Some injured employees with degenerative disc disease may require surgery. Surgery for degenerative disc problems include lumbar laminectomy, discectomy and fusion.
The lamina forms a roof-like structure over the back of the spinal column. When the nerves in the spinal canal are squeezed by a degenerated disc or by bone spurs pushing into the canal, a laminectomy removes most, or all of the lamina to release pressure on the spinal nerves.
Discectomy removes part or all of a problem disc. Discectomy is generally done when the degeneration is a disc bulge or herniated disc into the spinal canal or puts pressure on the spinal nerve roots. Surgeons commonly perform this operation through an incision in the low back. Before the disc material can be removed, the surgeon must first remove part of the lamina, a laminotomy. If more room is needed, the surgeon may need to take out a larger section of the lamina by doing a laminectomy.
Many surgeons now do minimally invasive surgeries that require only small incisions in the low back. These procedures are used to remove damaged portions of the problem disc and it prevents scarring around the nerves and joints and helps patients recover more quickly. Minimally invasive surgeries include percutaneous lumbar discectomy, laser discectomy, and microdiscectomy.
Fusion surgery joins two or more bones into one solid bone. This prevents the bones and joints from moving. Sometimes done with discectomy, fusion eases mechanical pain because it holds the moving parts steady, so they can’t cause irritation and inflammation. Types of fusion for degenerative disc disease include anterior lumbar interbody fusion, posterior lumbar fusion and combined fusion.
Anterior lumbar interbody fusion surgery is done through the abdomen, allowing the surgeon to work on the anterior (front) of the lumbar spine. Removing the disc (discectomy) leaves a space between the pair of vertebrae. One method is to take a graft from the pelvic bone and tamp it into place. Another method involves inserting two hollow titanium screws packed with bone into the place where the disc was taken out, forming one solid bone.
A posterior lumbar fusion is done though an incision in the back. In this procedure, the surgeon lays small grafts of bone over the problem vertebrae. Most surgeons will also apply metal plates and screws to hold the vertebrae in place while they heal.
A combined fusion involves fusing the anterior (front) and posterior (back) surfaces of the problem vertebrae. By locking the vertebrae from the front and back, some surgeons believe the graft stays solid and is prevented from collapsing.
In Milwaukee, Wisconsin McCormick Law Office workers compensation cases usually involve some surgery but not always.