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 Laminectomyspinal 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
  • 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).

 

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