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LAMINECTOMY

  What’s a Laminectomy?

 

The medical term “Laminectomy” refers to a type of surgery in which a neurosurgeon opens the spinal canal to give more space to the spinal nerves 1. This procedure involves the removal of a small part or all of the vertebral bone known as lamina that forms the roof of the spinal canal. Laminectomy eases pressure on the spinal cord or the nerve roots by enlarging the spinal canal. Based on the location, neurosurgeons perform laminectomy at any level of the spine. Laminectomy also removes the small bony portion or scar tissues that compressed the spinal cord or nerve roots. By this operation, patients get relief from the compression caused by an injury, herniated disc, spinal stenosis, or spinal tumors.

Physicians sometimes use the words laminectomy and laminotomy interchangeably. Laminotomy involves the removal of part of the lamina, while laminectomy involves the removal of most of the lamina. Physicians may also use Laminectomy as an alternative to laminoplasty. Laminoplasty involves the creation of more space in the spinal canal without removing the lamina. However, a laminectomy removes bone overgrowth and increases the need for spinal fusion. This may limit the movement of the patient’s spine. Laminectomy refers to a common but major surgery with potential risks and complications.

General symptoms of nerve compression include numbness in the arm or legs, pain in one or both legs, shoulders, or arm, stiffness in the back, arm, or legs, tingling in the arm or legs, weakness in the leg or buttock, difficulties while standing or walking, changes in the bladder or bowel control, etc. The exact symptom depends upon the location of the compressed nerve along the spinal cord. Neurosurgeons perform laminectomy only when other medical treatments have not worked. Sometimes, laminectomy may result in post-laminectomy syndrome in the patient.

What’s the Conditions for a Laminectomy?

Bony overgrowths and spurs narrow the space available for the spinal cord and nerves within the spinal canal. This results in weakness, pain, tingling, and numbness that radiates throughout the arms and legs. Patients with this kind of compression require laminectomy to widen their spinal canal by removing those compressors. Laminectomy procedure helps to enlarge the opening of the spinal canal and performed for various reasons. Basic indications for laminectomy may include 2:

What’s the different types of a Laminectomy?

Laminectomy involving oner vertebrae known as a single-level laminectomy. And when this involves more than one vertebra, neurosurgeons call it multilevel laminectomy. Based on the location of nerve compression, the laminectomy procedure includes 3:

  1. Cervical laminectomy: This involves the removal of the lamina in the neck area (cervical spine).
  2. Thoracic laminectomy: This involves the removal of the lamina in the middle part of the back (thoracic spine).
  3. Lumbar laminectomy: This involves the removal of the lamina in the lower back (lumbar spine).
  4. Sacral laminectomy: This involves the removal of the lamina in the back between the pelvic or hip bones (sacral spine).

What’s the risks associated with a Laminectomy?

Complications can occur during any surgical operation. A study reported the complication rate of laminectomy ranges from 4% to 8% after this operation 1. Similar to other surgical procedures, laminectomy has similar risks of infection at the surgical site, excessive blood loss, congestion and hematoma, stroke, heart attack, etc. Other potential complications of laminectomy may include 4:

  • Breathing difficulties
  • Paralysis (if spinal cord damaged)
  • Injury of the spinal nerve
  • Cerebrospinal fluid leakage, etc.

The associated risk factors of a patient for laminectomy involves hereditary factor, old age, duration and site of the operation, antibiotic prophylaxis, cardio-pulmonary disease, etc.

How should a patient prepare for a Laminectomy procedure?

Patients will discuss with their neurosurgeon about their qualifications for laminectomy surgery. Surgeons usually advise not to take any medicines such as blood thinners before the time of operation. Patients need to avoid eating and drinking food for at least 12 hours before the surgery. Prior to the surgery, neurosurgeons will perform additional imaging tests such as a magnetic resonance imaging (MRI) to get more information about the spinal column and nerves.

How does a Spinal Surgeon perform Laminectomy?

A professional medical team requires a laminectomy operation to perform successfully. This team should comprise a well-trained neurosurgeon, an anesthesiologist, and a nurse to assist. The overall procedure includes 5:

  • Patient will lie on their belly on the operation table.
  • Anesthesiologists will give general anesthesia to fall asleep so that patient will not feel any pain or sensation throughout the operation.
  • Neurosurgeons will make a tiny incision in the middle of the patient’s back or neck.
  • Neurosurgeons will push away the skin, muscles, fascia, and ligaments to expose the compressed area.
  • A small part of the whole lamina will remove from one or both sides of the patient’s spine.
  • Neurosurgeons will remove any small bony fragments, bone spurs, or other soft tissues.
  • If needed, neurosurgeons will perform foraminotomy to widen the opening of nerve roots or spinal fusion to stabilize the spinal column.
  • Finally, the neurosurgeon will put the muscles and other tissues back in place and suture the skin together.

How long does a Laminectomy procedure typically take?

Usually, a laminectomy requires one to two hours to complete perfectly. During the operation, the surgical team will monitor and evaluate the patient’s heart rate, respiration, blood pressure, blood oxygen level, etc. Neurosurgeons will carefully look after the possible complication during and after the operation.

What does recovery from a Laminectomy look like?

After surgery, patients will move to the recovery room for at least 24 hours where the health care team watches for complications from the surgery and anesthesia. Patients may able to return to their light activity such as desk work or light housekeeping within a few days to weeks after a minor laminectomy. Spinal fusion performed with laminectomy, means the recovery time will increase, ranging from 2 to 4 months more. An immediate appointment with a neurosurgeon may require in case of any emergency.

References

  1. Nishizawa, K., Mori, K., Saruhashi, Y. & Matsusue, Y. Operative Outcomes for Cervical Degenerative Disease: A Review of the Literature. ISRN Orthop. 2012, 1–6 (2012).
  2. El Tabl, M. A., El Sisi, Y. B., Al Emam, S. E., Hussen, M. A. & Saif, D. S. Evaluating the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function. Egypt. J. Neurosurg. 35, (2020).
  3. Yang, S., Yang, D., Ma, L., Wang, H. & Ding, W. Clinical efficacy of laminectomy with instrumented fixation in treatment of adjacent segmental disease following ACCF surgery: a retrospective observational study of 48 patients. Sci. Rep. 9, 1–6 (2019).
  4. Langevin, J. & Angeles, L. Lumbar Microlaminectomy vs. (2019).

Ding, H. et al. Laminoplasty and laminectomy hybrid decompression for the treatment of cervical spondylotic myelopathy with hypertrophic ligamentum flavum: A retrospective study. PLoS One 9, (2014).

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