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Laminectomy also known as decompression surgery is a process that removes the back part of vertebra which covers the spinal canal. This procedure helps to relieve excessive pressure on the nerves or the spinal cord that may occur due to stenosis of the spinal canal. The complete bony lamina and the thickened ligaments predominant the spinal cord and nerves. This is most commonly occurring in people with arthritis where the bony outgrowths cause pressure in the spinal canal.
Laminectomy is the final option after all other options such as injections, physiotherapy and medication have failed to relieve the symptoms on the spinal nerve roots due to stenosis or narrowing of the spinal canal.
Lumbar laminectomy is recommended:
- Heaviness feeling in legs and buttocks
- Pain in the area of shoulder blades
- Numbness or pain in one leg or both
- Problems in bladder and bowel control
- Pain not improved with physical therapy
- Difficulty in walking
- Diagnostic tests such as MRI and CT indicate stenosis
Tests and diagnosis of spinal stenosis
- To diagnose the spinal stenosis the doctor will discuss the medical history and conduct a physical examination. Several imaging tests are also required to detect the underlying cause.
- Imaging tests
- Magnetic resonance imaging (MRI) - An MRI of spine detects the damaged disks and ligaments and tumours. It remarkably shows the nerve compression areas in the spinal cord.
- X-rays - X-ray of spine back and neck is usually performed to diagnose the possible cause of neck pain, disk degeneration, spondylitis tumours, and abnormal spine curvature.
- Computerized tomography (CT) - The CT test generates images taken at different angles to produce cross-sectional and detailed images which define the spinal cord and nerves bone out growths, tumours and herniated discs.
- The Patient will be admitted to the hospital in the morning of the surgery. Overnight fasting is required before the surgery. Furthermore, the patient will not be permitted to eat food or drink past midnight the night before surgery. An intravenous line is placed in the arm and an anesthesiologist will elucidate the effects of anesthesia and its risks.
- The surgeon will ask for the medical history which includes allergies, medicines, bleeding history, reactions, past surgeries.
- Anti-inflammatory medicines and blood thinners such as Coumadin, aspirin, should be avoided one week before surgery.
- Chewing tobacco, smoking and drinking alcohol should be avoided one week before and two weeks after surgery.
- The patient is given anesthesia so that he/she may sleep through the surgery.
- An incision is made in the skin of patient’s back in the affected area. The muscles and soft tissues around the spine will be pulled aside to expose the spine.
- Once the spine is exposed, the lamina will be removed and to allow the visualization of the nerve roots.
- The facet joints will be directed over the nerve roots, and may be undercut to provide the nerve roots better space.
- The surgeon will further clear the bone, bone spurs, and ligaments that are compressing nerves, a procedure known as decompression.
- Thereafter, a small part or a large portion of several spinal bones will be removed depending on the reason for the operation.
- Spinal fusion will also be performed on some patients in order to stabilize the spine, the patient may receive a special implant that may help stabilize the bones in the lower back or have additional removal of bone to widen the passageway where nerves leave the spinal canal.
- Finally, the wound will be properly stitched and the patient may be turned back over.
After the surgery, the patient will be moved to a recovery room and carefully monitored by the health care for any complications of anaesthesia and surgery.
- The doctor may prescribe the pain relief medication and advice to go home the next day whereas in some cases a short hospital stay is required.
- The doctor also recommends physical therapy after the surgery to improve the flexibility.
- Strenuous activities such as lifting heavy objects, bending and standing for a long time may not be done for several months after the surgery.
- The recovery time from the surgery will depend on the patient condition, level of surgery and age of the patient.
- A minor laminectomy requires a short stay at the hospital and can resume normal activities in few weeks.
- If laminectomy was done along with spinal fusion the recovery time will be longer ranging from 2 to 4 weeks.
- Bending and lifting should not be done for 2 to 4 months.
- Exercises such as light walking and physical therapy will speed up the recovery process.