When is Spinal Laminectomy Needed & How is it Done?

The term Laminectomy (lamina + ectomy) means removal of lamina which is the back part of the vertebra that covers the spinal canal. Laminectomy is a surgical procedure in which the posterior arch of a vertebra is removed. Spinal Laminectomy is done to relieve pressure on the spinal cord or on the nerve roots that emerge from the spinal canal. Spinal Laminectomy surgery is done to relieve pressure on the spinal nerve roots caused by age-related changes in the spine. It is also done to treat conditions like injuries to the spine, herniated discs, or tumors.

If you have problem or difficulty walking, much more than a block or two, or the legs get numb or weak, if you have a problem going to the bathroom to urinate, or loss of bowel or bladder functions, if you have severe pain, numbness, or weakness of your arms or legs then that could be a warning sign for a condition called spinal stenosis. If you are diagnosed with spinal stenosis then the best treatment would be to relieve pressure from the nerve that is being pressed and Spinal Laminectomy would be the best option.

If you have failed conservative treatments then again Spinal Laminectomy surgery would be your best option to relieve these symptoms. Some conservative treatments include the following:

• Activity modification
• Medications, such as muscle relaxants, anti-inflammatory drugs, and pain relievers
• Spinal injections
• Physical rehabilitation and/or therapy
• Occupational therapy
• Weight loss (for overweight patients)
• Smoking cessation
• Assistive devices like mechanical back supports etc.

However, there may be other reasons for your healthcare provider to recommend spinal laminectomy.

The healthcare providers explain the Spinal Laminectomy procedure to you and offers you a chance to ask questions related to the procedure. You will be asked to sign a consent to undergo the Spinal Laminectomy surgery, and have the liberty to ask questions about the form or the surgery.

Your healthcare provider will take complete medical history and may also perform some physical examinations to ensure that you are in an appropriate physical condition to undergo the surgery. You may need to do some blood tests and other diagnostic tests.

You must inform your healthcare provider about any type of allergies that you have like any medications, latex, tape, anesthetic agents etc. Also, you must mention the medications whether prescribed or over-the-counter or any herbal supplements that you are on. If you have had any blood disorders, you must discuss it with your healthcare provider. You may get a chance to meet your physical therapist to discuss rehabilitation.

On the day of Spinal Laminectomy surgery you will likely be asked not to eat or drink at least 6 to 12 hours before the surgery. Take medicines that the doctor told you to with small sips of water.

• During the Spinal Laminectomy procedure, you lie face down on the operating table. The surgeon makes an incision (cut) in the middle of your back or neck.
• The skin, muscles, and ligaments are moved to the side. Your surgeon may use a surgical microscope to see inside your back.
• Part or all of the lamina bones may be removed on both sides of your spine, along with the spinous process, the sharp part of your spine.
• Your surgeon removes any small disk fragments, bone spurs, or other soft tissue.
• The surgeon may also do a foraminotomy at this time to widen the opening where nerve roots travel out of the spine.
• Your surgeon may do a spinal fusion to make sure your spinal column is stable after surgery.
• The muscles and other tissues are put back in place. The skin is sewn together.
• The Spinal Laminectomy surgery takes about 1 to 3 hours.

Some possible complications of Spinal Laminectomy include

• Problems with anesthesia
• Infection in the surgical wound
• Skin infection
• Reaction to medicines or breathing problems.
• Return of back pain in the future.
• Partial or no relief of pain after the surgery.
• If you are a diabetic, have circulation problems, or if you are a smoker, you may be at a higher risks of complications following Spinal Laminectomy surgery.

Spinal Laminectomy usually requires a hospital stay of 1 or more days. You will most likely begin getting out of bed and walking the same evening of your Spinal Laminectomy surgery. Your pain will be controlled with medication so that you can participate in the exercise program. You may be given an exercise plan to follow both in the hospital and after discharge following Spinal Laminectomy.

At home, its important to keep the surgical area clean, dry, and intact. You will be given specific bathing instructions. To control the pain after Spinal Laminectomy surgery, you can take pain killer but stick to the medicines prescribed by your doctor as taking aspirin or certain other pain medicines may increase the chance of bleeding. You should be able to drive within a week or two and resume light work after 4 weeks following Spinal Laminectomy surgery.

You must notify your doctor if you have fever; redness, swelling, bleeding, or other discharges from the incision site; any increased pain in the incision site; numbness or pain in your buttocks or legs; or loss of control of bowel or bladder.

It is recommended by most experts to try conservative treatments first before choosing the surgery.

Surgery like Spinal Laminectomy is usually effective if you have severe leg pain and numbness and you have not been able to move around well for a long time. But in some cases, the symptoms return after surgery. It is also possible that nerve symptoms, including numbness and clumsiness, may not be relieved or may return. Future spine problems are possible for all people after spine surgery.

Age should not be a factor in deciding whether to have decompressive laminectomy. But if you have other medical conditions that will make this procedure and follow-up rehabilitation less successful, surgery may not be recommended.