Name of the Procedure:

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (e.g., herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (e.g., far lateral herniated intervertebral disc)
Common names: Lumbar Transpedicular Decompression, Lumbar Spine Surgery, Far Lateral Disc Surgery

Summary

This procedure involves surgically accessing a lumbar vertebra through the pedicle to decompress the spinal cord, cauda equina, or nerve roots. It's typically performed to relieve pressure caused by a herniated disc.

Purpose

This surgery aims to alleviate pain, numbness, and weakness caused by pressure on the spinal cord, cauda equina, or nerve roots due to a herniated intervertebral disc. The goal is to restore normal function and improve the patient's quality of life.

Indications

• Persistent lower back pain that does not respond to conservative treatment
• Sciatica or radiating leg pain
• Numbness, tingling, or muscle weakness
• Loss of bowel or bladder control (in severe cases, indicating cauda equina syndrome)

Preparation

• Patients may need to fast for a specific period before the procedure.
• Medication adjustments might be necessary.
• Pre-procedure imaging tests such as MRI or CT scans are usually required.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made over the lower back, near the affected area.
3. The surgeon accesses the lumbar spine through the pedicle of the vertebra.
4. Using specialized instruments, the surgeon removes the part of the disc that is pressing on the spinal cord or nerve roots.
5. The area is carefully inspected to ensure complete decompression.
6. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes about 1 to 3 hours, depending on the complexity.

Setting

The surgery is performed in a hospital's operating room or specialized surgical center.

Personnel

• Orthopedic surgeon or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Nerve injury
• Spinal fluid leak
• Blood clots
• Adverse reactions to anesthesia Rarely, there may be incomplete relief of symptoms.

Benefits

Significant pain relief, improved mobility, and a better quality of life. Benefits can often be noticed within a few weeks post-surgery.

Recovery

• Immediate post-operative monitoring in a recovery room.
• Hospital stay of 1 to 3 days may be required.
• Pain management with medications.
• Physical therapy might be recommended to aid recovery.
• Restrictions on lifting, bending, or twisting for several weeks.
• Follow-up appointments for monitoring recovery and removing sutures.

Alternatives

• Physical therapy
• Epidural steroid injections
• Oral pain medications
• Minimally invasive procedures (e.g., microdiscectomy) Each option should be discussed with a healthcare provider to determine the best course of action based on individual circumstances.

Patient Experience

Patients will be under anesthesia during the procedure and should not feel any pain. Post-surgery, there may be discomfort at the incision site, controllable with pain medication. Early mobilization is usually encouraged. Full recovery and return to regular activities may take several weeks to months.