Overview
Decompressive laminectomy is the most common type of surgery done to treat spinal stenosis. This surgery is done to relieve pressure on the spinal cord or spinal nerve roots caused by age-related changes in the spine and to treat other conditions, such as injuries to the spine, herniated discs, or tumors. In many cases, reducing pressure on the nerve roots can relieve pain and allow you to resume normal daily activities.
Laminectomy removes bone (parts of the vertebrae) and/or thickened tissue that is narrowing the spinal canal and squeezing the spinal cord and nerve roots. This procedure is done by surgically cutting into the back.
In some cases, spinal fusion (arthrodesis) may be done at the same time to help stabilize sections of the spine treated with decompressive laminectomy. Spinal fusion is major surgery, usually lasting several hours.
There are different methods of spinal fusion:
In the most common method, bone is taken from elsewhere in your body or obtained from a bone bank. This bone is used to make a "bridge" between adjacent spinal bones (vertebrae). This "living" bone graft stimulates the growth of new bone.
In some cases an additional fusion method (called instrumented fusion) is performed, in which metal implants (such as rods, hooks, wires, plates, or screws) are secured to the vertebrae to hold them together until new bone grows between them.
There are a variety of specialized techniques that can be used in spinal fusion, although the basic procedure is the same. Techniques vary from what type of bone or metal implants are used to whether the surgery is done from the front (anterior) or back (posterior) of the body.
The method chosen will depend on a number of factors, including your age and health condition, the location (lower back or neck [cervical]) of stenosis, the severity of nerve root pressure and associated symptoms, and the surgeon's experience. Spinal fusion increases the possibility of complications and the recovery time after surgery.
Why It Is Done ?
You may be a candidate for decompression if you have :
- significant pain, weakness, or numbness in your leg or foot.
- leg pain worse than back pain.
- not improved with physical therapy or medication.
- difficulty walking or standing that affects your quality of life.
- diagnostic tests (MRI, CT, myelogram) that show stenosis in the central canal or lateral recess.
- Symptoms are so severe that you are unable to perform normal daily activities and your quality of life is affected.
- Most spinal stenosis occurs in the lower (lumbar) back. If you have stenosis in the neck (cervical) area, your health professional may recommend surgery to prevent worsening of the condition, which can cause nerve damage and paralysis.
How Well It Works ?
Surgery for spinal stenosis usually is elective but may be recommended if symptoms cannot be relieved with nonsurgical treatment. In general, experts feel that surgery has good results and relieves pain in the lower extremities for people with severe symptoms of spinal stenosis who have few other serious health problems. In general, up to 80% of people are satisfied with the results of surgery for spinal stenosis.2 For people with severe symptoms, surgery usually reduces leg pain and improves walking ability.3 However, symptoms may return after several years. About 10% to 20% of people who have had surgery need to have surgery again.
Reoperation may be necessary if:
- Spinal stenosis develops in another area of the spine.
- An earlier surgical procedure was not effective in controlling symptoms.
- Instability develops, or fusion does not occur.
- Regrowth of tissue (lamina) presses on the spinal cord or spinal nerve roots.
- Spinal fusion may be done at the same time as decompressive laminectomy.
Spinal fusion may help to stabilize sections of the spine that have been treated with decompressive laminectomy. Some studies suggest it may also improve function over time and relieve pain.
Risks
Complications from spinal stenosis surgery may result from the impact of other existing medical problems and the severity of the spinal problem. In addition, all surgery poses risks of complications. These complications may be more serious in an older adult.
Possible complications include:
- Problems from having general anesthesia.
- A deep infection in the surgical wound.
- A skin infection.
- Blood clots in the deep leg or pelvic veins (deep vein thrombosis), which rarely travel to the lungs (pulmonary embolism).
- An unstable spine (more common after multiple laminectomies are done without using spinal fusion).
- Nerve injury, including weakness, numbness, or paralysis.
- Tears in the fibrous tissue that covers the spinal cord and the nerve near the spinal cord, sometimes requiring reoperation.
- Difficulty passing urine or loss of bladder or bowel control.
- Death (rare) related to major surgery.
- If you have diabetes or heart disease or are a smoker, you may be at greater risk for complications.
Decompress the spinal cord
Once the lamina and ligamentum flavum are removed the protective covering of the spinal cord (dura mater) is visible. The surgeon can gently retract the protective sac of the spinal cord and nerve root to remove bone spurs and thickened ligament.
Decompress the spinal nerve The facet joints, which are directly over the nerve roots, may be undercut (trimmed) to give the nerve roots more room (Fig 5). Called a foraminotomy, this maneuver enlarges the neural foramen (where the spinal nerves exit the spinal canal). If a herniated disc is causing compression the surgeon will perform a discectomy.
Fusion
If you have spinal instability or have laminectomies to multiple vertebrae, a fusion may be performed. Fusion is the joining of two vertebrae with a bone graft held together with hardware such as plates, rods, hooks, pedicle screws, or cages. The goal of the bone graft is to join the vertebrae above and below to form one solid piece of bone.There are several ways to create a fusion. The right one for you depends on your own choice and your doctor’s recommendation.
What To Expect After Surgery ?
Depending on your health and the extent of the surgery, it may take several months or more before you are able to return to your normal daily activities.
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