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A lumbar laminectomy is similar to a microdecompression and is performed to correct pain being caused by nerve compression. This lumbar surgery is designed to remove the portion of the bone or disc material impinging the nerve root, increasing the space available.
Pain can be effectively decreased and for patients suffering side effects from spinal stenosis that are decreasing their function level a laminectomy can help to improve these symptoms. Elderly patients are more susceptible to spinal stenosis, caused as degenerative changes enlarge the facet joints. Enlarged joints place excessive pressure on the nerves, which a laminectomy can effectively relieve.
Laminectomy
Lumbar laminectomy is often referred to as open decompression and differs from a microdoscectomy as there is more muscle stripping and the incision required is longer.
- A two to five inch long incision is made in the midline of the back opening the back for surgery. The left and right muscles are dissected off the lamina on both sides.
- Visualization of the nerve roots occurs once the lamina is removed.
- The facet joints may be trimmed to give increased room for the nerve roots. The facet joints are located directly over the nerve roots.
Expect a one to three day stay in the hospital after your surgery. Returning to normal activity is dependent on the patients age and what their pre-operative condition was. A patient is encourage to start walking directly following the surgery. For the following six weeks a patient is recommended to avoid excessive bending, lifting or twisting as these motions can pull on the suture line before it is completely healed.
When considering the success rate of a laminectomy, about 70 percent of patients report significant improvement in their ability to perform normal activities with reduced amounts of pain and discomfort.
Leg pain caused by spinal stenosis seems to have better surgical result through a laminectomy, but the results for lower back pain relief are not nearly as favorable. When the facet joints become arthritic, lumber spinal stenosis is developed, although much of the back pain is a result of the arthritis. The reason the back pain is not often relieved is because although there has been room created for the nerve roots by trimming the facet joints, the initial arthritic problems have not been corrected. Even if reported as successful the patients symptoms may resurface after a few years as the original degenerative process that created the spinal stenosis continues.
Laminectomy risks
- 1 in 1000 patients will experience nerve root damage, 1 in 10000 people will develop bowel or bladder incontinence because of this
- 1 to 3% of the time the dural sac may become breaked causing a cerebrospinal fluid leak. If this occurs the patient will need to remain lying down so that the break can seal. This usually will take around 24 hours
- About 1% of the time infection may occur. Infection often requires follow up surgery to clean it along with IV antibiotics. Generally speaking infection caused from elective surgery can be managed and cured effectively
- It is very uncommon to have excessive bleeding in the area, as there is a lack of major blood vessels here
- 5 to 10% of people will experience postoperative instability at the operated level. Weakening or cutting the pars interarticularis during surgery can cause the development of isthmic spondylolisthesis after surgery. Continued degeneration of the facet joint may lead to degenerative spondylolisthesis. Either of these reasons may lead to further surgery of spinal fusion to the affected joint at a later date
Complications and side effects of general anesthetic include, heart attack, blood clots, stroke, pneumonia or pulmonary embolism. In the general population these risks are rare, but when considering that the majority of spinal stenosis lumbar surgery is being performed on elderly patients the complications and risk factors become somewhat higher.