Laminectomy

A laminectomy is a surgery used to relieve pressure on the spinal nerves by removing a portion of the vertebra (spine bone). The lamina is the flattened segments located at the back area of the vertebral arch, which is a ring of bone that joints the vertebra body to create a canal around the spinal cord.

Why have a laminectomy?

There are two causes of spinal nerve root pressure:

• Spinal stenosis – Narrowing of the spinal canal due to degenerative changes with aging. As the spinal canal narrows, it crowds the spinal cord and nerve roots that pass through it. Any pressure on the nerves will cause pain, numbness, and/or tingling in an arm or leg.
• Herniated disc – Between each vertebra is a fibrous, cushioning disc that is filled with a gel-like watery substance. When this material leaks out from the tough outer ring (annulus), it can irritate or press on a nerve root, causing pain.

How is the laminectomy done?

The laminectomy is performed under general anesthesia, which means you will be put to sleep. After being positioned face down on the procedure table, the doctor cleans the skin using an antiseptic. An incision is made over the areas of pathology. The muscles will be retracted or dissected to expose the spine. The lamina in question are removed to release the spinal cord. Using a shaving technique on the facet joint, the nerves are released. In addition, the lamina is removed along with any scarred or damaged ligaments. Once this decompression process is complete, the muscles are re-approximated, and the incision is closed using sutures.

How do I prepare for surgery?

The decision to have surgery will be made together by you and your surgeon. Once you agree to surgery, the surgeon will conduct a comprehensive physical examination and order some preliminary tests to assure you are fit for surgery. If you take any drugs that thin the blood, be sure to notify the doctor beforehand. In addition, you will need to arrange for someone to drive you and from the hospital. Do not eat or drink after midnight before your procedure, and leave all valuables at home.

What can I expect immediately after the laminectomy?

Because a local anesthetic is used to numb the skin, you will not be in pain right after the procedure. As you awake from general anesthesia, a nurse monitors you in the recovery room for 1-2 hours. Once you are moved to a room, a nurse will administer pain medicine to keep you comfortable, and you will begin working with a physical therapist.

How long will I stay at the hospital?

Patients are typically admitted for 1-3 days after surgery. During this post-operative time, a physical therapist will work with you to increase your activity level. You will learn how to use assistive walking devices, as well as how to get in and out of bed/chair. To strengthen the back muscles and improve range of motion, the therapist uses special exercises.

Is the laminectomy successful?

According to the results of a recent clinical study, patients undergoing laminectomy experienced significant improvements in neurogenic claudication, back pain, motor weakness, radiculopathy, and sensory deficit after the procedure.

Resources

Bydon M, Macki M, Abt NB, et al. (2015). Clinical and surgical outcomes after lumbar laminectomy: An analysis of 500 patients. Surg Neurol Int, 6(Suppl4), 190-193.

Whang W, Erens G, Jarrett CD, Hoffler C. Chapter 65. Common Orthopedic Surgical Procedures. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Principles and Practice of Hospital Medicine. New York: McGraw-Hill; 2012.