Laminectomy

Overview

Laminectomy is a surgical procedure that creates space by removing spine-related bone spurs and tissues. It typically involves removing a small portion of the back portion (lamina) of the spine’s small bones (vertebrae). Laminectomy widens the spinal canal to alleviate pressure on the spinal cord or nerves. Laminectomy is frequently performed during decompression surgery. Laminectomy is typically reserved for cases in which less invasive treatments, such as medication, physical therapy, or injections, have failed to alleviate symptoms. Laminectomy may also be recommended if the patient’s symptoms are severe or deteriorating rapidly.

Diseases treated with Laminectomy

Laminectomy is frequently performed to alleviate the symptoms of spinal stenosis. In this condition, the spinal column becomes constricted, placing pressure on the spinal cord or nerves. The human spine consists of vertebrae that form the body and the vertebral arch. The purpose of the bodies, which are separated by intervertebral discs, is to provide support for the spine. The arches, on the other hand, shield the spinal canal’s contents, i.e. the spinal cord. Narrowing of the canal (vertebral stenosis) is brought on by degenerative changes, inflammatory processes, cysts, or disc protrusions. Long-term pressure on the spinal cord, regardless of the cause of stenosis, causes severe pain and, over time, can lead to paresis. The most common symptom of spinal stenosis is leg pain after even a short distance of walking. There may also be radiating lower extremity back pain.

These conditions can cause central stenosis in the spine:

Osteoarthritis of the spine
Herniated disc
Spondylolisthesis

Types of Laminectomy

There are two types of laminectomy: open and minimally invasive.

A tubular retractor or similar device is utilized during a minimally invasive laminectomy so that the surgeon can access the bony spine without having to dissect a large area of soft tissue. Using X-ray or computer navigation, the retractor is positioned over the appropriate area, and a small amount of tissue is removed to expose the bony lamina. Utilizing specialized instruments, the bone is extracted through the thin tube. In some cases, the entire lamina can be removed through a single 2 to 3 centimeter (about 0.75 to 1 inch) incision. When appropriate, endoscopic techniques (using cameras and smaller incisions) may be utilized.

A standard, open laminectomy involves a posterior (from the back) spinal approach. Incisions are made along the spine in the center of the back. The lamina is revealed by deftly dissecting soft tissue from the spine, including the spinal erector muscles (the large muscles on either side of the bony spine). Using specialized instruments, the bony lamina is resected (removed) while protecting the surrounding neural elements. After removing bone and soft tissue, the surgeon will confirm that the area has been adequately decompressed.

What is the difference between laminectomy and laminotomy?

Laminectomy is the removal of both lamina of a spinal vertebra in order to decompress the spinal canal more thoroughly. In contrast, a laminotomy is a more targeted procedure that removes bone from only a small portion of the lamina. This minimally invasive procedure is designed to decompress only very specific spinal canal points. The laminectomy surgery may be performed at different spine levels:

lumbar laminectomy
cervical laminectomy
decompressive laminectomy

Preparation for Laminectomy

Qualification for laminectomy is based on imaging tests. Computed tomography allows for better visualization of the vertebrae, and magnetic resonance imaging gives a picture of the structures inside the spinal canal. The patient must abstain from eating and drinking for a certain period of time prior to surgery. Your health care provider can provide you with specific instructions regarding the medications you should and should not take prior to surgery.

Laminectomy Procedure

Laminectomy is typically performed under general anesthesia, so the patient is unconscious throughout the procedure. During whole operation, the surgical team monitors heart rate, blood pressure, and blood oxygen levels.

The surgeon makes an incision in your back over the affected vertebrae and, as necessary, moves the muscles away from the spine. Then, he uses small instruments to remove bone spurs and as little lamina as possible. The size of the incision may vary based on the patient’s condition and size. Incisions for minimally invasive surgeries are typically smaller than those for open procedures. When laminectomy is performed to treat a herniated disk, the surgeon also removes the herniated portion of the disk and any fragments that have broken off (diskectomy). Spinal fusion may be necessary to stabilize the spine if a vertebra has slipped over another or if the spine has a curvature. After removing the arthritic joints, the surgeon permanently fuses two or more vertebrae during spinal fusion. During surgery, bone grafts and, if necessary, metal rods and screws may be used. Depending on your condition and needs, the surgeon may perform the operation through a smaller (minimally invasive) incision and with a specialized surgical microscope.

A laminectomy typically lasts between one and three hours.

Compared to other spinal procedures, lumbar laminectomy requires less dissection, less time under anesthesia, and in certain instances can be performed as an outpatient procedure. However, lumbar laminectomy surgery does involve maneuvering surgical instruments around the spinal canal’s delicate structures. In addition, in order to perform the procedure safely, general anesthesia is frequently necessary (in which the patient is completely unconscious). Some surgeons are investigating alternative forms of lighter sedation for similar procedures; if you are interested, you should discuss this with your surgeon.

Your doctor will likely ask you to walk around after surgery (unless you had a spinal fusion). This procedure can be done outpatient, but you’ll likely stay in the hospital for one to three days. You may be able to return to work within a few weeks, depending on the amount of lifting, walking, and sitting your job requires. If you also undergo spinal fusion, your recuperation period will be lengthened. Your doctor will provide wound care instructions.

Benefits of Laminectomy

The majority of patients report measurable improvement in their symptoms following laminectomy, particularly a reduction in radiating leg or arm pain. However, this benefit may diminish over time with certain types of arthritis. Laminectomy is much less likely to alleviate back pain.

Patients who experienced pain and poor function prior to lumbar laminectomy may benefit from physical therapy following laminectomy. After surgery, physical therapy will help patients regain confidence, strength, and balance. The optimal time to begin therapy after surgery depends on your recovery and your surgeon’s plan.