Laminectomies: Missing The Big Picture

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Before I became a scoliosis specialist I worked in physical therapy orthopedics as a generalist for several years. As I became more aware of my own scoliosis I began to notice a trend in a group of people I was seeing for back pain. That trend was that nearly all of my patients who came to me after a laminectomy were also presenting with varying degrees of scoliosis.

For those of you who do not know what a laminectomy is, basically it is a minimally invasive surgery in which the back of a single vertebra is cut off to create more room in an irritated segment. The discs and nerves between the lumbar vertebrae 4 and 5, as well as between lumbar 5 and the sacrum tend to be major creators of low back pain and sciatica. The concept of the surgery makes sense. If there's too much pressure on the nerves at L5, opening up L5 should solve the problem right?

This procedure does help many people. I am NOT saying it is a bad surgery. However, I think there is often a failure to consider why there is too much pressure is on those low back segments to begin with. Especially if the issue is on one side more than the other would it not make sense to assess the individual's posture for imbalance?

Every case of scoliosis is a little bit different. Some people have a nice balance of their curves and will never progress or have pain; others are not as lucky. The size of one's curve has been proven NOT to predict pain. What CAN often predict pain is when upper body shifts to one side and is not balanced over the pelvis. Especially in lower curves there is often a dissociation between the lumbar spine and the pelvis. Guess where this typically happens? L4 and L5!  

In this case, the whole spine is shifted left of midline and the low back and pelvis change directions at L4/5

This is my X-ray. I have a very small curve, but the entire spine is shifted right of midline which causes sciatica in my right leg without posture correction.

Sometimes surgery is necessary. However, my hope is that if we spend a little more time looking at the BIG PICTURE of why one side of the spine is getting irritated, that maybe we can fix the CAUSE and not just the pain generator. In cases of low back pain and scoliosis, simple things like learning how to keep the trunk centered over the pelvis and maintaining elongation of the spine can eliminate pain that otherwise would have led to a laminectomy!

Cutting off a small portion of a vertebra does not change the overall scoliotic posture. So whether you have been told you need a laminectomy or have already had one, learning how to control your posture with the Schroth Method could be a game changer! Taking pressure off is something we can learn to do for ourselves with awareness and training!