Laminectomy

Laminectomy is surgery to remove the lamina, part of the bone that makes up a vertebra, or bone spurs in your back. The procedure can take pressure off your spinal nerves or spinal canal. Description Laminectomy opens up your spinal canal so your spinal nerves have more room. It may be done along with adiskectomy, foraminotomy, and spinal fusion. You will be asleep and feel no pain (general anesthesia). y y y y y y y 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: y y 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. Risks Risks for any surgery are: y y y y y y 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: y y y y y 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

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Nerve root damage (1 in 1,000) or bowel/bladder incontinence (1 in 10,000). Paralysis would be extremely unusual since the spinal cord stops at about the T12 or L1 level, and surgery is usually done well below this level. 1 to 3% of the time a cerebrospinal fluid leak may be encountered if the dural sac is breached. This does not change the outcome of the surgery, and generally a patient just needs to lie down for about 24 hours to allow the leak to seal. Infections happen in about 1% of any elective cases, and although this is a major nuisance and often requires further surgery to clean it up along with IV antibiotics, it generally can be managed and cured effectively. Bleeding is an uncommon complication as there are no major blood vessels in the area. In approximately 5 to 10% of cases, postoperative instability of the operated level can be encountered. This complication can be minimized by avoiding the pars interarticularis during surgery, as this is an important structure for stability at a level. Weakening or cutting this bony structure can lead to an isthmic spondylolisthesis after surgery. Also, the natural history of a degenerative facet joint may lead it to continue to degenerate on its own and result in a degenerative spondylolisthesis. Either of these conditions can be treated by fusing the affected joint at a later date.

y 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 You will have an MRI before the procedure to confirm that you have spinal stenosis. Always tell your doctor or nurse what drugs you are taking, those you bought without a prescription. During the days before the surgery: y y y 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.

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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: y y y 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. Outlook (Prognosis) Laminectomy for spinal stenosis will often provide full or partial relief of symptoms Future spine problems are possible for all patients after spine surgery. If you had spinal fusion and laminectomy, the spinal column above and below the fusion are more likely to have problems in the future. If you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may have more of a chance of future problems Alternative Names Lumbar decompression; Decompressive laminectomy; Spine surgery laminectomy

Complications of Lumbar Laminectomy

By Rose Kitchen , eHow Contributor

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A lumbar laminectomy is a surgical procedure performed on the lumbar area of the spine (the lower back) to alleviate pressure on the nerves of the spine, which in turn should alleviate pain and other symptoms. This is a condition called spinal stenosis. Spinal stenosis occurs when pressure is put on the spinal nerves due to narrowing of the spinal canal. During a lumbar laminectomy, the surgeon locates the back of the spinal canal and removes a part of its bony covering to relieve pressure on the affected spinal nerves. Since a lumbar laminectomy is a surgical procedure involving the spine, there is a risk of serious complications. Related Searches: y y Abdominal Surgery Post Surgery

1. Anesthesia Problems
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Anesthesia can cause complications. Though this lumbar laminectomy complication is not common it can be serious. If a patient has an allergic reaction to anesthesia he can experience respiratory distress, which can lead to death. An allergic reaction may also cause anaphylaxis, or

a closing of the throat due to allergies. When the throat closes it can cause the patient to not be able to breathe, which can also result in death if not immediately treated.

Blood Clots
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Patients who have had a lumbar laminectomy will have trouble getting around for a while and this may cause them to stay in bed. Not moving around can cause blood clots that can be a serious complication. If a patient experiences a blood clot it will develop in her lower legs. In some cases this clot may release and make its way to the lungs. If a blood clot lodges in the lungs it can cause serious problems, such as lowering the amount of oxygen in the blood, permanent lung damage due to the lung tissue not receiving an adequate supply of blood and sometimes death. Blood clots may also cause damage to other organs due to insufficient oxygen.

Infection
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All patients who have a lumbar laminectomy will have incisions made into their lower back. These incisions can become infected but often are easily treated with antibiotics and rest. However, if left untreated the infection may travel to deeper tissues, causing permanent damage and in some cases death.

Nerve Damage
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Nerve damage can occur if one or more nerves are damaged during surgery. If a nerve or nerves become damaged the patient may experience pain, tingling or numbness. If these symptoms are especially bothersome, persistent or severe the patient may need to have another surgery to repair the nerves, if repair is possible.

Ongoing Pain
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The main purpose of a lumbar laminectomy is to alleviate pressure on the spinal nerves to help reduce or eliminate the patient's pain. However, not all patients will experience a reduction in their pain. Some patients may even experience an increase in their pain. If this occurs the patient may need to have the surgery repeated or his doctor may suggest another type of spinal surgery.
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Causes !
Herniated Disk Six to twelve weeks conservative treatment of a herniated disk includes avoiding painful positions and following an exercise and pain-medication regimen relieves symptoms in 90 percent of people with a herniated disk, according to the American Academy of Orthopaedic Surgeons. In approximately 10 percent of patients, medication and physical therapy fail to improve symptoms such as sharp back pain that shoots down the leg, weakening of the leg muscles and loss of sensation in the leg and foot,

then laminectomy relieves the pressure. The herniated disk may occur at the level of the cervical, thoracic or lumbar spine.

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Lumbar Spinal Stenosis "Harrison's Principles of Internal Medicine" says that lumbar spinal stenosis refers to a narrowed spinal canal. According to AAFP.org, as stated by Jamie Alvarez, M.D., lumbar spinal stenosis commonly affects middleaged and elderly patients. Symptoms of spinal stenosis may include: back, buttock and leg pain made worse by walking or standing and relieved by sitting. Typically, canal stenosis occurs over several levels, so that the surgeon performs multilevel decompressive laminectomies. Mayoclinic.com says that laminectomy decreases symptoms in 60 to 90 percent of patients with spinal stenosis. Spinal Epidural Abscess Symptoms of spinal epidural abscess include the triad of fever, aching back pain and rapidly progressive weakness, states "Harrison's Principles of Internal Medicine." Risk factors include: diabetes, alcoholism and intravenous drug abuse. Skin infections that spread to the spinal canal through the bloodsteam account for approximately two-thirds of epidural abscesses. Staphylococcus aureus, an organism found on skin, most commonly causes epidural abscess. Epidural abscess may involve multiple spinal levels, sometimes requiring as many as seven, or more laminectomies. Urgent spinal decompression plus intravenous antibiotics prevents paralysis. Tumor Jong-Eun Sim, M.D. in the "Journal of Korean Neurological Society," states that spinal cord tumors have an incidence of 10 per 100,000 people. The most common spinal cord tumors involve the nerve sheath, like schwannoma and neurofibroma. Laminectomy allows removal of these tumors.

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Read more: http://www.livestrong.com/article/129683-reasons-laminectomy/#ixzz1l8VBOxRw

http://www.livestrong.com/article/129683-reasons-laminectomy/

Read more: Complications of Lumbar Laminectomy | eHow.com http://www.ehow.com/about_5414616_complications-lumbar-laminectomy.html#ixzz1l8TjDG6G

References ! http://orthodoc.aaos.org/khanna/lumbar_lamin.htm