A laminectomy is a surgical procedure to relieve pressure on the spinal cord or nerve roots exiting from the spinal cord by removing a small portion of vertebrae. Vertebrae are the bones of the spine. Disc herniation, bony spurs, or other problems can cause stenosis; narrowing of the canals that the nerves and spinal cord run through. Spinal stenosis can irritate the nerves making patients symptomatic. A narrowed spinal canal can compress (pinch) the spinal cord and/or the nerves that exit the spine and branch out to the rest of the body. Compression of spinal cord and/or nerves may cause radiculopathy: pain, numbness, tingling or weakness in a single arm or leg. Caused by compression of a nerve root. cauda equina syndrome: loss of bowel or bladder control and/or numbness in the buttocks, genital area, and inner thighs. Caused by compression of nerves in the lumbar spine. Often, a laminectomy is performed along with a disc removal to help make the canal larger and take pressure off the nerve being irritated.
When physical therapy, anti-inflammatory medications and steroid injections to the spine fail to yield pain relief and symptoms persist intolerably or become progressive; a stenotic patient is a candidate for laminectomy Laminectomy is typically performed on an outpatient basis under general anesthesia. The procedure typically takes one to three hours.
Once brought into an operatory the patient is anesthetized and positioned appropriately. An incision is made at the identified stenotic level. If the surgery is done with minimally invasive techniques, you will only need a few small incisions. A scope and small instruments will be inserted into these incisions. The surgeon moves aside layers of muscle and other tissue to expose the bones, called laminae, that form the roof over the spinal canal. After the lamina is removed, the spinal cord and discs that were hidden under the lamina will be inspected. The amount of bone removal depends on the specific condition. The surgeon may remove the lamina from one or both sides of one or more vertebrae. Often a portion of the ligamentum flavum (the ligament that connects the lamina of adjacent vertebrae) must also be removed. During a laminectomy, the surgeon may also shave down parts of the facet joints, joints between vertebrae that can compress nerve roots. A foraminotomy may also be performed at the same time. This procedure enlarges the foramina, small openings through which nerve roots exit the spine. Removal of a very small amount of lamina is called a laminotomy; this is often performed as part of a microdiscectomy.
In most cases, the degree of bone, ligament or facet joint removal will not significantly affect the strength of the spine. However, depending on the amount of tissue removal and whether the spine has been weakened by arthritis, degenerative changes or previous surgery, the strength of the spine may be compromised. In these situations, the surgeon may perform a spinal fusion, using metal implants and bone grafts to restore spinal strength. The surgeon then closes the incision layer by layer, using absorbable sutures that can be dissolved by the body.
Pain control at home is usually achieved with oral pain medication. For the first several weeks following surgery, patients can resume low-level activities (like walking) as they are able. More rigorous activities should be delayed until 4-6 weeks after surgery.