Laminectomy

What is 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 Laminectomy?

Laminectomy may be suitable for individuals who:

• 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 exams.
• Have imaging studies, such as an MRI or CT scan, that show significant spinal stenosis (narrowing of the spinal canal) or a herniated disc.

Benefits of 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, which is the lower part of the spine. It is also sometimes referred to as an "open decompression."

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: In certain cases, especially when there's spinal instability, the vertebrae may be fused. This can be done in combination with a laminectomy.
• 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

Tell Prof Malham about any medical conditions or previous operations. Suppose you have a medical condition such as diabetes, heart problems, high blood pressure or asthma. In that case, Prof Malham may arrange for a specialist physician to see you for a pre-operative assessment and medical care following the neurosurgery. 

Inform Prof Malham of the medication you are taking and/or have allergies to medications. You must stop using the following 10 days pre-operatively: 

• Aspirin
• Plavix
• Isocover
• Asasantin

You must stop using blood thinning medication (such as Warfarin) 3-5 days pre-operatively. 

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.
• 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 nerve space. The surgeon might also remove bone spurs or a herniated disc if they contribute to the compression.
• Closure: The muscles are put back in place, and the incision is stitched up.
• Recovery: You're then taken to a recovery room, monitored as you wake from the anaesthesia.

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 that strain your back or put pressure on the surgical area.
• Physical Therapy: Engage in physical therapy exercises as your surgeon or physical therapist recommends to help you regain strength, flexibility, and mobility.
• Wound Care: Following your surgeon's instructions, 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

• Infection: There is a risk of post-operative infection at the surgical site or surrounding tissues.
• Bleeding: Excessive bleeding during or after the surgery may occur, requiring additional medical intervention.
• 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.
• Blood Clots: There is a risk of developing blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism) following surgery.
• Failure to Relieve Symptoms: In some cases, laminectomy may not completely relieve the symptoms or the symptoms may recur over time.
• 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.

What if 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 surgeon who can assess your situation and provide appropriate guidance on the timing of the surgery.