Treatments

LUMBAR LAMINECTOMY PALM BEACH COUNTY

Lumbar laminectomy and laminotomy surgery is far more common than you may think - it has remained one of the most common surgeries for treating spinal stenosis in the United States since 1998. If you are planning your lumbar laminectomy surgery in Palm Beach County, look no further than Cuéllar Spine for the dedicated care you deserve.

A lumbar laminectomy or laminotomy helps to relieve pressure on the spinal canal that is created by the presence of ligamentous hypertrophy, facet joint hypertrophy and/or a herniated or degenerative disc. When more conservative treatment options do not improve a patient’s symptoms - such as radiating pain, muscle weakness or numbness in the region - a lumbar laminectomy or laminotomy may be the best option for living a pain-free life. Symptoms that are more serious, such as loss of bowel or bladder control or difficulty walking should be addressed right away by your doctor.

At Cuéllar Spine, we support our patients with holistic care every step of the way. One of the most common surgeries that we perform for our patients addresses issues stemming from conditions in the lower back, or lumbar spine. Dr. Cuéllar commonly performs lumbar laminectomy and laminotomy surgeries on patients to help ease the pressure on the spinal canal or nerve roots created by everyday “wear and tear” (disc degeneration), disc herniation, or in some cases, the presence of a tumor or trauma related to an injury.

Why Choose Dr. Cuéllar for Laminectomy or Laminotomy Surgery in Palm Beach County

Dr. Cuéllar is a fellowship-trained orthopaedic surgeon experienced in lumbar laminectomy and laminotomy surgeries, serving patients in South Florida. He is dedicated to providing compassionate surgical and non-operative treatments for all patients. Dr. Cuéllar has undergone two L5-S1 laminotomy surgeries himself, and understands the importance of having a great surgeon at your side. He is committed to working closely with his patients from diagnosis through to treatment and aftercare throughout the healing process, whether or not surgery is undertaken.

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What is Lumbar Laminectomy, Laminotomy, and Foraminotomy, and What is the Difference?

A lumbar laminectomy is a surgical procedure where the lamina and the spinous process, the back portion of a spinal bone, is removed. Removing this portion of the bone creates more room within the spinal canal in the lower back. A laminotomy is a minimally-invasive version of a full laminotomy whereby a small window is made in the lamina rather than removing the entire lamina. A foraminotomy is a procedure whereby specialized instruments are used to make more room within the foramen (hole) through which the nerve root exits. Dr. Cuéllar usually performs a laminotomy together with a foraminotomy, and rarely needs to perform a complete laminectomy.

Conditions That May Require a Lumbar Laminectomy, Laminotomy, or Foraminotomy.

A lumbar laminectomy surgery may be necessary if you suffer from:

BONE SPURS
When bony growths develop in the spine they crowd the space in the spinal canal and nerve roots and put pressure on it, thus causing pain, numbness and/or weakness in the legs. For most patients, the presence of bone spurs are the main reason for pursuing a lumbar laminectomy.
DEGENERATIVE DISC DISEASE
Typical “wear and tear” of intervertebral discs.
HERNIATED DISC
When a intervertebral disc slips out of place and puts pressure on the spinal canal or nerve root(s).
SPINAL TUMOR
A cancerous growth on the spine. TRAUMA/INJURY TO SPINE
Any number of sports injuries, overuse, or accident can cause trauma or sudden injury to the spine and cause structural issues for patients.

Benefits and Potential Risks of Lumbar Laminectomy and Laminotomy

Some benefits of a lumbar laminectomy or laminotomy are:

Space is created in the spine, thus relieving pressure and pain.
The removal of bone spurs and tissues that are associated with arthritis or disc herniation in the spine.
Maintenance of motion in the region when done without a fusion, as is usually the situation.

Some potential risks of a lumbar laminectomy are:

BLEEDING

There is far less bleeding that occurs with this minimally invasive procedure, but there is loss of blood during all surgeries.
INFECTION
Every surgery presents the risk of infection, but minimally invasive laminotomy when done outpatient in a healthy person carries minimal risk of infection. Obesity and diabetes can significantly increase the risk of infection however.
BLOOD CLOTS
Any surgery may increase the risk of blood clot. However, the risk is relatively low after minimally invasive laminotomy or laminectomy.
NERVE INJURY
Choosing a talented surgeon with a fantastic track record in lumbar laminectomy is crucial when wanting to avoid any complications during surgery, such as injury to the nerves.
SPINAL FLUID LEAK
A tear can occur in the layers surrounding the nerve roots, called the dura. If this occurs during surgery, the tear will be repaired with suture. After repair there is a very small risk of persistent leak after surgery requiring repeat repair.

Alternative Treatments to Lumbar Laminectomy and Laminotomy

Physical therapy, massage, acupuncture, anti-inflammatory diet, epidural steroid injections and A2M injections are all alternatives to surgery which will be tried before surgery is recommended unless you have a neurological deficit (weakness or severe numbness).

Preparing for Lumbar Laminectomy or Laminotomy

CHOOSING THE RIGHT SURGEON IN PALM BEACH COUNTY
Making the right decision about your spinal surgeon may be one of the most important decisions you will make - your spine health affects you for life! Find a surgeon with proven success stories, years of experience in state-of-the-art facilities and one who cares about your treatment from first consultation all the way through your recovery.

Dr. Cuéllar will spend as much time with you as you need and will perform physical exams, diagnostic imaging and an evaluation of your lifestyle and overall health, which all make up the components of an initial consultation.

QUESTIONS TO ASK YOUR SPINE SURGEON
Here are a list of questions you should ask your spinal surgeon:

Is there anything I can do to prepare my body for surgery? How long does the procedure take? What should I expect following the surgery? When can I return to work?
What are the alternatives? If the surgery is successful in relieving the symptoms how long will this last?

For most patients, recovery from a lumbar laminectomy falls between the 4-6 week mark. This surgery is minimally invasive and thus allows most patients to recover in a shorter amount of time than other traditional spine surgeries. However, it will depend on whether you need a single level or multiple levels of surgery performed. As a part of your pre-operative preparation, however, patients should quit smoking, eat healthy and balanced diets, exercise regularly and be sure to get adequate sleep. Patients should also prepare to have someone home to assist them in the weeks following surgery (with food, chores, medication management) as there will be little a patient can lift, and restrictions on movement.

The Lumbar Laminectomy/ Laminotomy Procedure

A lumbar laminectomy and laminotomy surgery involves the removal of part of the lamina (or roof) of the spinal vertebrae from the lower back to relieve pressure in the region by expanding the volume of the spinal canal.

Patients are first prepared with anesthesia for surgery.
During a lumbar laminectomy or laminotomy, the surgeon first creates a small incision and exposes the lamina at the level to be operated on. Fluoroscopy is used to confirm the correct level.
Dr. Cuéllar then brings a microscope into the field and performs the rest of the surgery using microsurgical technique.
A high-speed burr is then used to thin out the lamina on the symptomatic side – both if the patient has stenosis on both sides.
Once the lamina is thinned down to the level of the ligamentum flavum a microcurette is used to release the ligament from the undersurface of the lamina.
The ligament is then removed and the thecal sac containing the nerve roots is identified and protected.
Kerrison rongeurs can then be used to remove underlying bone spurs from the spinal canal.
Specialized curved kerrisons can then be used to perform a foraminotomy if necessary.
The passage of the nerve roots out of the foramen and down the canal are all checked to be sure all compression has been relieved. A microdiscectomy can also be performed at this point if needed.
Once the procedure is complete, the wound will be irrigated and closed in layers. Dr. Cuéllar uses a plastic surgery type of closure with small self-absorbable sutures beneath the skin, never staples that need to be removed later.

A lumbar laminectomy or laminotomy can usually be performed as an outpatient procedure, enabling the patient to go home and start the recovery process the same day.

Laminectomy and Laminotomy Recovery & Timeline

Most patients can get up and walk within hours of the surgery completion. For patients who do not have physical labor jobs, they can usually return to work in 1-2 weeks. For those that work heavier labor jobs, they may need to take 6-12 weeks off or work light duty for a period of time. The low back pain is usually mostly gone by around 6 weeks. Rehab for another 6 weeks to strengthen the low back muscles is usually needed to complete the healing process.

Physical therapy may be helpful to the recovery process. It helps us regain our strength and flexibility, and being active minimizes the risk for blood clots after surgery.

At Cuéllar Spine, our team is committed to your care - a big part of our job is staying on the journey with you as you achieve healthy benchmarks in your recovery. During your follow-up appointments we may ask you to participate in additional imaging and will track your progress throughout your physical therapy journey.

SUCCESS STORIES AND PATIENT EXPERIENCES

“Attentive, knowledgeable, professional, and treats every patient with individual care! Saved my dad’s life with his minimally invasive procedure and his mindfulness of the medication my father was on before procedure. Thank you Dr. Cuéllar!”

- Eleena H.

SUCCESS STORIES AND PATIENT EXPERIENCES

“I had my consult with Dr. Cuellar yesterday and I was very happy with my visit. The consultation was to discuss a potential surgery that would be pretty extensive/ significant. So it was important to me to have an understanding and compassionate provider. Dr. Cuellar did just that.

He had a great way of balancing his intelligence, understanding, and patience and I did not feel as though he was talking 'at me' or 'down to' me. He was allowing me to actively participate in the conversation (unlike most providers I have dealt with in the past). I was able to go through all of my imaging with him and he explained everything thoroughly. He was not trying to persuade me to do the surgery or push me into anything.
If I do decide to do the spinal revision and artificial disc replacement surgery it will most definitely be with him. His staff, Rachel in particular, was also extremely helpful with scheduling and she was prompt with all of her emails and correspondences with me. So far, nothing but good things to say about my visit with Dr. Cuellar”

- F.Q.

FREQUENTLY ASKED QUESTIONS

What is the cost of lumbar laminectomy or laminotomy surgery in Palm Beach County?

The cost of this surgery ranges depending on surgeon, facility and the number of levels that need to be done.

What are the common symptoms that indicate a need for lumbar laminectomy or laminotomy?

Common symptoms that indicate a need for a lumbar laminectomy are:

Low back pain

Buttock, thigh, hip and/or leg pain

Muscle weakness

Numbness in the thighs, legs and/or feet/toes

Difficulty walking

Loss of bowel control (seek emergency care)

Loss of bladder control (seek emergency care)

What is the success rate of a lumbar laminectomy?

The average success rate from a study of 170 patients with follow up from 1 to 11 years (average 5.1 years) showed the success rate of decompressive laminectomy to be 70.8% for lumbar stenosis, 66.6% for lumbar stenosis and herniated lumbar disc, and 63.6% for lateral recess stenosis. Success rates vary significantly by surgeon, level and patient selection however.

Is recovery from a lumbar laminectomy painful?

Recovery from all surgery is painful, but the more you do to prepare ahead of time for surgery, the better you will heal, and the more you commit to your physical therapy treatment post-op, the faster you will begin to start feeling like yourself again. If a single level minimally-invasive laminotomy is performed, the recovery period is usually not very painful. However, this varies from patient to patient.