed that my coordination in the legs was off when I would do some one-legged cycling on my trainer.

I got an x-ray that showed lower lumbar spine compression; my vertebra are closer together than most.  Based on all of my symptoms, the Physical Therapist accurately assessed that I have some disc issues.  Not to worry though, there are lots of people with this and many ways to treat.

The exercises were helping, and I started to feel better.  Part of it is my core.  My back is so strong from cycling, that I can cheat and not use my core.  Things were starting to come together.  Combine in my desk job as well, and that is a bad recipe for back issues.

No worries though, now that we had a good idea of what was going on and a plan, there was light at the end of the tunnel.

Saturday was nice.  I felt good and took my beach cruiser down to see the Olympic class triathlon down the street.  Very cool.  I hadn’t ridden my bike in months and was feeling like I might be getting close to riding again.  I practiced walking better and it was a nice evening.

I woke Sunday morning, stretched, took a nice warm shower, did some exercises and got up.  I went to up some pants on and then it popped.

My memory is foggy after that.  I was in shock within about 30 minutes and at the hospital shortly thereafter.  The ER only had a CAT Scan machine, but it was able to identify Degenerative Disk Disease, stenosis and two herniations.  The L5-S1 herniation appeared to be at lest 9mm.  There was a smaller one at the L4-L5.

What Next?

Pain killers got me home, but I could not walk, stand or sit.  We got an MRI fairly quickly and an appointment with Dr. Bawa (recommended by my general practitioner and physical therapist).  I spend almost all of my time lying on the floor.  My stomach was the only place I could be.  Some time on my left side, but not much else.  As long as I was still, I could manage the pain.

Getting to the MRI and the visit with Dr. Bawa’s office required a good dose of pain medication.  My wife had to take a seat out of the car so I could lie down.  Luckily we have a mini-van.

San Diego Orthopedic Associates was great.  They got me back in a room quickly where I could lie down.  I wasn’t in great shape, but they made it much nicer.

Why Did I need the Laminectomy Surgery?

Luckily the L4-L4 herniation wasn’t as bad, but the L5-S1 was 10mm.  Dr. Bawa did some tests on my leg, and I failed.  I had little muscle use or control. Pain and numbness are not big concerns for Dr. Bawa.  But the muscle loss is.

He presented two options.  The first is a steroid epidural and the other a procedure to relieve the pressure on the nerve.  I had been on a heavy steroid dose from the ER and it wasn’t doing anything.  He said that due the lack of change from the steroid, the epidural would likely not help a lot.

He also that that with time, the pain would likely go away and I would recover from the numbness and muscle problems.  The problem is that with nerve damage being enough to cause the muscle problems, the longer I leave the nerve impinged, the greater the chance I was looking at permanent damage.  Meaning I might not get my muscles back.

We got a few other opinions and they were the same.  We had two spine specialists and two other physicians make the same recommendation.  My father who is very against spine procedures even thought it might be the best course of action.

What is a Lumbar Laminectomy?

Laminectomy surgery is where a portion of the bone on your vertebra is removed.  The discetomy part is where the damaged disk is taken out.  Generally speaking, this is a pretty minor procedure.  There is a common quote that oints out minor surgery is surgery that happens to someone else.  I’ve heard that enough times I don’t know the originator, but it is true.

That said, I found two videos on youtube that describe it pretty nicely.  The first uses all props, the second actually is from a real procedure, so those faint of blood should not watch it.

Non-surgery view:

Surgery View:

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