Laminectomy: Spinal Decompression

Laminectomy: Spinal Decompression

What is a Laminectomy?

Laminectomy is a procedure that is performed to release (decompress) pressure on the nerve root or the spinal cord usually caused by spinal stenosis, a compression of nerves in the back. Laminectomy is a medical word taken from the Latin words ‘Lamina’ which is the bony root of the spinal canal, and ‘ectomy,’ meaning removal. It is also known as decompression surgery.

The procedure – the removal of the lamina, widens the spinal canal (space where the spinal cord goes through) and relieves the signs and symptoms of spinal nerve compression or irritation.

This procedure can be performed minimally invasively, through a small incision in the patient’s back. Utilizing a number of tubes, the physician will dilate the surgical area, being careful to avoid excessive cutting or tearing of the surrounding muscles and tissue. Unlike traditional open surgery, the minimally invasive lumbar laminectomy allows physicians to complete the entire procedure through a smaller incision, avoiding the additional trauma associated with larger incisions.

To further understand the procedure, a general overview about the indications, benefits, risks, perioperative care, and the steps in performing laminectomy are briefly described below.

Who is a Candidate for Laminectomy?

Your primary physician or surgeon may recommend a laminectomy if you have any of the following:

• Significant pain in any of your lower extremity
• Considerable numbness or weakness in your leg or foot
• Leg pain that is worse than back pain
• Impaired daily activities such as walking, standing, or sitting for extended periods
• Any of the symptoms mentioned above that is unresponsive to medication and other non-surgical treatments
• Stenosis in the spinal canal (as verified by diagnostic tests)

Laminectomy for spinal stenosis is considered an elective type of surgery. This means that it should always be scheduled in advance because it doesn’t involve a medical emergency, except on rare occasions such as cases of cauda equina syndrome. Cauda equina syndrome is a state which results from squeezing or compression of the spinal nerves at the base of the spinal cord. The clinical manifestations of cauda equina syndrome may include any or all of the following:

• Presence of bladder dysfunction
• Presence of bowel dysfunction
• Development of neurological issues
• Sexual Dysfunction

Common spine conditions treated by laminectomy include:

• Bulging discs
• Herniated discs
• Degenerative disc disease
• Pinched Nerve
• Bone spurs
• Facet disease
• Spinal stenosis

What are the Benefits of Laminectomy?

Most patients feel better soon after laminectomy. Some individuals recover within 1 to 3 months. In general, the benefits of laminectomy include:

• Less Pain – Laminectomy decompresses the area of irritation and nerve compression which results in decreased pain from a pinched nerve.
• Relievesf of leg or foot pain
• Improvementes leg strength – Laminectomy allows wider space in the spinal canal which alleviates weakness on the legs due to compressed nerves
• Reduction ofes numbness or weakness in the lower extremities
• Improvement ins theone’s quality of life – After laminectomy, you should be able to walk, stand or sit for long periods with ease.

The success rate of a lumbar laminectomy to alleviate pain from spinal stenosis is generally favorable; approximately 70% to 80% of patients will have significant improvement in their daily function and a noticeably reduced level of pain and discomfort.

What are the Risks of Laminectomy?

No surgery is without risks. General complications may include any of the following:
• Bleeding – As with any surgical procedures, there is a chance of bleeding but is usually minimal.
• Infection – The risk of having an infected surgical wound is less than 1%. To avoid this, patients may be given a dose of antibiotics.
• Blood clots/Deep Vein Thrombosis (DVT) – This is a risk of any surgical procedure. DVT occurs due to long periods of bed rest or immobility after any procedure. When immobile, the blood flows slower in the vein which can cause clotting.
• Nerve Injury – To expose the affected disc and subsequently remove the lamina, the nerve needs to be moved on the side. In rare cases, nerve damage may occur. Injury to the nerve can lead to a problem in the nerve function, as well as pain and signs of neurologic symptoms.

stcamillusmedicacenter-interior3 Laminectomy: Spinal Decompression

What Happens Before Laminectomy?

You may be required to undergo some diagnostic tests a few days before the surgery. You may also be asked to sign consent forms and other paperwork regarding your health history.

Don’t forget to ask all questions you have in mind before your laminectomy. You should also inform your primary care provider about medications that you are currently taking, as well as health problems you have, or general concerns about the procedure.

  • You may be requested to stop certain medications as well as drinking alcoholic beverages and smoking that may delay your healing.
  • You will be advised not to drive few days after the surgery, therefore, arrange for someone to drive you home after the procedure.
  • Once you are done with all the assessments and examination, your surgeon will explain the details of the procedure, which includes its benefits, risks, and possible complications.
  • Your healthcare team will prepare you regarding instructions about the operation, what to expect after, possible management approach after the procedure including diet, exercise, therapy, and other post-operative care.

Night before to the day of surgery.

You will be advised to have an empty stomach the night before your surgery. An empty stomach will reduce the chances of complications such as aspiration or stomach contents going to the lungs from the stomach.

The day of the surgery.

Pre-operative medications will be given to you by the nurse or your physician. You will then be transferred to the operating room and will be positioned on the operating bed for the surgery. Anesthesia will be given by the anesthesiologist.

What Happens During Laminectomy?

Laminectomy is performed under general anesthesia. Your orthopedic or neurosurgeon will facilitate and perform the procedure which may last for about 1 to 3 hours. The general steps of laminectomy are as follows:

  1. Preparation. After administration of your anesthesia, you will fall asleep. The surgical team will then position you on the bed over onto your stomach with pillow support. The area of incision will be cleansed and prepped.
  2. Incision. Your surgeon will make an incision over the appropriate vertebrae. The length of the cut or opening will depend on the number of affected vertebra. Your back muscles will temporarily be moved to the side to expose the lamina.
  3. Verification. Once the area is exposed, an x-ray is taken to confirm the correct vertebra.
  4. Laminectomy. Your surgeon will remove the bony lamina using special surgical tools. This step is repeated for each of the affected laminae if there are more.
  5. Decompression. Once the lamina is removed, the covering of the spinal cord will be visible. Your surgeon will gently retract the covering to remove the thickened ligament and bone spurs that compress the spinal cord.’
  6. Fusion (if needed). If you have multiple laminectomies or any spinal instability, fusion or joining of two vertebrae (with bone graft) will be performed. The graft/s will be kept in place with rods, screws, hooks, plates, or cages, as appropriate. Bone grafts aid in forming one solid piece of bone.
  7. Closure. Your muscles and skin will be sewn with sutures or staples depending on which is appropriate.

What Happens After Laminectomy?

Immediately after surgery.

After Laminectomy, you will wake up in the PACU or postoperative recovery room. Your vital signs (heart rate, blood pressure respiration) will be monitored and carefully watched. Once your surgeon confirms that you are doing well, you will be transferred to your hospital room.

Few days after surgery.

Your incision site will be sore after surgery. As per doctor’s recommendation, you may be prescribed with narcotic pain medication for a limited period because these pain pills are highly addictive. Aside from that, regular use may result in constipation. After that, your postoperative pain will be managed with other pain medication such as acetaminophen.

At home.

Before leaving the hospital, the doctor or nurses will discuss to you some restrictions such as cessation of smoking, heavy lifting, and other activities that may delay healing or promote complications.

If any concerns or problems arise at home during the first week after surgery, contact your physician immediately.

Your follow up visits may be scheduled at different intervals depending on your condition or the discretion of your surgeon.

Please follow specific instructions given by your primary caregiver for your situation.

Any information written above should not be used to replace a doctor’s advice. If you have more questions, please call Saint Camillus Medical Center and schedule an appointment with one of our highly-skilled physicians.

References:

• “Back Surgery Microdiscectomy & Lumbar Laminectomy A Patient & Family Education Booklet.” Search – VCH Patient Health Education Materials Resource Catalogue. Web. <http://vch.eduhealth.ca/pdfs/fb/fb.723.b126.pdf>.

• “Blood Clots After Surgery.” WebMD – Better information. Better health. Web. <http://www.webmd.com/dvt/blood-clots-after-surgery#1>.

• “Cauda equina – Wikipedia.” Wikipedia, the free encyclopedia.Web. <http://en.wikipedia.org/wiki/Cauda_equina#Cauda_equina_syndrome>.

• “Laminectomy .” California Pacific Medical Center 415-600-6000 | San Francisco Hospital Sutter Health Network. Web. <http://www.cpmc.org/learning/documents/laminectomy-ws.pdf>.

• “Laminectomy and Laminotomy.” My HealtheVet Veterans Health Library. Web. <http://www.veteranshealthlibrary.org/resources/flipbooks/orthopaedics/221905_VA.pdf>.

• “Spinal Decompression: Laminectomy and Lamniotomy.” Mayfield Brain & Spine, Neurosurgery, Spine surgeons, Brain surgeons , Cincinnati, Ohio. Web. <http://www.mayfieldclinic.com/PDF/PE-decompression.pdf>.

• “Why Can’t I Eat or Drink the Night Before Surgery? | Inside Mount Sinai.” Inside Mount Sinai | Latest Health Information, Patient Stories, & Research. Web. <http://inside.mountsinai.org/blog/why-cant-i-eat-or-drink-the-night-before-surgery/>.

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