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Laminectomy

A laminectomy is a surgery done on the spine and is usually done in the lumbar area to prevent lower extremity pain and weakness brought on by spinal stenosis. The procedure is also called an "open decompression" and is designed to correct neural impingement of the spine.

This is a surgery usually done on older patients, who have developed spinal stenosis due to osteoarthritis. The degeneration results in an increase in the size and quality of the facet joints. These joints cause increased pressure on the spinal nerves and on the spinal cord. After a laminectomy, the pressure on the nerves is released and the patient is able to function better.

With a laminectomy, a small piece of bone overlying the nerve root or disc is removed so that the nerve root has more space to travel to the outside part of the body.

During the procedure, a fairly large 3-5 inch incision is made in a vertical way in the midline of the back. The bilateral erector spinae muscles on both sides of the spine are dissected away from the spinal laminae at multiple levels of the spine. This exposes the spine. The lamina or laminae affecting the patient are uncovered and the affected laminae are removed. The nerve roots are exposed and the facet joints are trimmed away if necessary to give the nerve roots the complete ability to pass to the exterior of the body.

Risks & Complications

The lumbar laminectomy and laminectomies on other parts of the spine carry risks and complications. These risks include the following:

• There is a one out of a thousand chance of nerve root injury that is permanent. Paralysis fortunately is very uncommon.
• You can have a postoperative case of bowel and bladder dysfunction. This occurs in one out of every 10,000 surgeries.
• Leakage of cerebrospinal fluid happens about 1-3 percent of the time. This means that the patient must lie down for about twenty four hours after the procedure. This allows the leak to seal itself.
• Infections occur about 1 percent of the time. This means that further surgery must be done to clean up the space. IV antibiotics are necessary to clear the infection for good.
• Bleeding complications can happen but are rare due to the fact that there aren’t any major blood vessels in the area.
• You can develop postoperative instability in about 5 percent to 10 percent of cases. This is a complication that is avoided by not injuring the pars interarticularis at the time of surgery. This is an important part of the spine as it gives the spine its bony structure. A degenerated disc tends to get only more degenerated unless managed by spinal fusion procedures.

In a laminectomy, most patients do well. In fact, about 70 to 80 percent of postoperative patients have a significant reduction in pain and an improvement in their degree of daily functioning because of a resolution of spinal stenosis. Fewer patients have surgical success following a laminectomy when it comes to pain in the leg. Pain in the lower back is often not corrected by any of these types of surgeries. There is still going to be arthritis in the low back which will make the back pain unchanged following the surgery.

If the procedure is done along with a spinal fusion, the success rate for extremity pain and weakness of the extremities is better. When the joint is fused, the spinal stenosis does not reoccur and the back will be significantly more stable. Pain caused by spinal instability is better after having a fusion after a laminectomy. This is especially the case if the condition involves is called degenerative spondylolisthesis. Fusion is not necessary if there is a stenosis on multiple levels due to a congenitally shallow canal. Fusion is, however, a good procedure if just one joint is involved in the surgical procedure.