Laminectomy

From Wikipedia, the free encyclopedia

Intervention:
Laminectomy

Upper view of a human vertebra, showing the lamina

ICD-10 code:

ICD-9 code: 03.09

MeSH D007796

Other codes:

Laminectomy is a spine operation to remove the portion of the vertebral bone called thelamina. There
are many variations of laminectomy. In the most minimal form small skin incisions are made, back
muscles are pushed aside rather than cut, and the parts of the vertebra adjacent to the lamina are left
intact. The traditional form of laminectomy (conventional laminectomy) excises much more than just
the lamina; the entire posterior backbone is removed, along with overlying ligaments and muscles. The
usual recovery period is very different depending on which type of laminectomy has been performed:
days in the minimal procedure, and weeks to months with conventional open surgery.

As pictured, the lamina is a posterior arch of the vertebral bone lying between the spinous process,
which juts out in the midline, and the more lateral pedicles and transverse processes of each vertebra.
The pair of laminae, along with the spinous process, make up the posterior wall of the bony spinal
canal. Although the literal meaning of laminectomy is excision of the lamina, the operation called
conventional laminectomy, which is a standard spine procedure inneurosurgery and orthopedics,
removes the lamina, spinous process and overlying connective tissues and ligaments, cutting through
the muscles that overlie these structures. Minimal surgery laminectomy is a tissue preserving surgery
that leaves the muscles intact, spares the spinal process and takes only one or both lamina.
Laminotomy is removal of a mid-portion of one lamina and may be done either with a conventional
open technique, or in a minimal fashion with the use of tubular retractors and endoscopes.
A lamina is rarely, if ever, removed because it itself is diseased. Instead, removal is done to: (1) break
the continuity of the rigid ring of the spinal canal to allow the soft tissues within the canal to expand
(decompression), or (2) as one step in changing the contour of the vertebral column, or (3) in order to
allow the surgeon access to deeper tissues inside the spinal canal. Laminectomy is also the name of a
spinal operation that conventionally includes the removal of one or both lamina as well as other
posterior supporting structures of the vertebral column, including ligaments and additional bone.

Conventional open laminectomy often involves excision of the posterior spinal ligament, and some or
all of the spinous process, and facet joint. Removal of these structures, in the open technique, requires
cutting the many muscles of the back which attach to them. Laminectomy performed as a minimal
spinal surgery procedure, however, allows the bellies of muscles to be pushed aside instead of
transected, and generally involves less bone removal than the open procedure.

The success rate of laminectomy depends on the specific reason for the operation, as well as proper
patient selection and technical ability of the surgeon. Indications for laminectomy include (1) treatment
of severe spinal stenosis by relieving pressure on the spinal cord or nerve roots, (2) access to a tumor
or other mass lying in or around the spinal cord, or (3) a step in tailoring the contour of the vertebral
column to correct a spinal deformity such as kyphosis. The actual bone removal may be carried out
with a variety of surgical tools, including drills, rongeurs, and laser.

The recovery period after laminectomy depends on the specific operative technique, minimally invasive
procedures having a significantly shorter recovery period than open surgery. Removal of substantial
amounts of bone and tissue may require additional procedures to stabilize the spine, such as fusion
procedures, and spinal fusion generally requires a much longer recovery period than simple
laminectomy.

Most commonly, laminectomy is performed to treat spinal stenosis.

Contents
[hide]

• 1 For spinal stenosis

• 2 Results

• 3 See also

• 4 References

• 5 External links

[edit]For spinal stenosis

Spinal stenosis is the single most common diagnosis leading to any type of spine surgery, and
laminectomy is a basic part of its surgical treatment. The lamina of the vertebra is removed or trimmed
to widen the spinal canal and create more space for the spinal nerves and thecal sac. Surgical
treatment that includes laminectomy is the most effective remedy for severe spinal stenosis; however,
most cases of spinal stenosis are not severe and do not require surgery. When the disabling
symptoms of spinal stenosis are primarily neurogenic claudicationand the laminectomy is done without
spinal fusion, there is generally a very rapid recovery with excellent long term relief. But if the spinal
column is unstable and fusion is required, there is a recovery period of months to more than a year,
and relief of symptoms is less likely.

The first laminectomy was performed in 1887 by Dr. Victor Alexander Haden Horsley, a professor of
surgery at the University College London. He was lauded for his breakthrough procedure.

A common type of laminectomy is performed to permit the removal or reshaping of a spinal disc as
part of a lumbar discectomy. This is a treatment for a herniated disc, bulging or degenerated disc.

[edit]Results

In most known cases of lumbar and thoracic laminectomies,[citation needed] patients tend to recur pain or
spinal stenosis for a period of 1–1.5 years, and tend to recover very slowly. According to a World
Health Organization census in 2001, most patients who had undergone lumbar laminectomy recovered
normal functioning a year after their operation.[citation needed]

Back surgery can relieve pressure on the spine, but is not a cure-all spinal stenosis treatment. There
may be considerable pain immediately after the operation, and pain may continue for a period of time.
For some people, recovery can take weeks or months and may require long-term physical therapy.
Surgery does not stop the degenerative process, and symptoms may return, sometimes within just a
few years.[1]

[edit]See also

Definition
By Mayo Clinic staff
Laminectomy, also called decompression, is surgery to remove the lamina — the back part of
the vertebra that covers your spinal canal. Laminectomy enlarges your spinal canal, relieving
pressure on the spinal cord or nerves caused by narrowing of the spine (spinal stenosis).
Laminectomy may also be performed as part of surgical treatment for a herniated disk.

Laminectomy is not necessary for everyone who has spinal stenosis. Laminectomy usually is
used when more conservative treatment, such as medication and physical therapy, has failed
to relieve symptoms, or when symptoms are severe.
In some cases, laminectomy may be performed in conjunction with spinal fusion, a procedure
that helps stabilize your spine.

Why it's done

By Mayo Clinic staff
Spinal stenosis
Laminectomy is performed to relieve the pressure spinal stenosis places on your spinal cord or
spinal nerves.

Your doctor may recommend laminectomy if:

 Conservative treatment, such as medication or physical therapy, fails to improve your

symptoms after 12 weeks

 You have muscle weakness or numbness that makes standing or walking difficult

 You experience loss of bowel or bladder control

Disk herniation
In some cases, laminectomy may be necessary as part of surgery to treat a herniated spinal
disk. Your surgeon may need to remove part of the lamina to gain access to the damaged
disk.

Risks
By Mayo Clinic staff
Laminectomy is generally a safe procedure. But as with any surgery, laminectomy carries a
risk of complications.

Potential complications include:

 Bleeding

 Infection

 Blood clots

 Injury to blood vessels or nerves in and around the spine

 Injury to the protective layer surrounding the spine (dura mater)

How you prepare

By Mayo Clinic staff
You may need to avoid eating and drinking for a certain amount of time before surgery. Your
doctor will give you specific instructions.

What you can expect

By Mayo Clinic staff
During laminectomy
Surgeons usually perform laminectomy using general anesthesia, so you're unconscious during
the procedure. The anesthesiologist or anesthetist gives you an anesthetic medication as a gas
— to breathe through a mask — or injects a liquid medication into a vein.

The surgical team monitors your heart rate, blood pressure and blood oxygen throughout the
procedure with a blood pressure cuff on your arm and heart-monitor leads attached to your
chest. After you're unconscious:

 The surgeon makes an incision in your back over the area of your spine affected by
stenosis and moves the back muscles away from your spine as needed.

 Small instruments are used to remove the lamina covering the areas affected by spinal
stenosis.

 If laminectomy is being performed as part of surgical treatment for a herniated disk,

the surgeon also removes the herniated portion of the disk and any pieces that have
broken loose (diskectomy).

 If one of your vertebrae has slipped over another or if you have curvature of the
spine, spinal fusion may be necessary to stabilize your spine. During spinal fusion, the
surgeon permanently connects two or more of your vertebrae together using bone
grafts, and if necessary, metal rods and screws.

 The surgeon closes the incision using staples or stitches.

In some cases, your surgeon may use a laparoscopic technique to perform laminectomy,
rather than open surgery performed through one larger incision. In laparoscopic laminectomy,
a tiny camera and surgical instruments are inserted through several small incisions, and your
surgeon views the operation on a video monitor. Laparoscopic back surgery is complex and
requires great skill. It's not available at all hospitals. You may not be a candidate for
laparoscopic laminectomy if you have a herniated disk or spine instability.

After laminectomy
After surgery, you're moved to a recovery room where the health care team watches for
complications from the surgery and anesthesia. Your doctor may prescribe medication to
relieve pain at the incision site.

You may go home the same day you have surgery, although in some cases a hospital stay of
one to three days may be necessary following laminectomy. Your doctor may recommend
physical therapy after laminectomy to help you regain your strength.

Limit activities that involve lifting, bending and stooping for three weeks after laminectomy.
You may also need to avoid long car rides for at least four to six weeks. Depending on the
amount of lifting, walking and sitting your job involves, you likely will be able to return to work
within two to six weeks.

If you also had spinal fusion, your recovery time may be longer. In some cases after
laminectomy and spinal fusion, it may be eight to 12 weeks before you can return to your
normal activities.
Results
By Mayo Clinic staff
Laminectomy reduces symptoms in 60 to 90 percent of people who undergo the procedure
due to spinal stenosis. Most have less pain and are better able to walk following laminectomy.
You might not notice improvement right away, though. It can take up to six weeks after
surgery to start feeling a reduction in your symptoms. If your nerves were badly damaged
before surgery, some pain, numbness and other symptoms may not go away.

Because laminectomy doesn't stop the process that caused spinal stenosis in the first place,
symptoms may come back over time. One study found that approximately 19 percent of
people who had laminectomy underwent repeat surgery within 10 years of the initial
procedure.

Laminectomy
Laminectomy is surgery to remove the lamina, two small bones that make up a vertebra, or bone
spurs in your back. The procedure can take pressure off your spinal nerves or spinal column.

Description

Laminectomy opens up your spinal canal so your spinal nerves have more room. It is usually
done along with adiskectomy, foraminotomy, and spinal fusion. You will be asleep and feel no
pain (general anesthesia).

• You will lie face down on the operating table. The surgeon will make an incision (cut) in
the middle of your back or neck.
• The skin, muscles, and ligaments are moved to the side. Your surgeon may use a
surgical microscope to see inside your back.
• Part or all of the lamina bones may be removed on both sides of your spine, along with
the spinous process, the sharp part of your spine.
• Your surgeon will remove any small disk fragments, bone spurs, or other soft tissue.
• The surgeon may also do a foraminotomy (to widen the opening where nerve roots travel
out of the spine) at this time.
• Your surgeon may do a spinal fusion to make sure your spinal column is stable after
surgery.
• Surgery takes 1 to 3 hours.

Why the Procedure is Performed

Laminectomy is often done to treat spinal stenosis. The procedure removes bones and damaged
disks, and makes more room for your spinal nerve and column.

Your symptoms may be:

• Pain or numbness in one or both legs. You may feel weakness or heaviness in your
buttocks or legs. You may have problems emptying or controlling your bladder and
bowel.
 • You are more likely to have symptoms, or worse symptoms, when you are standing or
walking.

You and your doctor can decide when you need to have surgery for these symptoms. Spinal
stenosis symptoms often become worse over time, but this may happen very slowly.

When your symptoms become more severe and interfere with your daily life or your job, surgery
may help.

You will have an MRI before surgery that shows you have spinal stenosis.

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs

• Breathing problems
• Infection, including in the lungs (pneumonia), bladder, or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medications

Risks for spine surgery are:

• Infection in wound or vertebral bones

• Damage to a spinal nerve, causing weakness, pain, or loss of feeling
• Partial or no relief of pain after surgery
• A return of back pain in the future

If you have spinal fusion, your spinal column above and below the fusion is more likely to give
you problems in the future.

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought
without a prescription.

During the days before the surgery:

• Prepare your home for when you leave the hospital.

• If you are a smoker, you need to stop. People who have spinal fusion and continue to
smoke may not heal as well. Ask your doctor for help.
• Two weeks before surgery, your doctor or nurse may ask you to stop taking drugs that
make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin),
naproxen (Aleve, Naprosyn), and other drugs like these.
• If you have diabetes, heart disease, or other medical problems, your surgeon will ask you
to see your regular doctor.
 • Talk with your doctor if you have been drinking a lot of alcohol.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses
you may have.
• You may want to visit a physical therapist to learn some exercises to do before surgery
and to practice using crutches.

On the day of the surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the
procedure.
• Take your drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Your doctor or nurse will ask you to get up and walk around as soon as your anesthesia wears
off, if you did not also have spinal fusion. Most patients go home 1 to 3 days after their surgery.