Laminectomy
Laminectomy is a surgical procedure in which the lamina of the vertebra is removed. The lamina is actually the dorsal part of the vertebra and its main purpose is to cover the spinal canal. This procedure is also known as decompression surgery and it is often recommended for the enlargement of the spinal canal. When successful, the intervention relieves the pressure commonly felt on the spinal cord or nerves. In most of the cases, the pressure is caused by excessive bone growth, having a negative effect on the spinal canal.
The indication for laminectomy is given when other treatments (medication, physical therapy or injections) have failed to provide the desired results. It might also be recommended in case the symptoms caused by the excessive pressure are severe or if there is a sudden worsening of the symptoms. When the spinal canal is narrowed, the patient can experience a wide range of symptoms, including pain, weakness or numbness. These symptoms most commonly affect the limbs, radiating towards the extremities. It is important to understand that laminectomy usually relieves the symptoms of the condition but does not eliminate the actual back pain.
In certain patients, the procedure is recommended because daily activities, such as walking have become difficult or impossible to perform. Laminectomy is also recommended as a procedure for herniated disks but it cannot solve the problem on its own. As a matter of fact, the surgeon will need to remove the back part of the vertebra or the lamina in order to gain access to the actual herniated disk.
Laminectomy Procedure
There are different procedures that can be chosen:
Minimally invasive
- Tissue preserving surgery
- Small incisions are made on the skin
- Back muscles pushed aside (not cut) – more muscle is intact
- Part of the vertebra next to the lamina is left intact
- The spinous process is spared
Conventional approach
- Excision of posterior spinal ligament
- Excision of spinous process (partial or complete)
- Open procedure – muscles are cut in order for the other structures to be excised
- Removal or one or both lamina
- The bone removal can be performed using a wide range of surgical tools, including drills, rongeurs or lasers
Laminotomy
- Removal of lamina middle portion
- Performed as:
- Conventional open technique or
- Minimally invasive
Generally speaking, these are the steps that the laminectomy procedure entails:
- A small or larger incision is made in the back (depending on the area in which the lamina will be removed)
- The erector spinae muscle are dissected off the lamina
- The lamina is then removed
- The nerve roots are now visible
- If the nerve compression is severe, the surgeon might decide to trim the facet joints
- The erector spinae muscles are sewn back together
- The incision is closed and a dressing is applied at the site of the incision
- The procedure is performed with the patient under general anesthesia
- May be combined with spinal fusion in case of spinal stenosis diagnosis.
Complications of Laminectomy
These are the most common complications of laminectomy:
- Excessive post-operative bleeding
- This is a rare complication
- No major blood vessels are in the area
- Infection at the site of the operation
- Intravenous antibiotics will be administered in order to effectively treat any post-operative infections
- Injury done to the nerves during the procedure
- Dural and nerve root damage
- Cauda equina syndrome
- Scar tissue formation (intra-dural and extra-dural)
- Bowel/bladder incontinence
- Leakage of spinal fluid
- Breach in the dural sac
- The recommendation is for the patient to lie down for a day, allowing for the leak to seal on its own
- The operated level might be unstable after the surgery (this condition is known as segmental instability)
- Isthmic spondylolisthesis
- Degenerative spondylolisthesis
- Spinal fusion surgery might be required as treatment for such problems
- Complications related to the anesthesia
- Heart attack
- Formation of blood clots (thrombophlebitis or deep venous thrombosis)
- Blood in the large veins of the leg forms blood clots
- They can travel to the lungs and cause life-threatening symptoms
- They can cause swelling in the affected leg
- Pressure stockings can prevent the formation of blood clots
- Blood-thinning medication can be administered before the procedure in order to prevent blood clots from forming
- Stroke
- Pneumonia
- Pulmonary embolism – this happens when a blood clot formed in the leg travels to the lungs
- Higher risk in older patients
- In rare cases, the pain experienced by the patient is worse after the surgery than it previously was
Laminectomy Recovery time
The patient is allowed to get out of the bed a few hours after the surgical intervention has ended. However, the movements of the back should be kept a minimum and certain movements should definitely be avoided during the initial recovery period (such as rotations). The patient is released from the hospital once the vital signs are stable and the critical period has passed.
Provided there are no complications, one can leave the hospital the next day after the surgery. Driving is recommended to be resumed in two weeks but this depends from patient to the other. Certain activities can be resumed in a month but generally, for sports and other kind of strenuous physical activity, it is recommended that the patient waits at least three months. A change in occupation might be recommended in case of severe affectation. Physical therapy can reduce the recovery time and it is recommended that the patient starts a physical therapy program four weeks after the surgery.
With physical therapy and by following the recommended postoperative care advice, you should expect a complete recovery somewhere around four months. Ice applications might help with the reduction of pain and electrical stimulation of the muscles might prevent the muscle atrophy. Massage therapy is recommended to speed up the recovery time, by draining the excessive lymph accumulated in the recently operated area. The patient will become more active with the passing of time.
