Lumbar Laminectomy

What is Lumbar Laminectomy?

Lumbar = having to do with the spine in the lower back
Laminectomy = removal of the lamina (a section of bone that forms the “roof” over the spinal canal)

A lumbar laminectomy describes the removal of the lamina, a part of the spine that forms a bony “roof” over the spinal canal. This common procedure allows a neurosurgeon to gain access to the spinal canal and relieve compression on the spinal cord or nerve roots.

When performed in the lumbar spine (low back), the procedure is known as a lumbar laminectomy. (Click here for information about laminectomies elsewhere in the spine.)

When is this Procedure Performed?

The most common reason for a lumbar laminectomy in adults is lumbar spinal stenosis, or a narrowing of the lumbar spinal canal. A narrowed spinal canal can compress (pinch) the spinal cord and/or the nerves that exit the spine and branch out to the rest of the body.

Stenosis usually occurs when degenerative changes in the spine lead to a growth of ligaments and joints in the affected area. This growth is the body’s attempt to restore stability to the spine.  Unfortunately, the growth interferes with the space normally occupied by the spinal cord and/or nerves, compressing them. Compression of these tissues may cause:

  • radiculopathy: pain, numbness, tingling or weakness in a single arm or leg. Caused by compression of a nerve root.
  • cauda equina syndrome: loss of bowel or bladder control and/or numbness in the buttocks, genital area, and inner thighs. Caused by compression of nerves in the lumbar spine.
  • neurogenic claudication: activity-related back and leg pain that is relieved with rest.

Nonoperative measures such as physical therapy and pain management may relieve or improve symptoms in some patients. Definitive correction often requires that the compression be relieved surgically.

A lumbar laminectomy may also be performed for reasons besides the relief of compression.  A surgeon may perform a laminectomy in adult or pediatric patients to gain access to the spinal canal to remove a tumor or a vascular malformation, or to treat a tethered spinal cord.

How is this Procedure Performed?

A lumbar laminectomy is performed under general anesthesia, which means the patient is unconscious.

An incision is made in the lower back. The surgeon moves aside layers of muscle and other tissue to expose the bones, called laminae, that form the roof over the spinal canal.

The amount of bone removal depends on the specific situation. The surgeon may remove the lamina from one or both sides of one or more vertebrae. Often a portion of the ligamentum flavum (the ligament that connects the lamina of adjacent vertebrae) must also be removed. During a laminectomy, the surgeon may also shave down parts of the facet joints, joints between vertebrae that can compress nerve roots.  A foraminotomy may also be performed at the same time. This procedure enlarges the foramina, small openings through which nerve roots exit the spine. Removal of a very small amount of lamina is called a laminotomy; this is often performed as part of a microdiscectomy.

In most cases, the degree of bone, ligament or facet joint removal will not significantly affect the strength of the spine. However, depending on the amount of tissue removal and whether the spine has been weakened by arthritis, degenerative changes or previous surgery, the strength of the spine may be compromised. In these situations, the surgeon may perform a spinal fusion, using metal implants and bone grafts to restore spinal strength.

The surgeon then closes the incision layer by layer, using absorbable sutures that can be dissolved by the body.

How Should I Prepare for this Procedure?

Make sure to tell your doctor about any medications that you’re taking, including over the counter medication and supplements, especially medications that can thin your blood such as aspirin. Your doctor may recommend you stop taking these medications before your procedure. To make it easier, write all of your medications down before the day of surgery.

Be sure to tell your doctor if you have an allergy to any medications, food, or latex (some surgical gloves are made of latex).

On the day of surgery, remove any nail polish or acrylic nails, do not wear makeup and remove all jewelry. If staying overnight, bring items that may be needed, such as a toothbrush, toothpaste, and dentures.

What Should I Expect After the Procedure?

Patients are usually encouraged to walk the day after surgery. On average, patients are discharged from the hospital one to three days following surgery. Pain control at home is usually achieved with oral pain medication. A follow-up visit will be scheduled 4-6 weeks after surgery.

  • Will I need to wear a brace?
    No brace is usually required.
  • When can I resume exercise?
    For the first several weeks following surgery, patients can resume low-level activities (like walking or using a stationary bike) as they are able. More rigorous activities should be delayed until 4-6 weeks after surgery.
  • Will I need rehabilitation or physical therapy?
    Physical therapy may be useful for strengthening the lower back and increasing its range of motion. It may be begun after the follow-up visit 4-6 weeks after surgery.
  • Will I have any long-term limitations due to lumbar laminectomy?
    There are no long-term limitations due to lumbar laminectomy.

Preparing for Your Appointment

Drs. Paul C. McCormick, Michael G. Kaiser, Peter D. Angevine, Alfred T. Ogden, Christopher E. MandigoSheng-fu (Larry) Lo and Richard C. E. Anderson (Pediatric) are experts in lumbar laminectomy.

 

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