Lumbar laminectomy

Lumbar laminectomy is a surgical procedure to relieve the pressure over the spinal nerves which results in pain and numbness in the legs. The narrowing of the spinal canal can occur either due to wear and tear or degenerative changes of the different parts of the spine. This results in a condition known as spinal stenosis. Laminectomy involves the complete removal of the lamina, a small bony plate covering the spinal canal. Laminectomy is another spinal decompression surgical procedure in addition to foraminotomy and facetectomy.

The spinal nerves may be compressed due to following reasons:

• Age related wear and tear of the spine
• Excessive stress and strain causing weakening of the spinal disc
• Abnormal bulging or even rupture of the intervertebral disc into the spinal canal
• Degenerative changes such as bone spur formation around the facet joints or along the edges of the vertebrae

The symptoms of spinal stenosis and nerve compression include back pain, leg pain, leg numbness and difficulty in walking.

Procedure

Lumbar laminectomy involves the following steps:

• The procedure is conducted under general anaesthesia.
• The patient is placed, facing downward, in a special frame.
• This frame is designed to relax the abdomen to prevent blood loss as well as provide more space for surgery.
• Fluoroscopy is used to identify the positioning of the incision.
• An incision is made through the skin, over the back, to approach the spine.
• The muscles are retracted with the help of a retractor.
• The bony projections present on each side of the vertebra and the lamina are removed by cutting along the inner edge of the facet joint until the pedicle bones are reached.
• A small portion of the ligamentum flavum, present between the lamina bones and the spinal cord, is also removed.
• Removal of this ligament exposes the nerves present in the spinal canal.
• Soft tissues present around the spinal nerves are carefully removed with small cutting instruments.
• Any bone spurs or intervertebral disc fragments present near the nerves, are also removed.
• These surgical interventions help in relieving the pressure over the spinal nerves, present in the spinal canal
• Finally, the muscles and soft tissues are repositioned and the wound is sutured.

Post-operative care

Generally, patients are discharged home on the same day of the surgery.  Patients are instructed to move their back carefully and avoid strain for the next few days. Other post-operative instructions include:

• Avoid driving for at least 2-3 weeks
• Patient can perform light work after 4 weeks
• Avoid heavy work for at least 2-3 months
• Physical therapy should be started after 3-4 weeks

Risk and complications

There are always some complications associated with any major surgery. Some of the common complications associated with lumbar laminectomy include:

• Complications related to anaesthesia
• Conditions such as thrombophlebitis
• Infection
• Damage to the spinal nerves
• Persistent pain
• Spinal segments instability