Laminectomy

Anatomy of the spinal column

 The spinal column, also called the vertebral column or backbone, is made up of 33 vertebrae that are separated by spongy disks and classified into 4 distinct areas. The cervical area consists of 7 vertebrae in the neck; the thoracic spine consists of 12 vertebrae in the back area; the lumbar spine consists of 5 vertebrae in the lower back area; 5 sacral bones (fused into 1 bone, the sacrum); and 4 coccygeal bones (fused into 1 bone, the coccyx):

• Lamina. The bony arch on the posterior part of the vertebrae that is over the spinal column. This is the part of the spine that is removed during a laminectomy.
• Disks. Soft pads between the bones of the vertebrae that allow the back to bend and act as shock absorbers.
• Spinal cord. The bundle of nerves that connects the brain to the rest of the body. The spinal cord passes through the center of the vertebrae.
• Spinal nerves. Nerves that connect the spinal cord to the rest of the body. These nerves may become compressed or “pinched” by a vertebra or disk.
• Muscles and ligaments. Support the spinal column, providing both strength and movement.

Reasons for the procedure

Low back pain can range from mild, dull, annoying pain, to persistent, severe, and disabling pain. Pain in the lower back can restrict mobility and interfere with normal functioning. Laminectomy may be performed to relieve pressure on the spinal nerves, treat a disk problem, or remove a tumor from the spine.

One common reason for undergoing a laminectomy is a herniated disk in the spine. A disk may be displaced or damaged because of injury or wear and tear. When the disk presses on the spinal nerves, this causes pain, and sometimes numbness or weakness. The numbness or weakness will be felt in the body part where the nerve is involved, often the arms or legs. The most common symptom of a herniated disk is sciatica (generally, a sharp, shooting pain along the sciatic nerve, extending from the buttocks to the thigh and down the back of the leg).

If medical treatments are not satisfactory, back surgery may be an effective treatment. Some medical treatments for back pain may include, but are not limited to, the following:

• Activity modification
• Medication, such as muscle relaxants, anti-inflammatory drugs, and analgesics
• Spinal injections
• Physical rehabilitation and/or therapy
• Occupational therapy
• Weight loss (if overweight)
• Smoking cessation
• Assistive devices, such as mechanical back supports

   

Laminectomy is usually performed for back pain that continues after medical treatment, or when the back pain is accompanied by symptoms of nerve damage, such as numbness or weakness in the legs.

There may be other reasons for your doctor to recommend a laminectomy.

Risks of the procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

• Bleeding
• Infection
• Blood clots in the legs or lungs
• Spinal cord injury
• Risks associated with the use of general anesthesia

Nerve or blood vessels in the area of surgery may be injured, resulting in weakness or numbness. The pain may not be relieved by the surgery or may become worse, although this is rare.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the surgery.

Before the procedure

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
• Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• If you are pregnant or suspect that you are pregnant, you should notify your doctor.
• You will be asked to fast for eight hours before the procedure, generally after midnight.
• You may receive a sedative before the procedure to help you relax.
• You may meet with a physical therapist before your surgery to discuss rehabilitation.
• Since certain activities may be restricted following your surgery, you will need to arrange for someone to help you for a few days with the household activities and driving.
• Based on your medical condition, your doctor may request other specific preparation.

   

During the procedure

A laminectomy usually requires a stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

A laminectomy may be performed while you are asleep under general anesthesia, or while you are awake under spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Newer techniques are being developed that may allow a laminectomy to be done under local anesthesia on an outpatient basis. Your doctor will discuss this with you in advance.

Generally, a laminectomy follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.
2. An intravenous (IV) line may be started in your arm or hand.
3. Once you are under anesthesia, a urinary drainage catheter may be inserted.
4. If the surgical site is covered with excessive hair, the hair may be clipped off.
5. You will be positioned either on your side or abdomen on the operating table.
6. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
7. The skin over the surgical site will be cleansed with an antiseptic solution.
8. The surgeon will make an incision over the selected vertebra.
9. The surgeon will spread the back muscles apart.
10. The lamina (bony arch of the posterior part of the vertebra) is removed to relieve the pressure on the nerves in the area. This may involve removing bone spurs or growths, or removing all or part of a disk.
11. In some cases, spinal fusion may be performed at the same time. During a spinal fusion, the surgeon will connect 2 or more bones in the back to help stabilize the spine.
12. The incision will be closed with stitches or surgical staples.
13. A sterile bandage or dressing will be applied.

     

After the procedure

In the hospital

After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Laminectomy usually requires an in-hospital stay of 1 or more days.

You will most likely begin getting out of bed and walking the evening of your surgery. Your pain will be controlled with medication so that you can participate in the exercise. You may be given an exercise plan to follow both in the hospital and after discharge.

At home

Once you are at home, it is important to keep the surgical incision area clean and dry. Your doctor will give you specific bathing instructions. The surgical staples or stitches are removed during a follow-up office visit.

Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Notify your doctor to report any of the following:

• Fever
• Redness, swelling, bleeding, or other drainage from the incision site
• Increased pain around the incision site
• Numbness in your legs, back, or buttocks
• Difficulty urinating or loss of control of your bladder or bowel

You should not drive until your doctor tells you to. You should avoid bending over to pick up objects or arching your back. Other activity restrictions may apply.

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.