Laminectomy is a surgical procedure that involves the removal of the lamina, a part of the vertebrae that protects the spine. This enlarges the spinal canal to create space for the nerves and relieve pressure on them. It is often a part of a decompression surgery that involves other steps to create the adequate space in the spinal column required for optimum functioning of the body.
A surgical procedure like laminectomy is not uncommon, but it is not recommended for patients if other treatment options are available. A laminectomy may also be referred to as a lumbar laminectomy, cervical laminectomy, or a decompressive laminectomy.(2) To learn more about laminectomy spine surgery, keep reading.
What is a Laminectomy?
Laminectomy is a spine surgery that removes the lamina, which is the protective layer of the vertebrae covering the back of the spinal cord. A spinal laminectomy can be performed in the neck area (cervical spine) or the lower back region (lumbar spine). A surgeon will decide, based on the individual case, whether to remove only a part of the lamina (laminotomy) or all of it (laminectomy).(3) It can also be performed as an outpatient procedure in a minimally invasive manner that may not require the patient to stay in the hospital for more than 24 hours; however, this is highly subjective and depends on the individual case.
The purpose of laminectomy surgery is to relieve pressure on the nerves or nerve roots by creating space within the spinal canal. A spinal laminectomy is recommended only when other conservative forms of treatment have failed to improve the patient’s symptoms and there is no alternative left to try. It is crucial that the patient exhaust all possible treatment options before opting for laminectomy surgery, which removes a part of the bone from an extremely important part of the body—the spine.
When is a Spine Laminectomy recommended?
With age, people can develop bone spurs (growth on the bone), disc herniation (bulging disc), narrowing of the spinal column due to injury, bone tumours in the lamina, or degeneration of the spine. These conditions can put pressure on the nerves, causing a tingling sensation, numbness, or pain that worsens with movement. The pain caused by the extra pressure on the nerves can range from mild to debilitating. Magnetic resonance imaging (or MRI) can confirm the diagnosis and help the doctor provide the most suitable care plan for the patient.
Pressure on a nerve in the neck region can affect the upper body (including the arms and shoulders) and the lower body (including the buttocks, legs, and feet) if the affected nerve is in the lower back. In some cases, people may lose bladder or bowel control.
Laminectomy can also be a part of other surgical procedures, such as the treatment of herniated discs or spinal stenosis. A patient with a herniated disc that is not improving with other forms of treatment is a likely candidate for a spinal laminectomy.
Preparing for a Laminectomy
Once the doctor and patient have determined that the best course of action is laminectomy surgery, the doctor will start preparing for the surgery. They may order an X-ray and other screening tests to make the necessary arrangements for the surgery and have a baseline for the patient to compare their improvement over time. Pre-operative blood tests will also be recommended in addition to other necessary tests to check the readiness of the patient for the surgery.
The healthcare provider will explain the surgery in detail and clear up any doubts that the patient has before confirming a tentative date for the surgery. A detailed medical history is also taken from the patient, and their medications and supplements (including any herbal ones) may be stopped or altered a few days before the surgery. The patient may also be required to fast for a few hours before the surgery to avoid any complications with the anaesthesia. Women who are pregnant or could be pregnant should also inform their doctor about the same.
Other instructions and safety precautions may be provided to the patient depending on their health condition and other factors.
Laminectomy Surgery Procedure
The patient will change into a hospital gown, and a healthcare provider will start an IV line that will be used during and after the procedure to administer medications and fluids. The patient may be given general anaesthesia to help them sleep through the procedure, or spinal anaesthesia may be used to help them stay awake and relax during the procedure without feeling any discomfort. If necessary, a urinary drainage catheter may be inserted.
The patient will be positioned on their belly or side on the operating table for the surgery. A certified anaesthesiologist will be present in the operating theatre to monitor the patient’s heart rate and other vital signs and manage any complications with the anaesthesia if needed.
The surgeon will start by making a small incision (about an inch) over the affected vertebrae on the back to access the lamina. The length of the incision depends on the number of vertebrae that need to be operated on; the incision will be longer than one inch if multiple vertebrae need to be operated on. They will then proceed to spread the muscles and, using a special drill, start to cut into the lamina without touching the vertebral joint.
After removing the lamina, the surgeon will check for any remaining bone spurs and remove them too. In some patients, the ligament that sits between the lamina and the spinal cord may also get enlarged over time, and the surgeon will likely remove it partially or completely during the surgery. A laminectomy may be performed with the help of a laparoscope, which is a long, thin tube with a camera attached to its end.
Depending on the case, a laminectomy may be followed by a discectomy (partial or complete removal of the intervertebral disc) or spinal fusion (joining two vertebrae).
The doctor will conclude the surgery after ensuring that everything is in order, close the incision with stitches or surgical staples, and apply a sterile bandage to the incision.
Laminectomy after-care
After the laminectomy surgery, the patient is taken to a recovery room and kept under observation for a few hours until their vital signs and normal bladder and bowel functions are restored. The patient may be required to stay in the hospital for a day or more.
The doctors encourage patients to start getting out of bed and walking as soon as they can, and most patients will be able to do so a few hours after the surgery. Pain relievers and other medications will be administered through the IV to control the pain after the surgery. This will allow the patient to participate in physiotherapy sessions for a speedy recovery. The doctor may share an exercise regime with the patient to start in the hospital and modify it over time during the patient’s recovery stage.
Before the patient goes home, they will be given specific instructions by the doctor, such as keeping the incision area clean and dry until the stitches are removed during a follow-up visit to the doctor’s clinic or hospital. The patient must follow the guidelines for a quick recovery and to avoid complications after the surgery. In case, any of the following symptoms occur, the patient must inform their doctor immediately:
- Fever
- Drainage (including bleeding) from the incision site
- Swelling or redness around the incision site
- Excessive pain around the incision site
- Numbness in the legs, back, or buttocks
- Problems urinating or loss of bowel or bladder control
Additionally, certain activities must be avoided, including the following, until the doctor tells the patient they can engage in them.
- Driving
- Diving
- Bending over
- Picking heavy objects
- Arching the back
The recovery time after a laminectomy surgery depends on the individual case; here are some general things to expect during the recovery:
- After a minor laminectomy or laminotomy, the patient can return to low-impact activities such as desk work within a few days or weeks.
- People who had a spinal fusion as well as a laminectomy will likely take longer to heal (about 2-4 months).
- Patients may be advised against returning to normal activities such as lifting and bending for two to three months.
- The doctor usually encourages the patient to walk in addition to physiotherapy to help them recover quickly.
It is better to arrange for help around the house if the patient lives alone, as they will likely not be able to perform chores or cook for themselves.
Risks of Laminectomy Spine Surgery
All surgeries carry some risk factors with them; listed below are some of the complications that may occur during or after a laminectomy surgery:
- Infection
- Blood clots in the lungs or the legs
- Adverse reactions to the anaesthesia used during the surgery
- Excessive bleeding
- Difficulty breathing
- Stroke
- Heart attack
- Damage to the spinal cord or the nerve root
- Spinal fluid leaks
There are other risks associated with different health conditions, and patients are recommended to share a detailed medical history with their doctors beforehand to help avoid any complications. It is possible that, in rare cases, the patient’s symptoms may not resolve or get worse after a laminectomy.
Long-term Outlook of Laminectomy
The long-term outlook after undergoing a laminectomy procedure is generally positive, as it often alleviates symptoms associated with spinal stenosis. However, it’s important to note that a laminectomy cannot guarantee the prevention of future spine problems, and it may not fully eliminate pain for everyone.
Individuals who have undergone both a laminectomy and a spinal fusion are at a higher risk of experiencing spinal issues in the future.
