Laminectomy

Listed below is the step by step procedure of laminectomy:

1. What is Laminectomy?
2. Why is Laminectomy Required?
3. Pre-operative Preparation
4. Day Before Surgery
5. Procedure Day
6. Methods/Techniques of Laminectomy
7. Post Procedure
8. Risks and Complications
9. FAQs

What is Laminectomy?

Laminectomy is a surgical process which is applied for relieving compression on the spinal cord. Pressure on the roots of nerves and spinal cord can lead to severe back pain, walking problems, weakness in the legs and numbness. Lamina is one of the parts of the bone which makes the vertebral arch. Laminectomy is also called as,

• Lumbar laminectomy
• Cervical laminectomy
• Decompressive laminectomy

Most of the times, symptoms of spinal stenosis are relieved with the help of laminectomy. Still it is not possible to completely prevent the future problems linked with spine. It may not help in reducing pain in every case. In general, patients with spinal fusion are prone to get spinal problems.

Why is Laminectomy Required?

Usually,laminectomy is preferred in cases where there is interference in daily life of the patient due to spinal problems. When minimal invasion techniques are not providing proper response, laminectomy is used.

For relieving spinal stenosis, laminectomy is used. In case of spinal stenosis, spinal column narrows and puts pressure on the spinal cord as well as roots of the nerves. Spinal stenosis develops as a result of shrinking spine discs, spine arthritis, congenital defects, swelling of the bones and ligaments, achondroplasia i.e., dwarfism, spinal tumor, slipped disc and a traumatic injury.

Pre-operative Preparation

Prior to the surgical process, patient needs to follow the instructions given by the surgeon. All prescription drugs, over the counter medications and vitamin supplements need to be taken with the advice of surgeon only.

Female patients need to inform the surgeon if they are pregnant or planning to become pregnant. Allergic reaction or history of allergy to medications, anesthetic agents, latex and tape if any, need to be informed to the surgeon prior to laminectomy. This avoids complications during and after surgery. Blood thinning agents such as Aspirin are advised to be stopped by the surgeon since they can interfere with the surgery. Smoking needs to be stopped prior to laminectomy.

Day Before Surgery

Few hours prior to the surgery, based on the advice of the surgeon, no food items are allowed to eat and no drinks are allowed too. It is preferred that patients get help from their close relatives or friends to be with them during and after surgical process. This helps in getting moral support as well as faster recovery after operation.

Procedure Day

On the day of surgery, patient needs to maintain cleanliness. Instructions given by the surgeon for the surgery day need to be implemented. Medications if any need to be consumed only with the recommendation of the surgeon. All records of patient's medication history and diagnostic tests need to be kept handy to avoid complications during the laminectomy. Prior to actual anesthesia, a small test for allergy is conducted to ensure there is no harm in general or spinal anesthesia to the patient.

Methods/Techniques of Laminectomy

After giving anesthesia, patient becomes unconsciousness. After this, laminectomy is performed. In cases where spinal anesthesia is given, patients will be awake. In both cases, no pain can be experienced during the process.

Throughout the surgery, monitoring of the patient by an anesthetist is carried out.

Given below are the steps involved in laminectomy. In general the complete process of laminectomy can be performed within one to three hours.

1. Firstly, surgical site skin is cleaned with the help of an antiseptic lotion for prevention of bacterial infection.
2. Mini incisions are made in the middle of the back or neck of the patient. Skin of the patient is moved for getting quality view during surgical process.
3. Removal of lamina bones on the spine of the patient is carried out.
4. Bone spurs or small disc fragments are removed.
5. Incisions are closed with help of stitches.
6. Sterile bandages are used for covering the incisions.
7. Spinal fusion (major surgery) may be carried out where two or more bones are linked in the back of the patient. This helps in getting better spine stability. A process called foraminotomy can be carried out by the surgeon for widening the area in which nerve roots enter via spine.

Post Procedure

The patient is transferred from operating room into a recovery room post surgery. After the effects of anesthetic medicine wears off, the patient regains consciousness. Soon afterwards, they are subjected to a complete physical examination. The surgeon will ask the patient to remain resting in a position comfortable for them , where the back muscles do not undergo a lot of strain.

The patient is encouraged to start moving around at the earliest, depending upon the surgeon's advice. The patient should be ambulating, but care should be taken to avoid excessive bending or twisting of the back muscles. In most cases, the patient is advised to stay back in the hospital for 2-3 days after surgery to ensure proper recovery..

Post recovery, patients need to avoid following activities.

• Climbing stairs in hurry
• Strenuous activities including heavy weight lifting

Gradually, patients need to increase movements such as walking and all follow-up appointments need to be done in timely manner for avoiding complications.

Patients need to be very careful while having a bath or shower post operation. Incision site should not be scrubbed as it can harm the stitches and can cause infections. No lotions or creams can be applied near incision site without consulting to the surgeon. Bathtubs, hot tubs and activities such as swimming need to be avoided.

Special care suggested by the surgeon for recovery of wound needs to be followed.
Surgeon needs to be consulted in time if patients experience following symptoms.

• Chest pain
• Redness at the incision site
• Draining sensation
• Heat sensation
• Difficulty in breathing
• Swelling on or around the incision site
• Urination difficulties
• Loss of bowel or urinary control
• High fever
• Swelling in the legs

Gradually, patients need to increase movements such as walking and all follow-up appointments need to be done in timely manner for avoiding complications.

Risks And Complications

Since laminectomy is associated with the spinal cord, great care needs to be taken while performing the surgery. There are risks involved; even though enough precautions are taken. The general risks of laminectomy are listed here.

• Heart attack
• Stroke
• Drug reactions
• Breathing problems
• Infections
• Blood loss
• Blood clot formation in the legs which may result in pulmonary embolism

FAQs

1. Is it possible to get rid of the back pain and other symptoms completely after laminectomy?

   A. In most of the cases, pain relief is much better and patients are able to go back to their normal routine. Though this is the case, diseased vertebra or the disk may not get normal completely. Also, there are chances of recurrence of problem in same or adjacent disks.

2. Is there entire disk removal in laminectomy?

   A. No. Only ruptured and diseased part of the disk is removed by laminectomy which usually is 15-30% of the entire disk.

3. What is the success rate of laminectomy?

   A. Post laminectomy, it has been reported in the medical literature that approximately 70 – 80% of the patients have got improvement in their functioning. A marked decrease in the back pain and discomfort is observed in the patients after laminectomy.

4. What is the mortality rate for lumbar laminectomy?

   According to medical literature, the mortality rate for lumbar laminectomy is 0.8% to 1%.

5. Is laminectomy dangerous? Is there chance of spinal harm during this process?

   Laminectomy is safe and good patient recovery is seen in most of the cases. There is low risk of bowel or bladder incontinence and paralysis involved. Patients need to talk with their surgeon about what they will be going through, prior to the surgery. Knowing the post surgery possibilities helps in making the patients less anxious.

   
   
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