Laminectomy
Back and neck problems that interfere with one’s normal daily activities may ultimately need surgery, such as laminectomy. This is the surgical removal of the lamina, the portion of the vertebral bone that projects around the back of the spine. It protects the spinal cord and nerves as they pass through the spinal canal. The lamina overlap one another, much like shingles on a tile roof.
Laminectomy is considered a major surgery, but finding the right spine doctor in Fort Lauderdale to perform it reduces the risks significantly. Read on to learn more about laminectomy and get an idea whether this could be the solution to your back and neck pain.
What is laminectomy?
A laminectomy is usually performed when there is a compressive lesion on the spinal cord or nerve roots that must be relieved or there is some other condition that requires access to the neurologic structures. The laminectomy is akin to “taking the roof off” to relieve pressure, and is most commonly performed for spinal stenosis. Newer MISS techniques allow laminectomy to be performed as an outpatient procedure in some cases.
Laminectomy is performed to create a ‘space’ by enlarging the spinal canal. The ultimate purpose of the procedure is to relieve pressure on the nerves and spinal cord. This pressure is typically caused by bone spurs or bony overgrowths in the spinal canal, which are indicative of spinal arthritis. Bone spurs are also common among aging individuals.
When is laminectomy necessary?
Laminectomy may be recommended by our spine doctor in Delray Beach when more conservative treatments such as medication and injections did not help improve your symptoms. It is also done in patients whose symptoms are severe and/or have worsened dramatically.
In general, laminectomy is often considered when a patient begins to experience muscle weakness or numbness, making it difficult to stand or walk. Patients who also experience loss of bladder and bowel control due to their spine problem may also benefit from laminectomy.
Who is a candidate for laminectomy?
The most common indication for laminectomy is arthritis that produces thickened ligaments, disc protrusions, and enlarged facet joints that compress the nerves and spinal cord producing spinal stenosis. This is most common in the neck and lumbar spine where most spinal motion occurs and less common in the mid back (thoracic spine) as the ribs limit motion.
Spinal stenosis is caused by a number of problems, including:
- Shrinking of the spinal discs
- Swelling of the ligaments and bones in the spine
- Arthritis of the spine
- Abnormal growth of the spine, which may be a congenital defect
- Paget’s disease, causing bones to grow improperly
- Achondroplasia, a type of dwarfism
- Spine tumor
- Traumatic injury
- Slipped or herniated disc
Most patients with spinal stenosis are treated non-operatively and those with neurologic injury or who fail to improve with non-operative treatment might be candidates for surgical treatment. Patients with instability or underlying deformity (kyphosis, scoliosis, spondylolisthesis) may also require a stabilization procedure with fusion and instrumentation.
What are the pros and cons of laminectomy?
The primary benefit of undergoing laminectomy surgery is the relief or alleviation of pain that stems from nerve pressure. As a result, a recovered laminectomy patient can experience:
- Increased mobility
- Reduced radiating nerve symptoms
- Significant improvement in back and/or neck pain
- Overall better quality of life
However, all surgical procedures have inherent risks. These include, but are not limited to, infection, dural tear, nerve injury, instability, and chronic pain.
Each patient is unique and only a comprehensive evaluation with a fellowship-trained spine surgeon can give you the best appreciation of the risks and benefits for surgical treatment of your condition.
What is involved in laminectomy?
A laminectomy requires a posterior approach to the spine. The paraspinal muscles are retracted off the posterior elements and the ligamentum flavum connecting the lower lamina of the upper vertebra to the upper lamina of the lower vertebra is resected with Kerrison rongeurs. The lamina is then resected with a combination of a high speed burr and rongeurs.
Portions of the facet joints may be removed (medial facetectomy) to provide access and decompression of the nerve roots as they exit the spine through the foramen (foraminotomy).
How do you prepare for a laminectomy?
Proper preparation is needed to ensure the best outcome for laminectomy. Patients have a responsibility to tell the doctor if they are:
- Currently taking any prescription or OTC drugs, supplements, or vitamins
- Pregnant or may be pregnant
- Sensitive or allergic to any medications or other items used in surgeries (e.g. latex or tape)
Upon learning your medical history, the spine surgeon may require the patient to:
- Pause taking blood thinners (aspirin)
- Stop smoking
- Fast the night before the scheduled surgery
A patient scheduled for laminectomy should also arrange for someone to pick them up after the surgery. They may also need to make sure that someone accompanies and assists them around the house while recovering.
What happens after laminectomy?
After a laminectomy surgery, a patient will be moved to a recovery room where the medical staff will observe them for any complications that the surgery or anesthesia may cause. The doctor will also observe movement of arms and legs, and prescribe pain medication and antibiotics.
Although laminectomy is considered a major spine surgery, patients can be discharged the same day after surgery. However, some may need to be confined for longer.
Moreover, the doctor may also recommend physical therapy to regain and improve strength, flexibility, and mobility.
How soon can you walk after laminectomy?
In all, if there are no complications such as advanced arthritis, a person who undergoes laminectomy can return to normal activities and their work within a few weeks. In general, walking is the most recommended activity in the first 6 weeks after laminectomy. It’s recommended to start walking slowly until you can walk up to 30 minutes straight, at least twice per day.
What outcome can you expect from laminectomy for the long term?
Many people who had laminectomy report significant improvement in their symptoms. Most experience a decrease in the pain that used to radiate down their leg or arm.
Generally, laminectomy can relieve most symptoms of spinal stenosis. However, this procedure is not meant to prevent future spine problems. It may also not relieve pain away completely for some patients.
For the best possible laminectomy outcome, count on Dr. Matthew D. Hepler
Indeed, laminectomy is a complex procedure yet is one of the most commonly performed by one of the top spine surgeons in Palm Beach County, Dr. Matthew D. Hepler. He has been a practicing spine surgeon for about two decades and is an expert in back surgeries. With fellowship training in both pediatric and adult spine surgery, Dr. Hepler has the experience, training, and overall capacity to ensure the best possible outcome for laminectomy.
Contact us today to learn more or schedule a consultation at our Delray Beach or Fort Lauderdale location. Get started in your journey toward improved comfort and quality of life!
Further Information about laminectomy or related:
Cervical laminectomy for myelopathy (case 11)
Lumbar spinal stenosis handout
The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.
