Laminectomy is a surgical procedure in orthopedic spine surgery that involves the removal of the lamina. The lamina is a portion of the vertebral bone located on the dorsal portion of the spine. A laminectomy is usually done at the level of the cervical and lumbar area, but the thoracic vertebrae can also be a site.
The performance of laminectomy is done to relieve symptoms associated with spinal cord conditions and also to prevent the deterioration of the neurological status of patients as a result of compression of the spinal cord and nerves.
Why is Laminectomy Performed?
The removal of the lamina has a principal use: to relieve pressure on the spinal nerves and spinal cord as a result of compression from narrowing of the spinal canal or other conditions affecting the vertebrae. Some of the common conditions requiring laminectomy include:
- Herniated Disc
A herniated intervertebral disc is a common reason for laminectomy. When the disc herniates, the disc may compress the spinal nerves along the affected area causing problems in muscle strength and sensations in the limbs. With laminectomy, the pressure is relieved on the herniated disc and spinal nerves relieving associated symptoms.
- Arthritis of the spine
When degeneration occurs on the spine, the space within the spine also narrows leading to spinal stenosis. When this happens, the narrowed space may compress the spinal cord. To relieve the compression, the removal of the dorsal portion of the spine or the lamina is warranted.
- Spinal tumor
When tumors arise along the spine, the most common entry point inside the vertebrae is through the removal of the lamina. When the lamina is already removed, the surgeon can access the tumor inside the vertebral foramen.
Is Laminectomy Frequently Done?
Except for the presence of a spinal tumor, laminectomy is not routinely done. The surgical procedure is by far, the last treatment modality for spinal conditions. For instance, it is not done for disc herniation when patients can still respond to more conservative approaches such as physical therapy and traction. Since laminectomy is an invasive procedure, it is only done when no other managements are deemed effective to relieve the symptoms.
What Happens during the Procedure?
The procedure is generally done under general anesthesia after the patient has eaten nothing at least 8 hours prior to the surgery. After the induction of the anesthesia, the patient is positioned depending on the location of the spinal condition.
Incisions are made on the skin up to the muscles. After which, the muscles are retracted from the vertebrae to expose the spine. When the lamina has been accessed, the surgeon often cuts or drills over the area to remove the lamina. The spinal nerves and spinal cord are also evaluated whether they are still compressed or not. After being certain that the spinal nerves are not compressed any more, the muscles, subcutaneous tissues and skin are sutured to close the surgical site.
What Interventions are done After the Procedure?
After any surgery, post-operative care should be employed to promote healing and prevent complications. The following are the important points to consider when recovering from a laminectomy:
- Proper positioning. Immediately after the surgery, the patient will be placed on a prone position to relieve the back from tension. The patient is then rolled as a unit when turning on the bed to maintain the spine in a straight alignment.
- Early ambulation. Patients are also encouraged to ambulate early after 24 hours of surgery. Physical therapists usually assist post-laminectomy patients in ambulation and exercise to prevent stress on the operative site.
- Activity limitations. Activities that strain the spine such as bending, climbing, prolonged sitting and standing should be avoided. Wearing high-heeled shoes should also be postponed or avoided throughout.
- Proper sleeping measures. Firm mattress should be used to adequately support the back. A supine position is preferred following the acute phase of surgery to maintain the proper alignment of the spine.
- Proper monitoring. Signs of infection and bleeding should also be monitored to prevent more serious complications. Fever, severe pain and abnormal drainage are all signs of infection following surgery.
Before undergoing the procedure, make sure to discuss it with your surgeon completely to have adequate knowledge on the preparation and post-operative care.