Laminectomy

What is a Laminectomy?

Laminectomy is a back surgery to relieve spinal cord or spinal nerve compression.

During this procedure, the surgeon removes a section of bone called the lamina from one or more vertebrae, creating more space for the nerves or spinal cord. This can alleviate pain, numbness, or weakness radiating down the arms or legs.

Who is Suitable for a Laminectomy?

Laminectomy may be suitable for individuals who:

• Laminectomy is often the treatment of choice for the spinal surgical emergency, Cauda Equina Syndrome, where the lumbosacral spinal nerves are critically compressed and can lead to irreversible bowel dysfunction and bladder and leg dysfunction.

OR

• Have severe and debilitating symptoms, typically pain, numbness, or weakness, that limit their daily activities and radiate down the arms or legs.
• Have symptoms that have not improved significantly with conservative treatments, such as medications or physical therapy.
• Show signs of nerve damage on neurological exam.
• Have imaging studies, such as an MRI or CT scan, that show significant spinal stenosis (narrowing of the spinal canal) or a herniated disc that matches the clinical presentation.

Benefits of a Laminectomy

• Relief of Symptoms: A laminectomy can often relieve pain, numbness, and limb weakness from pressure on the spinal cord or nerve roots.
• Increased Mobility: By relieving the symptoms of spinal compression, a laminectomy can help improve a patient's ability to perform daily activities and overall quality of life.
• Prevention of Further Damage: A laminectomy can prevent further nerve damage and associated symptoms.

Types of Laminectomy

• Cervical Laminectomy: This type of laminectomy is performed on the cervical spine, which is the upper part of the spine located in the neck.
• Thoracic Laminectomy: This procedure is performed on the thoracic spine, the middle part of the spine.
• Lumbar Laminectomy: This surgery is performed on the lumbar spine, the lower part of the spine.

Alternative Options to Laminectomy

• Non-surgical treatments include physical therapy, pain management with medications, and epidural steroid injections to relieve inflammation and pain.
• Laminotomy is a less invasive surgery where only a portion of the lamina is removed to decompress the spinal cord or nerves.
• Laminoplasty: This procedure, often performed on the cervical spine, involves reshaping the lamina rather than removing it entirely, thus preserving spinal stability.
• Foraminotomy: This procedure enlarges the foramen, the gap through which the nerve roots exit the spine, to relieve pressure on the nerves.
• Microdiscectomy or Micro-Laminectomy: These minimally invasive surgeries use a smaller incision and specialised instruments to achieve the same goal as a traditional laminectomy.
• Spinal Fusion: The vertebrae may be fused in certain cases, especially spinal instability. This is often done in combination with a laminectomy. Insertion of an intervertebral cage/spacer can achieve “indirect decompression”.
• Artificial Disc Replacement: In some cases, a damaged disc can be replaced with an artificial one to restore normal spacing between the vertebrae and relieve pressure on the nerves or spinal cord.

Preparation for Laminectomy

Before a laminectomy, your surgeon will likely advise you to do the following:

• Medical Evaluation: Undergo a thorough physical examination and possibly some diagnostic tests to ensure you are healthy enough for the procedure.
• Medication Review: Discuss with your surgeon the medications, supplements, or vitamins you take. You may need to stop taking certain medications before the surgery, particularly those that can increase bleeding risks, like aspirin or blood thinners.
• Fasting: You'll likely need to avoid eating or drinking anything after midnight on the night before your surgery.
• Pre-surgical Testing: You may need to have pre-surgical tests, such as blood tests, ECG, or additional imaging studies, before the surgery.
• Smoking: If you're a smoker, you'll likely be asked to quit well before the procedure, as smoking can interfere with healing and recovery.
• Arrange for Help: Organise for someone to drive you home after the procedure and assist with tasks at home as you recover.
• Pre-surgical Physiotherapy: Some surgeons recommend a course of physiotherapy to strengthen the back muscles and improve recovery outcomes.

Laminectomy Procedure

Here is a general overview of what happens during a laminectomy:

• Anaesthesia: You'll be given general anaesthesia, so you will be asleep and not feel pain during the surgery.
• Indwelling Catheter (IDC): A bladder tube will be placed to allow emptying your bladder before and during surgery. This will be removed day-1 post-operation.
• Positioning: Your surgeon and the theatre team will position you on the surgical table face-down. 
• Incision: The surgeon incurs your back over the affected vertebrae.
• Exposure: The muscles are moved aside to expose the spine.
• Removal of Lamina: The surgeon removes the lamina (the back part of the vertebra that covers the spinal canal) to create more space. The surgeon might also remove bone spurs, hypertrophied ligaments or a herniated disc if they contribute to the compression.
• Closure: The muscles are put back in place, and the incision is stitched.
• Recovery: You're then taken to a recovery room and monitored as you wake from the anaesthesia. You will then be transferred to a hospital room before being discharged home between 1-3 days later.

Laminectomy Recovery Plan

Your surgeon will provide personalised instructions, which can include the following.

• Medication Management: Take prescribed pain medications as your surgeon directs to manage pain and any other prescribed medications for other conditions.
• Activity Restrictions: Follow the activity restrictions provided by your surgeon, avoiding activities such as bending, lifting and twisting that strain your back or put pressure on the surgical area for the first three months.
• Physical Therapy: Engage in physical therapy exercises as your surgeon or physiotherapist recommends to help you regain strength, flexibility, and mobility.
• Wound Care: Following your surgeon's instructions, never lie on your wound and keep the incision clean and dry. Watch for signs of infection, such as increased redness, swelling, or drainage, and report any concerns to your healthcare provider.
• Healthy Lifestyle: Follow a healthy lifestyle by eating a balanced diet, staying hydrated, getting adequate rest, and avoiding smoking and excessive alcohol consumption, as these factors can impact healing and recovery.
• Follow-up Appointments: Attend all scheduled follow-up appointments with your surgeon to monitor your progress and address any concerns or complications.

Remember, recovery from a laminectomy can take time, and it's important to be patient and follow your surgeon's guidance.

Laminectomy Prognosis

Laminectomy is a well-established procedure with a good prognosis for many patients. Following a successful laminectomy, most individuals experience significant improvement in their symptoms, such as pain, numbness, or weakness. However, individual results may vary, and some patients may have residual symptoms or require additional treatment or rehabilitation.

Laminectomy Risks

While laminectomy is generally considered safe, like any surgical procedure, it carries certain risks. Potential risks and complications of laminectomy may include

• Complications related to anaesthesia: General anaesthesia carries risks, including allergic reactions, respiratory issues, or adverse medication reactions.
• Bleeding: Excessive bleeding during or after the surgery may occur, requiring additional medical intervention such as blood transfusion.
• Nerve Damage: There is a small risk of damage to the spinal nerves during the procedure, which can result in neurological deficits or worsening of symptoms.
• Dural Tear: The thin membrane covering the spinal cord and nerves (dura) may tear during surgery, leading to cerebrospinal fluid leakage or infection.
• Extension of levels treated: If a dural tear occurs or your surgeon feels the decompression isn’t adequate, the laminectomy may need to be extended.
• Spinal Instability: Removing the lamina can affect the stability of the spine. In such cases, spinal fusion may be performed with the laminectomy to maintain stability.
• Blood Clots: There is a risk of developing blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism) following surgery.
• Infection: There is a risk of post-operative infection at the surgical site or surrounding tissues.
• Failure to Relieve Symptoms or Recurrence: In some cases, laminectomy may not completely relieve the symptoms or recur over time.

What if a Laminectomy is Delayed?

If a laminectomy is delayed, the symptoms that led to considering the surgery may persist or worsen. The progressive compression of the spinal cord or nerves can result in ongoing pain, numbness, weakness, and potentially irreversible neurological damage. In some cases, delaying surgery may lead to a higher risk of complications or make the condition more difficult to treat.

It's crucial to consult with a qualified spinal surgeon who can assess your situation and provide appropriate guidance on the timing of the surgery.