A laminectomy is a surgical procedure that removes a portion of the vertebral bone called the lamina in order to relieve pressure on the spinal cord and nerve roots. At its most minimally invasive, the procedure requires only small skin incisions. The back muscles are pushed aside rather than cut and the parts of the vertebra adjacent to the lamina are left intact. Recovery occurs within a few days.
Lumbar Laminectomy or Lumbar Decompression
This surgery is performed to take pressure off the pinched nerve roots causing sciatica. Spinal stenosis is the medical term. Spinal stenosis can be further classified into two types: central or subarticular stenosis and foraminal or lateral stenosis. Central or subarticular stenosis usually cause so called neurogenic claudication in which patients complain of low back and bilateral buttock pain with pain radiation into both lower extremities. In severe cases neurological deficit such as foot drop may be present. Pain is usually relieved by sitting and aggravated by standing and walking. In foraminal or lateral stenosis only one leg is affected and the sciatica may persist regardless of patient's position even though usually standing and walking are worse positions than sitting.
Surgery takes about two to three hours depending on number of levels to be "decompressed." CT scan or MRI scan and at times CT Myelogram are necessary to make the diagnosis. Nerve root injection may be necessary in lateral or foraminal stenosis to confirm the fact that radiographically pinched nerve root is indeed the cause of patient's leg pain. Lumbar epidural steroid injections or therapeutic nerve root injections may be tried up to three times a year to try to prevent the surgery. Success rate of these procedures are less than 50%. The surgery usually carries about 80 to 90% success rate in relieving patient's symptoms long term.
Complications include about 3 to 5 % chance of dural tear, 1% or less chance of nerve root injury, wound infection, and postoperative instability requiring subsequent fusion surgery. In order to prevent postoperative instability and recurrent stenosis lumbar spine fusion is carried out at the same time when spinal stenosis is accompanied by degenerative spondylolisthesis, isthmic sypondylolisthesis, and degenerative scoliosis.
Please refer to "Postoperative Recovery after Lumbar Decompression" for further information regarding recovery after this surgery.
To prevent postoperative epidural hematoma causing possible paralysis patients should avoid taking all types of blood thinners such as coumadin, persantin, and anti-inflmmatory medications including even Vioxx and Celebrex.