Laminectomy

Answer 1

Definition

Laminectomy is surgery to remove the lamina, two small bones that make up a vertebra, or bone spurs in your back. The procedure can take pressure off your spinal nerves or spinal column.

Alternative Names

Lumbar decompression; Decompressive laminectomy; Spine surgery - laminectomy

Description

Laminectomy opens up your spinal canal so your spinal nerves have more room. It is usually done along with a diskectomy, foraminotomy, and spinal fusion. You will be asleep and feel no pain (general anesthesia).

• You will lie face down on the operating table. The surgeon will make an incision (cut) in the middle of your back or neck.
• The skin, muscles, and ligaments are moved to the side. Your surgeon may use a surgical microscope to see inside your back.
• Part or all of the lamina bones may be removed on both sides of your spine, along with the spinous process, the sharp part of your spine.
• Your surgeon will remove any small disk fragments, bone spurs, or other soft tissue.
• The surgeon may also do a foraminotomy (to widen the opening where nerve roots travel out of the spine) at this time.
• Your surgeon may do a spinal fusion to make sure your spinal column is stable after surgery.
• Surgery takes 1 to 3 hours.

Why the Procedure Is Performed

Laminectomy is often done to treat spinal stenosis. The procedure removes bones and damaged disks, and makes more room for your spinal nerve and column.

Your symptoms may be:

• Pain or numbness in one or both legs. You may feel weakness or heaviness in your buttocks or legs. You may have problems emptying or controlling your bladder and bowel.
• You are more likely to have symptoms, or worse symptoms, when you are standing or walking.

You and your doctor can decide when you need to have surgery for these symptoms. Spinal stenosis symptoms often become worse over time, but this may happen very slowly.

When your symptoms become more severe and interfere with your daily life or your job, surgery may help.

You will have an MRI before surgery that shows you have spinal stenosis.

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the lungs (pneumonia), bladder, or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medications

Risks for spine surgery are:

• Infection in wound or vertebral bones
• Damage to a spinal nerve, causing weakness, pain, or loss of feeling
• Partial or no relief of pain after surgery
• A return of Back pain in the future

If you have spinal fusion, your spinal column above and below the fusion is more likely to give you problems in the future.

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

During the days before the surgery:

• Prepare your home for when you leave the hospital.
• If you are a smoker, you need to stop. People who have spinal fusion and continue to smoke may not heal as well. Ask your doctor for help.
• Two weeks before surgery, your doctor or nurse may ask you to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and other drugs like these.
• If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular doctor.
• Talk with your doctor if you have been drinking a lot of alcohol.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have.
• You may want to visit a physical therapist to learn some exercises to do before surgery and to practice using crutches.

On the day of the surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Your doctor or nurse will ask you to get up and walk around as soon as your anesthesia wears off, if you did not also have spinal fusion. Most patients go home 1 to 3 days after their surgery.

Outlook (Prognosis)

Laminectomy for spinal stenosis will often provide full or partial relief of symptoms

Future spine problems are possible for all patients after spine surgery. If you had spinal fusion and laminectomy, the spinal column above and below the fusion are more likely to have problems in the future. If you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may have more of a chance of future problems

References

Curlee PM. Other disorders of the spine. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 41.

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358:794-810.

Answer 2

Definition

Laminectomy is surgery to remove the lamina, part of the bone that makes up a vertebra, or bone spurs in your back. The procedure can take pressure off your spinal nerves or spinal canal.

Alternative Names

Lumbar decompression; Decompressive laminectomy; Spine surgery - laminectomy

Description

Laminectomy opens up your spinal canal so your spinal nerves have more room. It may be done along with a diskectomy, foraminotomy, and spinal fusion. You will be asleep and feel no pain (general anesthesia).

• You will lie face down on the operating table. The surgeon will make an incision (cut) in the middle of your back or neck.
• The skin, muscles, and ligaments are moved to the side. Your surgeon may use a surgical microscope to see inside your back.
• Part or all of the lamina bones may be removed on both sides of your spine, along with the spinous process, the sharp part of your spine.
• Your surgeon will remove any small disk fragments, bone spurs, or other soft tissue.
• The surgeon may also do a foraminotomy (to widen the opening where nerve roots travel out of the spine) at this time.
• Your surgeon may do a spinal fusion to make sure your spinal column is stable after surgery.
• Surgery takes 1 to 3 hours.

Why the Procedure Is Performed

Laminectomy is often done to treat spinal stenosis. The procedure removes bones and damaged disks, and makes more room for your spinal nerve and column.

Your symptoms may be:

• Pain or numbness in one or both legs. You may feel weakness or heaviness in your buttocks or legs. You may have problems emptying or controlling your bladder and bowel.
• You are more likely to have symptoms, or worse symptoms, when you are standing or walking.

You and your doctor can decide when you need to have surgery for these symptoms. Spinal stenosis symptoms often become worse over time, but this may happen very slowly.

When your symptoms become more severe and interfere with your daily life or your job, surgery may help.

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the lungs (pneumonia), bladder, or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medications

Risks for spine surgery are:

• Infection in wound or vertebral bones
• Damage to a spinal nerve, causing weakness, pain, or loss of feeling
• Partial or no relief of pain after surgery
• A return of back pain in the future

If you have spinal fusion, your spinal column above and below the fusion is more likely to give you problems in the future.

Before the Procedure

You will have an MRI before the procedure to confirm that you have spinal stenosis.

Always tell your doctor or nurse what drugs you are taking, those you bought without a prescription.

During the days before the surgery:

• Prepare your home for when you leave the hospital.
• If you are a smoker, you need to stop. People who have spinal fusion and continue to smoke may not heal as well. Ask your doctor for help.
• Two weeks before surgery, your doctor or nurse may ask you to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and other drugs like these.
• If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular doctor.
• Talk with your doctor if you have been drinking a lot of alcohol.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have.
• You may want to visit a physical therapist to learn some exercises to do before surgery and to practice using crutches.

On the day of the surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Your doctor or nurse will ask you to get up and walk around as soon as your anesthesia wears off, if you did not also have spinal fusion. Most patients go home 1 to 3 days after their surgery.

Outlook (Prognosis)

Laminectomy for spinal stenosis will often provide full or partial relief of symptoms

Future spine problems are possible for all patients after spine surgery. If you had spinal fusion and laminectomy, the spinal column above and below the fusion are more likely to have problems in the future. If you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may have more of a chance of future problems

References

Curlee PM. Other disorders of the spine. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 41.

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358:794-810.

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2010 Jun 15;35(14):1329-38.

Reviewed By

Review Date: 12/20/2010

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.