Laminectomy

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Laminectomy is a surgical procedure for treating spinal stenosis by relieving pressure on the spinal cord. The lamina of the vertebra is removed or trimmed to widen the spinal canal and create more space for the spinal nerves.

The first laminectomy was performed in 1887 by Dr. Victor Alexander Haden Horsley, a professor of surgery at the University College London.

A common type of laminectomy is performed to permit the removal or reshaping of a spinal disc as part of a lumbar discectomy. This is a treatment for a herniated disc, bulging or degenerated disc.

Herniated intervertebral disc

One of the most common reasons for laminectomy is a prolapsed or herniated intervertebral disc. If the herniated disc is in the lumbar region, this can cause sharp and continuing back pain, a weakening of the muscles in the leg, and some loss of sensation in the leg and foot. It may also be difficult to raise the leg when it is held in a straight position. A herniated disc in the neck region can cause symptoms including pain, numbness and weakness in the arm. A herniated disc may be triggered by, for example, twisting the back while lifting something heavy. The surgeon will attempt to relieve the pressure on nerves and nerve roots by removing the pulpy material that is protruding from the disc.

Medical issues to consider

Tests are usually performed prior to surgery to aid diagnosis. These tests may include:

• Spinal x-ray
• Myelogram
• Computerised tomography (CT) scan
• Magnetic resonance imaging (MRI) scan.

Your surgeon should explain the nature of your operation, the reasons for it, the outcome and the possible risks involved. They should be able to tell you the approximate length of stay in hospital that will be required and the number of weeks you will need to recuperate before returning to work. Your anaesthetist will visit you to see how suitable you are for surgery. Laboratory tests, including blood and urine samples, are taken before the operation.

Operation procedure

The patient will have 'nil by mouth' (nothing to eat) for a number of hours prior to surgery, and an enema to empty your bowel. A pre-medication injection is usually given to make you drowsy and dry up some internal secretions.

Laminectomy is usually performed under general anaesthetic. The patient are placed face-down on the operating table. The exact procedure depends on the location of the herniated disc; e.g., if the disc is located in the neck, the head is clamped to prevent movement. The skin is marked for incision. The surgeon first cuts through the skin. The muscle is then cut, peeled back from the vertebrae and held in place with special instruments called retractors. The lamina, which is between the bony projection of the vertebrae (the 'points' that can be felt with fingers) and the transverse process or 'wing', is either removed or drilled with small holes. What happens next depends on the problem. For example, the surgeon may then trim the protruding bits of a herniated disc. Once the surgery is completed, the lamina is placed back into position, and the muscle and skin are sutured (sewn) closed.

Immediately after the operation

After the operation, the patient can expect:

• Routine post-operative observations will be taken and charted, including temperature and blood pressure. The patient's wound is checked for redness, swelling and signs of infection.
• Muscle spasms are quite common following laminectomy. Pain relief is ordered and given regularly. Note is made of ability to pass urine, as sometimes this may be affected immediately following surgery.
• The patient may have intravenous fluids for a few days, which may include an antibiotic.
• Initially, two people have to help the patient to roll over in bed. The patient is taught the proper method of rolling the body in order to maintain proper body alignment. This is most important for the first 48 hours or so.
• The patient is assisted out of bed after a few days. A physiotherapist gives specific instructions on how to get out of bed properly in order to avoid stress and strain on the wound site.
• The patient is encouraged to walk, stand and sit for short periods. The patient is taught how to prevent twisting, flexing or hyperextending the back while moving around.

Possible complications

Some of the possible complications of laminectomy include:

• Infection of the wound
• Blood clots in the legs
• Splitting open of the wound (wound dehiscence)
• Injury to the spinal cord
• Paraplegia or quadriplegia (depending on the site and severity of the spinal cord injury).

Post-operative recovery

Although guided by a doctor, general suggestions include:

• Continue to take your medications as ordered, especially the full course of antibiotics.
• If the operation was performed on your neck, you will need to wear a collar for about six weeks.
• Try to rest as much as possible for at least two weeks.
• Avoid activities that strain the spine – such as sitting or standing for too long, flexing your spine, bending at the waist, climbing too many stairs or going for long trips in the car.
• Avoid wearing high-heeled shoes.
• Sleep on a firm mattress.
• Continue with any exercises you were shown in hospital.
• Beware of heavy lifting for a long period.
• After two weeks at home, try to have a 10 minute walk each day, unless advised otherwise by your doctor.
• Report to your doctor any signs of infection, such as wound redness or drainage, elevated temperature or persistent headaches.

Long term outlook

A regular exercise program following surgery is most important to increase your spinal muscle strength and flexibility, and to protect against future injury. Occasionally, the operation doesn't work and the original symptoms remain. At other times, the operation isn't expected to relieve symptoms, but is performed to prevent the area from deteriorating further. In this case, original symptoms will probably remain, but might not get any worse. Concerns and expectations with a doctor.

Other forms of treatment

Even with signs of spinal nerve pressure, such as sciatica, recovery without any treatment may occur. Alternative treatment to surgery isn't always possible, but generally should be tried first. This may include:

• Stabilisation exercises
• Stretching and strengthening exercises
• Training on how to safely use the back (such as proper lifting techniques)
• Chiropractic
• Osteopathy
• Switching to ergonomic furniture.

Discectomy without laminectomy may also be an option, and this can often be done as day surgery using arthroscopic microscopic discectomy.

 

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