A laminectomy is a surgical procedure that involves removing a portion of the lamina, which is the bony arch that forms the back of the spinal canal, in order to relieve pressure on the spinal cord or nerve roots. This procedure is often done to treat conditions such as spinal stenosis, herniated discs, or tumors of the spinal cord.
What is a laminectomy?
The lamina is a bony structure that forms the back of the spinal canal. The spine is made up of a series of bones called vertebrae, and each vertebra has a lamina, which is a thin, flat piece of bone that sits on top of the spinal cord and nerve roots, forming an arch.
A laminectomy is a surgical procedure that involves removing a portion of the lamina, in order to relieve pressure on the spinal cord or nerve roots.
When is a laminectomy considered?
A laminectomy is a decompressive surgery to treat narrowing of the spinal canal (also known as spinal stenosis). Surgery is typically a treatment of last resort in patients who were not effectively treated with more conservative measures such as physical therapy, medications, or epidural injections.
Some conditions in which laminectomy may be amenable include:
- Herniated discs: A herniated disc, also known as a slipped disc or a ruptured disc, is a condition in which the outer layer of a disc (annulus) breaks and the gel-like contents (nucleus pulposus) leaks into the canal.
- Degenerative changes: General wear and tear and age related changes can cause narrowing of the canals. Osteophytes, also known as bone spurs, are bony overgrowths seen in arthritis. Thickening of the ligaments which hold the bones together, known as ligamentum flavum hypertrophy, is another cause of stenosis from degenerative changes.
- Tumors: Tumors or abnormal growths, which may be cancerous or benign, can cause narrowing of the spinal canal.
How is a laminectomy performed?
A laminectomy is typically done under general anesthesia and can be performed as an open surgery or minimally invasive surgery.
Open laminectomy
During an open laminectomy, the surgeon will make a small incision in the back, and then use specialized instruments to remove the portion of the lamina that is pressing on the spinal cord or nerve roots. In some cases, the surgeon may also remove any surrounding tissue, such as a herniated disc, that is putting pressure on the spinal cord or nerve roots. The incision is then closed with sutures or staples.
Minimally invasive laminectomy
During a minimally invasive laminectomy, the surgeon will make small incisions in the back and use specialized instruments and a camera to remove the portion of the lamina that is pressing on the spinal cord or nerve roots.
What is the recovery time?
Recovery time after a laminectomy can vary depending on the extent of the surgery and the patient’s overall health.
In general, patients can expect to spend several days in the hospital after the surgery. Physical therapy is often recommended to help the patient regain strength and mobility, and the patient will be encouraged to get up and move around as soon as possible to prevent blood clots and improve circulation.
After being discharged from the hospital, patients can expect to take several weeks to several months to fully recover. Most patients are able to return to their normal activities within a few weeks after surgery.
What are the risks of a laminectomy?
As with any surgical procedure, a laminectomy carries certain risks that should be considered. Some of these include:
- Bleeding: There is a risk of bleeding during or after the surgery.
- Infection: As with any surgical procedure, there is a risk of infection at the surgical site.
- Adjacent segment disease: removing the lamina can cause instability in the spine, leading to the degeneration of the adjacent segment which can lead to further pain, spinal cord compression and other symptoms.
- Persistent or new pain: Some patients may experience persistent or new pain after the surgery.
- Spinal cord or nerve root injury: there is a risk of injury to the spinal cord or nerve roots during the surgery, which can lead to new or worsening symptoms.
How effective is a laminectomy?
The effectiveness of a laminectomy can vary depending on the underlying condition and the extent of the compression, however studies have shown patient satisfaction greater than 70% of the time.
Is a laminectomy right for me?
The decision to undergo a laminectomy is typically made on a case-by-case basis after a thorough evaluation of the patient’s symptoms, diagnostic test results, and overall health.
Here are some factors that may be taken into consideration when determining if a laminectomy is the right treatment option for you:
- Symptoms: If you are experiencing pain, numbness, tingling, or weakness in your legs or arms caused by compression of the spinal cord or nerve roots, a laminectomy may be considered.
- Previous treatment: If more conservative treatments such as physical therapy, medications, or epidural injections have failed to provide relief, a laminectomy may be considered.
- Overall health: Your surgeon will consider your overall health and any other medical conditions you may have to determine if you are a good candidate for surgery.
It’s important to have a thorough discussion with your surgeon about all the potential options, their risks and benefits, as well as the recovery time and outcomes. This will help you make an informed decision about the best course of treatment for you.
References
Phan, Kevin, and Ralph J Mobbs. “Minimally Invasive Versus Open Laminectomy for Lumbar Stenosis: A Systematic Review and Meta-Analysis.” Spine vol. 41,2 (2016)