Laminectomy is a method of reducing spinal cord compression

A laminectomy involves partial or complete removal of the lamina, which is part of the vertebral bone. Doctors typically use this procedure to treat symptoms of spinal stenosis and conditions such as herniated discs.

This article looks at the different types of laminectomy and what to expect during and after the procedure.

What is a laminectomy?

The lamina is the part of the vertebrae that covers and protects the spinal canal. A laminectomy is a type of back surgery in which the surgeon removes all or just part of the laminae. To some people, this surgery is known as posterior spinal decompression.

Doctors use a laminectomy to widen the spinal canal and relieve pressure on the spinal cord, or to remove bone spurs that are compressing nerve roots.

Some different types of laminectomy include:

• Cervical laminectomy: A procedure performed by a surgeon on the cervical vertebra in the neck area.
• Lumbar laminectomy: This procedure affects the vertebrae in the lower back. It can help relieve pain in the lower back, buttocks and legs.
• Sacral laminectomy: This procedure removes the lamina on the fused sacral vertebrae.

Some other forms of decompressive spine surgery include laminotomy and discectomy.

Laminotomy is similar to laminectomy. However, during a laminotomy, the surgeon removes only a small portion of the lamina. The procedure is less invasive, according to the authors of one 2021 review article. It may also result in fewer complications than a traditional laminectomy.

A discectomy involves partial or complete removal of a damaged intervertebral disc. Intervertebral discs are made up of thick rings of cartilage. These cartilage discs cushion the vertebrae and act as shock absorbers for the spine.

Types of laminectomy and main indications

Spinal laminectomy can be performed according to one of several technical options. The principle of intervention is selected taking into account the state of the spinal system, the type and specificity of the disease. So, in modern neurosurgery, vertebrology and orthopedics, such leading decompressive techniques are used as:

• hemilaminectomy - a procedure to remove the arch of only the 1st vertebra on one side or its arches simultaneously on both sides, preserving the spinous processes;
• interlaminar laminectomy is a method in which the ligamentum flavum is partially resected, as well as the arch of not only the affected vertebra, but also the arches of the vertebral bodies adjacent to it;
• total operation - a technique in which the vertebral arch is excised along with the spinous process;
• osteoplastic laminectomy is a volumetric laminectomy operation with subsequent closure of defects with autologous bone material, allograft or artificial tissue.

Before performing a laminectomy (the process is well depicted in the video), skeletonization is first performed from the side of the created access. Skeletonization of the vertebrae involves exposing the main parts to be resected at the level of the affected spinal motion segment: arches, spinous processes, facets. Exposing the arches and spinous processes of the cervical spine is fraught with certain difficulties. The tops of the arches here are bifurcated, deeply immersed and covered with an impressive muscular mass, and the processes are characterized by increased mobility and low strength. Therefore, this department requires from the surgeon the highest professionalism, wealth of experience, mega-precision of the actions performed and accuracy.

Of course, every surgeon must meet these requirements, regardless of what area is being operated on. Even one small error made during spinal manipulation can end very badly for the patient, leading to irreversible damage to the nervous tissue and substance of the spinal cord, chronic pain, paralysis, etc. So choose your doctor especially carefully.

So, surgery may be advisable for the following pathological conditions that cause compression of the spinal cord and nerve roots:

• large intervertebral hernias;
• intra-articular and vertebral osteophytes,
• tumors of the spine (bone, spinal cord, etc.);
• arachnoid cysts and subarachnoid adhesions;
• pinching of the spinal cord of traumatic origin;
• congenital anomalies of the spine;
• serious curvatures and deformations of the ridge (in this case, it sometimes makes sense to resort to such a procedure even in the absence of nerve pinching and stenosis).

For all of the above pathologies, the question of the need for such intervention is considered strictly on an individual basis. Of course, the degree of compression, the severity of the neurological deficit and the intensity of the pain syndrome are taken into account. The laminectomy procedure may be recommended if conservative measures are ineffective or there is a clear threat to the patient’s physical fitness and life.

Cause

In most cases, doctors recommend a laminectomy when a person shows signs of spinal stenosis or possible symptoms of a herniated disc.

Spinal stenosis occurs when the spinal canal narrows, putting pressure on the spinal cord or nerve roots.

Depending on the location and severity, spinal stenosis can lead to:

• pain in the neck or lower back
• numbness, pain or tingling radiating from the forearm into the palm
• numbness or pain that travels down the buttocks and legs
• cramps or weakness in the arms, legs, or feet
• difficulty walking
• difficulty controlling your bladder or bowel movements

A person can develop spinal stenosis for several different reasons, but the most common cause of the condition is natural aging, according to the National Institutes of Health (NIH).

Other common causes of spinal stenosis that may require a laminectomy include:

• arthritis of the spine, including osteoarthritis and rheumatoid arthritis
• spinal injuries due to road traffic accidents or falls
• herniation or displacement of an intervertebral disc from old age or moving heavy objects
• tumors growing inside the spinal canal
• bone spurs growing into the spinal canal

Although a laminectomy can help relieve painful symptoms of spinal stenosis, your doctor may first recommend less invasive treatment options, such as physical therapy and medications.

However, they may recommend a laminectomy if symptoms persist despite the person trying other forms of treatment.

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Preparation

Your doctor will explain specific preparation requirements during your pre-surgery appointment.

Before a laminectomy, the doctor may ask the person:

• avoid smoking
• stop taking blood thinning medications
• do not eat or drink for several hours before the procedure
• purchase a back brace and other assistive devices for use at home
• place clothes, food, dishes and other necessary items in easily accessible places

Before the procedure, the patient should tell his doctor if he:

• currently taking any prescription or over-the-counter medications, vitamins, or supplements
• is pregnant or thinks she may be pregnant
• is allergic to any medications, anesthetics or latex

The person will need to arrange transportation to and from the hospital. It is also a good idea to ask someone to help around the house for a few weeks after surgery.

Decompressive surgery technique

Let us immediately note that such a surgical approach is in a certain way fraught with destabilization of the laminectomized bone bodies. Therefore, quite often there is a need to perform a laminectomy with fixation of the vertebrae, that is, together with spinal fusion. This means that upon completion of the main surgical process, a pair or several vertebrae can be fastened together with a special metal plate; it may be additionally necessary to transplant bone tissue taken from the patient’s ilium. Thanks to the fixation, although the connected elements will be immobilized, people, as a rule, do not experience any significant restrictions on mobility.

Fusion of vertebrae on x-ray.

The leading criterion for indications for surgical intervention is pathological narrowness of the spinal canal, compression of the spinal roots and compression of the spinal cord. How does the operating session take place? Next, we will outline the surgical technique in an understandable form.

1. The procedure is performed in 90% of cases under general anesthesia. The patient is placed in one of the positions: lying on his stomach or on his side. The session usually takes place under fluoroscopic control.
2. After extensive treatment of the surgical field with antiseptics, markings are made for the future incision.
3. Next, the surgeon in the right place linearly cuts the skin, subcutaneous fatty tissue and fascia along the spinous processes to their apexes. The length of the incision is made so that its boundaries end one vertebra above and one below from the intended area of ​​opening of the spinal canal.
4. In order to ensure good access, the cut soft tissues are separated using a retractor. To avoid massive blood loss, tamponade is performed.
5. Then the muscle fibers are detached from the arches, and, if necessary, from the spinous processes. Afterwards, the skeletonized units are “bitten” with special forceps and removed from the anatomical space to the outside.
6. An integral step is the removal of those formations that actually became the culprits of compression. For example, removal of intervertebral hernia, adhesions, bone growths along the edges of the vertebrae, tumors, etc.
7. If a specialist considers it necessary to stabilize the vertebrae in order to prevent the formation of instability, special support-stabilizing structures are installed on the desired area of ​​the spine, grafts or synthetic bone tissue substitutes are implanted.
8. The final stage consists of sealed sutures in several layers, starting with the longitudinal and superficial muscles, then moving to the fascia, and the skin edges of the wound are tightened with the last layer of suture material. In total, the entire session lasts approximately 2-3 hours.

Procedure

During the procedure, the surgeon may:

1. disinfect and clean the skin where the incision will be made
2. make a small incision in the skin
3. push back the skin, muscles and ligaments to gain access to the spine
4. carefully cut out part or all of the bones of the plate
5. remove bone spurs or any broken or loose disc fragments
6. fix any displaced, broken or weak vertebrae by fusing two or more vertebrae
7. sew up the incision
8. close the stitched incision with gauze bandages

The surgeon may only perform some of the steps above for certain types of laminectomy.

How is spine surgery performed?

The intervention is carried out under general anesthesia and takes 1–3 hours. After providing access to the spinal column, resection of the vertebral arches, part of the intervertebral disc, osteophytes, and scars is performed. If necessary, spinal stabilization (spinal fusion) is performed. After this, all dissected tissues are sutured layer by layer.

In 80% of cases, surgical intervention is successful: the pain syndrome is partially or completely relieved, and neurological disorders are eliminated. The consequences of laminectomy depend on how strictly the patient adheres to the recommendations of the recovery period. His age, the presence of excess weight, diabetes and bad habits, as well as the state of the circulatory system play a role.

In rare cases, complications occur after laminectomy:

• infections of the surgical wound or spinal cord membranes;
• thrombophlebitis of deep veins in the lower extremities;
• nerve injury (threatens paralysis and disturbances in the functioning of internal organs);
• bladder atony;
• bleeding (if the epidural veins are damaged).

What to expect after the procedure

When a person wakes up after surgery, the doctor may ask him to walk around on his own a little.

Some people may go home the same day after the procedure, while others may need to stay in the hospital for 1 to 4 days.

Over the next few weeks, the person should get plenty of rest and avoid:

• flexion or curvature of the spine
• driving or operating heavy machinery
• interactions with heavy objects
• participating in any strenuous exercise

During the healing process, a person must remember to take medications as prescribed by the doctor.

The doctor or nurse will explain how to care for the incision while it heals. Following these aftercare tips can help your incision heal faster and prevent infection.

Complications

Although laminectomy procedures rarely cause serious complications, nerve root injuries and dural tears may occur. They are more common among older people.

Cerebrospinal fluid (CSF) can leak from tears in the dura mater, which is the thick membrane surrounding the spinal cord. CSF leakage is a serious problem that can lead to additional complications including dizziness, headaches, and seizures.

Other possible complications associated with laminectomy procedures include:

• failed treatment, which may lead to recurrent symptoms
• infection at the surgical site
• damage to the nerves, muscles, or tendons that stabilize the spine
• postoperative back pain, especially after spinal fusion

2.When is decompressive laminectomy performed?

Decompressive laminectomy is used to treat spinal stenosis in the following cases:

• The symptoms interfere with normal functioning and you cannot tolerate them;
• Nonsurgical treatment does not control the pain and progressive neural complications of stenosis;
• There are disturbances in urination and bowel movements;
• Impaired coordination of movement (especially walking) appears.

Thus, the decision to perform decompressive laminectomy is based not only on the images obtained, but also on the severity of symptoms.

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Recovery time

According to the National Health Service (NHS), recovery will depend on the person's fitness and activity level before surgery.

It usually takes about 4–6 weeks for a person to return to normal levels of mobility and functionality. However, this will depend on the severity of the condition and symptoms before surgery.

It may take up to 6 weeks for general pain and fatigue after surgery to completely disappear.

Most people will feel ready to drive 2-3 weeks after surgery. Many people can return to work in 4–6 weeks. However, if a person's work involves a lot of effort, they may require 12 weeks of rehabilitation.

How long does it take to recover from a laminectomy?

This time depends on the extent of the operation and the patient's condition. If the laminectomy is minor, the patient will usually be able to perform light housework and jobs that do not require bending in a few days to a few weeks. But if this operation is accompanied by a merger; recovery time is longer. This may take two to four months.

As soon as the doctor deems it appropriate, he will prescribe light walking and physical therapy exercises to speed up recovery. In any case, you cannot be sure of your full recovery before six weeks.

Summary

A doctor may recommend a laminectomy for a person with spinal stenosis. This procedure involves partial or complete removal of the lamina, which helps relieve pressure on the spinal cord.

Laminectomy procedures are a safe and effective treatment for people who experience chronic back pain. However, older adults and people with chronic medical conditions may have a higher risk of complications such as dural tears, nerve injuries, and infections.

The recovery period can last from 2 months to a year.

3.How does it work?

Decompressive laminectomy is a generally successful procedure for treating spinal stenosis. After laminectomy, leg pain is noticeably reduced and other symptoms are eliminated. The effect of the operation lasts from 8 to 10 years. People who have decompressive laminectomy tend to be more active than those who have non-surgical treatment for spinal stenosis.

Symptoms, however, may return, in which case further surgery will be required.

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