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Laminotomy versus Minimally Invasive Fusion

jkay510jjkay510 Posts: 1
edited 06/11/2012 - 7:50 AM in Back Surgery and Neck Surgery
I have leg and back pain and the back pain is more serious relative to my quality of life. Diagnosis is degenerative disc at L5/S1 and therefore bone on bone.

I have seen 2 surgeons. The ortho surgeon is recommending a laminotomy to free up the nerves in the L4, L5, S1 areas and while this addresses the leg pain he said I should also get back pain relief.

The neuro surgoen feels that minimally invasive fusion at L5/S1 will address the back pain and the leg pain would be addressed by creating the added space at L5/S1.

Anyone have any experience or comments on this. My fear is not reducing both the back & leg pain.



  • Hmmm, I'm not a doctor but DDD doesn't mean you are bone on bone. It means the disc is degenerating and while it might be leading to that it doesn't always mean that's where you are.

    People can live years with Degenerative Disc disease.

    To start, no one here will tell you which surgery, if any, to have. From there, it's about doing research to understand the terms, risks, success rates, success definitions, potential future issues, and your current symptoms.

    I'll start with a few things
    1 - what if you decide to do nothing? Did they offer you any alternatives such as PT?

    2 - Laminectomy: Did they explain what this is? I've had a discectomy which includes a laminectomy. Laminectomy I believe is where they shave away some of the lamina (bone) which I equate to the 'wing' piece and it does free up the canal for the nerves to move a bit more freely.

    I believe they can do this procedure minimally invasive too.

    3 - Minimally Invasive: don't let this fool you. This doesn't mean the surgery is minimally invasive. The surgery on the lower back is always a big deal and comes with risks. What they mean by minimally invasive is that they use a smaller incision and they do not cut through the back muscles. Instead, they use equipment to 'weave' between the muscle tissue to get at the site.

    The pro's are smaller scar, less to recover from since your muscles don't have to heal.
    The con's are that they are working through a microscope basically so their 'line of sight' is a bit impaired.

    For my procedure it posed additional risks b/c they ran the risk of not being able to see all of the herniated disc. For a fusion, there is always some risk they'll have to switch to regular fusion if your doctor's line of sight is impaired. However, in fusion, it's similar that they are doing everything through smaller incision.

    4 - Fusion: regardless Minimally Invasive or not, a fusion is a BIG surgery. They are removing the disc, shaving bone, drilling screws into your spine, attaching rods, adding some synthetic spacer combined with shaved bone to help the fusion. It's big. I don't want to scare you but "minimally invasive fusion" sounds like a walk in the park and you need to know it is not

    5 - did anyone talk to you about Artificial Disc Replacement (ADR)? It's not as widely accepted in the USA but for 1-level it might be a great option. I know it wasn't for me b/c my surgeon said I was too young and that since it is performed through the front, it's a risky surgery since you need a vascular surgeon. He suggested that in a few years time, it might be an option for me.

    My thoughts -
    Did you ask the NS what's the harm in trying the laminectomy first?
    Did you ask the OrthoSpine why he wouldn't just have you go in for a fusion?

    In all honesty, it is probably based on how conservative or aggressive their approaches are.

    From my experience, lumbar fusions are a complex deal. They are final. Meaning, once you try it, you can't say...darn, let me try something less. Whereas if you try to Laminectomy, you always leave yourself the fusion option as well as other technologies. It doesn't mean, go for the laminectomy but it does seem you have been presented 2 options that you need to understand.

    With surgery - please be sure that you understand the risks and will have no regrets looking back.

    I opted against a fusion but my situation was different than yours. I have a herniated disc at L5S1 - lost feeling in my left butt, back thigh, and heel to outer toe and had significant pain in my back and leg. I opted for the microdiscectomy (they shave away the disc that came out and cut the lamina). I have very little disc left at L5/S1. Probably close to bone on bone but am doing pretty good considering how bad things were when the herniation happened.

    I think the best advice I can give is to talk to your surgeons about the long term plan. When they present an option to you, ask them to give you one more aggressive option and one less aggressive option. Ask them to explain the pros/cons. Then ask them how they will approach recovery. Then ask them how will the track progress/success of the surgery and what if you or he feels the surgery didn't work. Aks him what his next option would be.
    These types of questions helpe me find a spine doctor that I could rely on for years to come if I needed.

    Oh - if you can, bring someone with you to the appointment or at least write your questions down and his answers. They throw a lot of info at you.
  • Also, if you are in the USA, there are specialty hospitals that will give you an e-opinion (electronic opinion) as long as you are under the care of a doctor. They will have you fill out a questionairre, send in your Images, and doctor's office notes, etc. They'll answer questions for you - such as "based on my case, would you recommend fusioni, laminectomy, or anther procedure and why?"

    Some company's even offer this as part of your benefits (mine did which is how I found out you can now take advantage of some of the top hospitals in the US via remote opinion). But even if you have to pay, it's like $600 which would have been worth it to me.
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  • One thing to note is, from what I have read it is not possible to do a min invasive fusion on the L5-S1 disc as the hip bone is in the way making it impossible to go in that way, You might want to ask questions about it.
    Whatever you do, I would get a third opinion, that would give you another to see what they say. It would be helpful when you have 2 Drs saying different things, Good Luck
  • Hi jkay,

    I'm 19 months out from MI TLIF l5-s1 along w/ decompressions of l4-5, l5-s1, hemilaminectomies, PEEK cage. My pre-op diagnosis was DDD, facet arthropathy, radiculopathy, multiple herniated discs, bone on bone @ l5-s1, spondy. Along w/ the pain & spasms, I had severe neurological issues that affected the entire leg & foot (had drop foot). I could have considered trying just the lammies, but, I did a lot of reading, asking questions and came to the decision to go w/ the TLIF as I had fears that if the lammies didn't free up the nerves enough I could end up w/ permanent nerve damage. The other consideration in my case was my age (51 at the time of the surgery) - I did not want to undergo more than one procedure if I could avoid it. It's a long/hard recovery if you decide to go w/ fusion and it's critical that you follow the instructions you're given on limitations, exercise, stretches to maximize a good outcome. As the others have suggested do your homework & pick the doc's brain about all your concerns & the pros/cons. The surgery for me worked, I have virtually no pain, have almost complete resolution of the neurological issues (some residual numbness of the last 3 toes) which still could resolve and I'm back to many of the activities I used to do although I may have need to modify how I do them. My OSS gave me a timeline of 2-3 years for recovery, as a result, he will follow me til that time. Overall, I feel I made the right decision for me.

    Hope this helps,

  • I have DDD l5-s1 and I was bone on bone. Luckily for me I didn't have any nerve pain to speak of. Every now and then my right leg would feel like it was asleep after being in bed all night. I had fusion three months ago. I have two rods and four screws in my back. All of my original pain is compeletely gone. It is a slow recovery and I feel blessed mine went so well. Of course I have the new pain of healing. I went back to work after two and a half weeks part time and am just now weaning off my brace. Fusion was the best option for me my Orthopod thought. You really need to do homework to make sure you make the right decision as fusion is final.

    On another note. Even thougth I feel great there isn't any sign of bone growing yet but this can take a while from what I am told.

    Good Luck,
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