Overview
Back pain can grow progressively worse and more disabling, depending on the cause. At some point, your doctor may suggest surgery. The lumbar laminectomy may be one procedure. Despite medical breakthroughs, back pain has been a common problem through the centuries with no simple solutions.
Facts about back pain
- Back pain results in more lost work productivity than any other medical condition. It is the second leading cause of missed workdays (behind the common cold).
- In their lifetime, 70% of people in the United States will have some kind of back pain. Each year 1 person in 5 will have it.
- Back pain is more common in men than women.
- Back pain is more common among whites than among other racial groups.
- Most back pain occurs among people aged 45-64 years.
- Each year 13 million people go to the doctor for chronic back pain. It is estimated that the condition leaves 2.4 million Americans chronically disabled and another 2.4 million temporarily disabled.
- Discussion of back pain has been found on Egyptian papyrus dating 3500 years ago. As the centuries went by, thousands of physicians have discussed it and recommended treatments for it.
Lumbar laminectomy is a surgical procedure most often performed to treat leg pain related to herniated discs, spinal stenosis, and other related conditions. Stenosis occurs as people age and the ligaments of the spine thicken and harden, discs bulge, bones and joints enlarge, and bone spurs or osteophytes form. Spondylolisthesis (the slipping of one vertebra onto another) also can lead to compression.
The goal of a laminectomy is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing or trimming the lamina (roof) of the vertebrae to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. Various devices (like screws or rods) may be used to enhance the ability to obtain a solid fusion and support unstable areas of the spine.
Risks
All operations have risks. Complications occur rarely, but include the following:
- Nerve damage
- Blood clots
- Spinal fluid leak
- Bleeding
- Infection
- Worsening of the back pain
- Weeks before your surgery is scheduled, both your doctor and a neurosurgeon or orthopedic surgeon will examine you to make sure you are healthy enough for the surgery.
- A few days before the surgery, you will meet with the anesthesiologist to discuss your options. Usually you will have either a general anesthesia or spinal anesthesia.
- You should give the surgeon and anesthesiologist a list of all prescriptions and over-the-counter medications you are taking.
- The doctor may instruct you to stop taking anti-inflammatories such as aspirin and ibuprofen (Advil, Motrin) before surgery.
- If you smoke, you should stop or at least cut down before surgery.
- Imaging tests such as x-rays and MRIs will be done. Many hospitals and surgeons require other tests such as ECGs (a heart tracing) and routine blood work before surgery.
- On the day of surgery, take no food or drink by mouth after midnight. Most surgeons do allow you to brush your teeth and take medicine.
- You should arrive at the hospital about 2 hours early to do paperwork, last-minute tests, and prepare for the surgery.
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Lumbar Laminectomy Preparation
During the Procedure
Usually you will be placed in a kneeling position to reduce the weight of your abdomen on your spine.
The surgeon will make a straight incision over the desired vertebrae and down to the lamina, the bony arches of your vertebrae.The doctor removes the ligament joining the vertebrae along with all or part of the lamina. The goal is to see the involved nerve root. The doctor pulls the nerve root back toward the center of your spinal column and removes the disk or part of the disk. The doctor closes the incision. Your large back muscle now protects your spine or nerve roots.
After The Procedure
Recovery: You will be moved to a recovery area until you are fully awake, and then you will return to your hospital room.
- Normally you will lie on your side or back.
- You may have a catheter in your bladder.
- You should expect to have some pain at first. Nurses will provide pain medicine as needed.
- You likely will wear compression stockings or compression boots to reduce the chance of blood clots.
Hospital room: Once you return to your hospital room, nurses will check your vital signs and help with pain control.
- Depending on the surgeon’s preferences and your needs, you may be given pain medicine orally or by IV injection.
- The medication will not make you pain free, but it should make the pain tolerable.
- Sometimes the surgeon will give you a machine that allows you to provide pain medicine as needed, within certain limits. Patient controlled analgesia (PCA) pumps allow you a little more control over managing your pain.
Walking: Normally you will begin to walk within hours of the surgery. To avoid loss of air in a lung or pneumonia, you may be asked to do a variety of breathing exercises.
Protection while moving: A few simple techniques will help reduce post-surgical pain and injury. The goal is to protect your back.
- Tighten your abdominal muscles to help support your spine. Stand up straight, keeping your ears, shoulders, and hips in a straight line.
- Always bend at the hip and not at the waist. Move your body as a unit and do not twist at the hips or shoulders.
Sleeping and getting in and out of bed: You may have difficulty sleeping for the first few nights, especially if the recommended positions are different from your normal sleeping positions.
Some options include the following:
- Sleep on your back with pillows under your neck and your knees.
- Lie on your side with your knees slightly bent and a pillow between your knees.
- Getting out of bed also can be tricky initially, but with some simple techniques you can minimize possible injury or pain.
- Tighten your abdominal muscles and roll on to your side, making sure to move your body as a unit.
- Scoot to the edge of the bed and press down with your arms to raise your body. As you raise your body, gently swing your legs to the floor.
- Place one foot behind the other, tighten your abdominal muscles, and raise your body with your legs.
- To get into bed, back up to the edge of the bed, tighten your abdominal muscles, and lower yourself into bed with your legs.
- Once sitting on the bed, use your arms to lower your body onto the bed while you lift your feet into bed.
- Roll your body as one unit onto your back.
Recovery At Home
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You can do several things to make your recovery at home easier:
- Move groceries, toiletries, and other supplies to places between the level of your hip and shoulder where you can reach them without bending over.
- Make sure someone can drive you around for 1-2 weeks after surgery and to help with chores and errands.
- Buy a pair of slip-on shoes with closed backs to make dressing easier and to minimize bending over.
- Short frequent walks each day may reduce your pain as well as speed your recovery.
Normally, if you have a sedentary job, you may return to work in 1-2 weeks. A person with a more strenuous job may have to remain off work for 2-4 months. As your back heals, you may feel ready to have sex. This is normally fine. Choose a position that puts as little pressure on your back as possible.
- Side positions or lying on your back are generally acceptable.
- Avoid putting pressure on your back or arching your back during sex.
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