Laminectomy refers to removal or cutting of the lamina (roof) of the vertebral bones to provide space for the nerves to exit from spine.
Cervical Laminectomy
A cervical laminectomy is an operative procedure of removing the bone at the neck (cervical spine) region to relieve pressure on the spinal nerves. It can also be performed to relieve the symptoms of narrowed spinal canal known as spinal stenosis.
Indications
Degeneration of the facet joints and intervertebral discs results in narrowing of the spinal canal known as spinal stenosis. In addition, the arthritic facet joints become bulkier and consume the space available for the nerve roots. Bony out growths, also known as bone spurs or bone osteophytes, can also narrow the spinal canal. This condition of spinal stenosis, narrowing of the spinal canal, puts pressure on the spinal nerves and spinal cord, causing symptoms such as neck pain, tingling sensation, numbness or weakness that extends to the shoulders, arms and/or hands, and bowel or bladder impairment.
The objective of cervical laminectomy is to relieve pressure on the spinal nerves by removing the part of the lamina that is putting pressure on the nerves. Your surgeon recommends you for cervical laminectomy after examining your spine, medical history, and imaging results of cervical vertebrae from X-ray, CT (computed tomography) scan or MRI (magnetic resonance imaging). Surgery is recommended only after non-surgical treatment approaches fail to relieve symptoms after a reasonable period of time.
Procedure
The procedure is performed with you resting on your stomach and injected with sleep inducing medication (general anesthesia). Your surgeon makes a small incision near the center of your neck on the back side, and approaches the neck bones (cervical vertebrae) by moving the soft tissues and muscles apart. Then, the total lamina or a part of the lamina is removed to relieve the compression. Other compression sources such as bone spurs and/or disc fragments (discectomy) are also removed. After the procedure, your surgeon brings back the soft tissues and muscles to their normal place and closes the incision.
In some instances, spinal fusion may also be done along with the cervical laminectomy which involves placing bone graft or a bone graft substitute between two affected vertebrae to allow bone growth between the vertebral bodies. The bone graft acts as a medium for binding the two vertebral bones, and grows as a single vertebra which stabilizes the spine. It also helps to maintain the normal disc height.
Recovery
A specific post-operative recovery/exercise plan will be designed by your physician to help you return to normal activity at the earliest possible. After surgery, your symptoms may improve immediately or gradually over the course of time. The duration of hospital stay depends on this treatment plan. In few instances, surgery may also be performed on an outpatient basis. You will be able to wake up and walk by the end of the first day after the surgery. Your return to work will depend on your body’s healing status and the type of work/activity that you plan to resume. Discuss with your spinal surgeon and follow the instructions for optimized healing and appropriate recovery after the procedure.
Risks or complications
Treatment results and outcome are different for each patient. All surgeries carry risk and it is important to understand the risks of the procedure in order to make an informed decision to go ahead with the surgery. In addition to the anesthetic complications, spinal surgery is associated with some potential risks such as infection, blood loss, blood clots, nerve damage, and bowel and bladder problems. Failure to fuse the vertebral bones with the bone graft (fusion failure) is an important complication of spinal fusion which requires an additional surgery.
Please take your physician’s advice for a complete list of indications, clinical results, adverse effects, warnings and precautions, and other relevant medical information about cervical laminectomy procedure.
Lumbar Laminectomy
Lumbar laminectomy is a surgical procedure of the spine to relieve excess pressure on the spinal nerve(s) in the lumbar region of the lower back. The surgery can be executed to relieve the back pain or radiating leg pain due to compression over the nerve. The term laminectomy originated from the Latin words ‘lamina’ which is a ‘thin plate, sheet or a layer’ and the word ‘ectomy’ which means ‘removal’. The laminectomy involves removal of the lamina or roof of the vertebra to provide room for the nerves to leave the spine.
Indications
Spinal stenosis is one of the major indications for lumbar laminectomy. It is a condition of narrowing of spinal canal due to arthritic changes of facet joints and intervertebral discs that causes enlargement of the joint and decreases the available space for the nerve roots. Formation of bony spurs or osteophytes also can aggravate the condition.
Progression of spinal stenosis causes narrowing of your spinal canal and creates pressure over the nerve roots of the spinal cord. You may develop certain symptoms from impingement on the nerve such as back pain or radiating pain into the hips, buttocks or legs, numbness or tingling sensation and muscle weakness in the back and lower extremities.
The aim of the laminectomy is to release the compression of the spinal nerve by eliminating the part of the lamina that is causing pressure on the nerve.
To diagnose the requirement for lumbar laminectomy, the physician may inspect your back and medical history and request tests such as X-ray, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of your spine. Once the non- surgical treatment options such as rest, medications and physical therapy fails to reduce the symptoms after a reasonable period of time, lumbar laminectomy surgery can be recommended.
Procedure
Lumbar laminectomy is a major surgery and mostly performed under general anesthesia. In this procedure the patient lies on his or her stomach to provide accessibility to the spine. A small incision is made along the midline of your back through which the operated site can be exposed. The surgeon slowly removes the soft tissues such as skin, fat and muscles to get better exposure of the vertebral bone at the back of the spine. Next, the surgeon removes a part or the entire lamina to eliminate the pressure over the nerve roots. If required, other sources of compression such as bony spurs or disc material also can be removed to relieve the symptoms. After the procedure the surgeon aligns the soft tissues and closes the incision.
Sometimes lumbar laminectomy may be performed along with spinal fusion which includes placement of bone graft or substitute between two or more affected vertebrae. The graft material works as a binding medium and promotes bone growth between the vertebral bodies. As the healing process progresses, the vertebral bone grows along with the bone graft to join the vertebrae and stabilize the joint.
Recovery
After surgery each patient has their definite post-operative rehabilitation plan that helps the patient to return to their normal active life as soon as possible. Following a laminectomy, you may observe an immediate improvement of some or all symptoms or sometimes a gradual improvement of the symptoms also may be seen.
The amount of time of hospitalization mostly depends on the treatment plan. At the end of the first day of the surgery you are allowed to move and walk around the hospital. Returning back to your daily life or to work depends on the level of healing and the type of work or activity level.
Follow your spinal surgeon’s post-operative instructions to determine the proper recovery program and to augment the healing process.
Risks or complications
Each patient has a particular treatment plan and outcome result. Sometimes outcome results may vary from individual to individual. The complications of the lumber laminectomy include infection, nerve damage, blood clots, blood loss, bowel and bladder problems and any problem associated with anesthesia. The underlying risk of spinal fusion surgery is failure of fusion of the vertebral bones and bone graft which usually requires an additional surgery.
Please talk to your physician to obtain an ample list of indications, warnings or adverse effects or precautions, clinical results and other significant medical information related to the lumbar laminectomy procedure.
