Orthopaedic Tests and Procedures

Laminectomy

(Lumbar Laminectomy, Cervical Laminectomy, Decompressive Laminectomy, Back Surgery, Disk Surgery)

Procedure overview

What is a laminectomy?

Back pain that interferes with normal daily activities may require surgery for treatment. Laminectomy is a type of surgery in which a surgeon removes part or all of the vertebral bone (lamina) to relieve compression of the spinal cord or the nerve roots that may be caused by injury, herniated disk, spinal stenosis (narrowing of the canal), or tumors. A laminectomy is considered only after medical treatments have proven to be ineffective.

Other related procedures that may be used to help diagnose back problems include CT scan, X-ray, MRI, electromyogram (EMG), and myelogram. Please see these procedures for additional information

Anatomy of the spinal column
Click image to enlarge

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 is 7 vertebrae in the neck; the thoracic spine is the 12 vertebrae in the mid and upper back; and the lumbar spine is the 5 vertebrae in the lower back area. The "sit bones" are the 5 sacral bones, which are fused into 1 bone called the sacrum, and 4 coccygeal bones, which are fused into 1 bone called the coccyx. Other parts of the spine are:

  • Lamina. These are the bony arches on the back of the vertebrae. It covers the spinal column. This is the part of the spine that is removed during a laminectomy.

  • Disks. These are soft pads between the bones (vertebrae) that act as shock absorbers. They allow the back to bend.

  • Spinal cord. This is 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 connect the spinal cord to the rest of the body. These nerves may become compressed or “pinched” by a vertebra or disk at the nerve root (the place where the never branches from the spinal cord).

  • Muscles and ligaments. These 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 keep you from moving and get in the way of your daily life. Laminectomy may be needed to relieve pressure on the spinal nerves, treat a disk problem, or remove a tumor from the spine.

One common reason for having a laminectomy is a herniated disk in the spine. A disk may be moved 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. Sciatica is a sharp, shooting pain along the sciatic nerve which runs from the buttocks to the thigh and down the back of the leg.

If medical treatments don't help, back surgery may be a good option. Some medical treatments for back pain may include:

  • Changing your activities

  • Medication, such as muscle relaxants, anti-inflammatory drugs, and analgesics

  • Injections of medication into the spine

  • Physical rehabilitation and/or therapy

  • Occupational therapy

  • Weight loss (if overweight)

  • Quitting smoking

  • Assistive devices, such as mechanical back supports

Laminectomy is usually done when 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 health care provider to recommend a laminectomy.

Risks of the procedure

As with any surgical procedure, complications can occur. Some possible complications may include:

  • 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 talk about your concerns with your surgeon before your 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

View of the spine and a vertebra with the lamina removed
Click image to enlarge

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.

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