Laminectomy

What is a Laminectomy?

The term “Laminectomy” refers to a surgical operation that opens up your spinal canal so your spinal nerves have more space. This operation relieves pressure on the spinal nerves by enlarging your spinal canal ¹. We can perform laminectomy at any level of the spine.

Laminectomy involves the removal of a portion of the vertebrae known as lamina, forming the roof of the spinal canal. This also removes a small portion of bone or scar tissues that cause compression of the spinal cord or nerve roots. Sometimes, laminectomy may cause the post-laminectomy syndrome.

What are the most common conditions, symptoms, and ailments that a Laminectomy treats?

A laminectomy enlarges the opening of the spinal canal. Neurosurgeons perform laminectomies for several reasons. Basic indications of laminectomy include ²:

• Narrowing of the spinal canal;
• Bulging of the bones and ligaments;
• Degenerative arthritis;
• Abnormal growth of the spine;
• Paget’s disease of the bones;
• Achondroplasia;
• Tumor in the spine;
• Traumatic injury;
• Congenital anomalies such as dwarfism;
• Ankylosing spondylitis (fusion of spine);
• Herniated or slipped disc;

About 0.1% of people older than 65 years and about 0.5% of people older than 50 years suffer from spinal stenosis ³. The associated risk factors for laminectomy involve:

• Old age;
• Hereditary factor;
• Surgical site;
• Antibiotic prophylaxis;
• Cardio-pulmonary disease;
• Duration of operation;

Symptoms of laminectomy depend upon the location of the compressed nerve along the spinal cord. These include ⁴:

• Pain in one or both legs, shoulder, or arm
• Numbness in the arm or legs
• Stiffness in the back, arm, or legs
• Tingling in the arm or legs
• Weakness in the buttock or legs
• Loss of bladder and bowel control
• Difficulties while walking or standing

During any operation, complications can occur. Potential complications of laminectomy include:

• Loss of excessive blood
• Infection in the surgical site
• Congestion and hematoma
• Stroke
• Heart attack
• Difficulties in breath
• Paralysis (if spinal cord damaged)
• Spinal nerve injury
• Spinal cord injury
• Spinal fluid leak
• Unsuccessful treatment may lead to pain that persists after surgery

How do neurosurgeons perform a Laminectomy procedure?

A laminectomy procedure requires a professional medical team to perform successfully. The medical team should include a neurosurgeon, an anesthesiologist, and a nurse to assist. The whole operation requires about two to three hours to complete. The process includes ⁵:

• You need to lie on your belly on the operating table.
• Anesthesiologists will give anesthesia to fall asleep. You will not feel any pain or sensation during the operation.
• Nurses will monitor the vital signs during operation.
• Surgeons will make a small incision in the middle of your back or neck.
• Skin, muscles, fascia, and ligaments will push away to the side to expose the affected area.
• Surgeons will remove a small part or whole lamina on one or both sides of your spine.
• Surgeons will remove any small disk fragments, bone spurs, or other soft tissues.
• Surgeons can do a foraminotomy to widen the opening of nerve roots if needed.
• Surgeons may also do a spinal fusion to stable your spinal column if needed.
• Finally, surgeons will put back the muscles and other tissues in place and suture the skin together.

A follow-up monitoring for 24 hours requires the patient after surgery. In the case of less care, certain post-surgical complications may arise. The complication rate may range from 4.8% after this operation. The patient will take up to 6 weeks for a full recovery. An immediate appointment with a doctor may require in case of any emergency situation.

References

1. Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, Coumans JVCE, Harrington JF, Amin-hanjani S, Schwartz JS, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. New England Journal of Medicine. 2016;374(15):1424–1434. doi:10.1056/NEJMoa1508788
2. Karukonda TR, Mancini N, Katz A, Cote MP, Moss IL. Lumbar Laminectomy in the Outpatient Setting Is Associated With Lower 30-Day Complication Rates. Global Spine Journal. 2020;10(4):384–392. doi:10.1177/2192568219850095
3. Kim JE, Choi DJ. Clinical and radiological outcomes of unilateral biportal endoscopic decompression by 30° arthroscopy in lumbar spinal stenosis: Minimum 2-year follow-up. CiOS Clinics in Orthopedic Surgery. 2018;10(3):328–336. doi:10.4055/cios.2018.10.3.328
4. Bydon M, Macki M, Abt NB, Sciubba DM, Wolinsky JP, Witham TF, Gokaslan ZL, Bydon A. Clinical and surgical outcomes after lumbar laminectomy: An analysis of 500 patients. Surgical Neurology International. 2015;6(5):S190–S193. doi:10.4103/2152-7806.156578
5. Langevin J, Angeles L. Lumbar Microlaminectomy vs. 2019;(May).