What Is It?
Spinal laminectomy is an operation performed on the lower spine to relieve pressure on one or more nerve roots. The term is derived from Spinal (lower spine), lamina (part of the spinal canal's bony roof), and -ectomy (removal), Decompressive Laminectomy Surgery
The human spine extends from the skull to the pelvis. It is made up of individual bones called vertebrae. The vertebrae, stacked on top of each other,
Are grouped into four regions:
- the cervical spine or neck (7 vertebrae)
- the thoracic spine or chest area (12 vertebrae)
- the lumbar spine or low back (5 vertebrae)
- the sacrum or pelvis area (5 fused, nonseparated vertebrae) The base of the spine, the coccyx (or tailbone), includes partially fused vertebrae and is mobile.
How will I prepare for surgery?
The decision to proceed with surgery must be made jointly by you and your surgeon. You should understand as much about the procedure as possible. If you have concerns or questions, talk to your surgeon.
Once you decide on surgery, your surgeon may suggest a complete physical examination by your regular doctor. This exam helps ensure that you are in the best possible condition to undergo the operation.
On the day of your surgery, you will probably be admitted to the hospital early in the morning. You shouldn't eat or drink anything after midnight the night before.
What Happens During The Operation?
Patients are given a general anesthesia to put them to sleep during most spine surgeries. As you sleep, your breathing may be assisted with a ventilator. A ventilator is a device that controls and monitors the flow of air to the lungs.
Some surgeons have begun using spinal anesthesia in place of general anesthesia. Spinal anesthesia is injected in the low back into the space around the spinal cord. This numbs the spine and lower limbs. Patients are also given medicine to keep them sedated during the procedure.
This surgery is usually done with the patient kneeling face down in a special frame. The frame supports the patient so the abdomen is relaxed and free of pressure. This position lessens blood loss during surgery and gives the surgeon more room to work.
The surgeon makes a short incision down the middle of the low back. The skin and soft tissues are separated to expose the bones along the back of the spine. An X-ray of the low back ensures the surgeon works on the right vertebra. Some surgeons use a special surgical microscope during surgery to magnify the area they'll be working on.
In a complete laminectomy, the spinous process (the bony projection off the back of the vertebra) and the lamina on each side are removed over the area where stenosis is occurring. To accomplish this, the surgeon cuts along the inside edge of the facet joint on each side and detaches the lamina bone completely from the pedicle bones. This opens a section in the bony ring. A small portion of the ligamentum flavum is removed. The ligamentum flavum runs all the way down the spinal canal between the lamina bones and the spinal cord. Removing a small section of this ligament exposes the nerves inside the spinal canal.
The surgeon may use small cutting instruments to carefully remove soft tissues near the spinal nerves. Then the surgeon takes out any disc fragments and scrapes off nearby bone spurs. In this way, the nerves inside the spinal canal are relieved of additional tension and pressure. The surgeon also enlarges the neural foramina, if needed. The neural foramina are the small openings between the vertebrae where the nerves travel out of the spinal canal. The muscles and soft tissues are put back in place, and the skin is stitched together.
What Might Go Wrong?
As with all major surgical procedures, complications can occur. Some of the most common complications following lumbar laminectomy include:
- problems with anesthesia
- nerve damage
- segmental instability
- ongoing pain
This is not intended to be a complete list of the possible complications.
Possible Complications During A Laminectomy
All operations carry the risks of heart problems, stroke, chest and wound infections and leg thrombosis. Risks are higher, the older and sicker you are. The specific risks of laminectomy depend on the particular operation being carried out and will be discussed by the surgeon beforehand. When the spine is being operated on, there is a small risk that the spinal cord may be damaged and the patient ends up paralysed. The risks in the lumbar region for a slipped disc are very small. In the cervical or thoracic regions (especially for a tumour) they are higher. Normally high risk operations are not advised unless they are considered to be essential by the surgeon: the result of not having the operation may be paralysis.
On recovery from the anaesthetic, observations of blood pressure, pulse and limb movement will take place at regular intervals for the first few hours. The back will be sore and regular painkilling injections or a painkilling drip will be given. Next day you will probably be able to eat or drink and the drip will be removed. Sometimes there is difficulty passing urine after the operation and a catheter is passed into the bladder, usually being left there until the you are up and about. The decision about when you can get up is made by the surgeon and usually depends on the type of operation.
Most surgeons like to get people mobile as soon as possible, sometimes even the next day after a simple procedure. Once up, you will have physiotherapy to stop the back stiffening up. Most patients go home within 2 weeks of surgery, their stitches coming out after 10 days. Most patients also require some physiotherapy. In some, a spinal (corset) support will be advised. It may be wise to avoid car driving until it is comfortable to do so.
If A Laminectomy Is Not Performed ?
Where weakness or paralysis was the initial problem, not having an operation can lead to serious disability which may not recover. Where pain alone was the initial problem (usually with slipped disc), pain may worsen without treatment. Occasionally, pain may subside completely without operation.
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