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Laminectomy

Spinal stenosis results in a symmetric compression on the spinal nerves due to degeneration and overgrowth of the joints, ligaments, and bone spurs. Surgery to treat spinal stenosis often requires more extensive decompression than a simple microdiscectomy and is known as a Laminectomy.

Laminectomy is generally used only when more-conservative treatments — such as medication, physical therapy or injections — have failed to relieve symptoms. Laminectomy may also be recommended if symptoms are severe or worsening dramatically. This procedure involves “unroofing” the spinal canal by removing the bone, known as the lamina, and enlarged ligaments along the back of the spine. The arthritic facet joints are also shaved down to provide more room for the exiting spinal nerves.

Laminectomy is surgery to remove the lamina. This is part of the bone that makes up a vertebra in the spine. Laminectomy may also be done to remove bone spurs in your spine. The procedure can take pressure off your spinal nerves or spinal cord. Activities are limited to walking for the first several weeks following the operation. Physical therapy is often useful, initially involving stretching and range of motion exercises followed by endurance and strength training.

Hospital Stay: Hospital Stay: 3 days
Duration: Duration: 1-3 hrs
Cost Estimate: Cost Estimate: 2500 USD - 4500 USD These are indicative prices in Indian Hospitals

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:

  • 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 of spine surgery are:

  • 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

Before the Procedure

You may have an MRI or CT myelogram before the procedure to confirm that you have spinal stenosis.
Tell your doctor or nurse what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.
During the days before the surgery:

  • 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 medicines that make it harder for your blood to clot.
  • 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 medicines you should still take on the day of the surgery.
  • Let your doctor know right away if you get a 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.
  • Your doctor or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.

On the day of the surgery:

  • You will likely be asked not to drink or eat anything for 6 – 12 hours before the procedure.
  • Take the medicines your doctor told you to take with a small sip of water.

Surgery

Laminectomy opens up your spinal canal so your spinal nerves have more room. It may be done along with a discectomy, foraminotomy, and spinal fusion. You will be asleep and feel no pain.

  • You lie face down on the operating table. The surgeon makes an incision 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 removes any small disk fragments, bone spurs, or other soft tissue.
  • The surgeon may also do a foraminotomy at this time to widen the opening where nerve roots travel out of the spine.
  • Your surgeon may do a spinal fusion to make sure your spinal column is stable after surgery.
  • The muscles and other tissues are put back in place. The skin is sewn together.
  • Surgery takes 1 – 3 hours.

After the Procedure

Your doctor or nurse will encourage you to get up and walk around as soon as the anesthesia wears off, if you did not also have spinal fusion. Most patients go home 1 – 3 days after their surgery.

Outlook /Prognosis

Laminectomy for spinal stenosis often provides full or some relief of symptoms.
Decompressive laminectomy is successful in relieving leg pain in 70% of patients allowing significant improvement in function and markedly reduced level of pain and discomfort. However, back pain may not be relieved and 17% of older adults need another operation.

Laminectomy is a type of back surgery used to relieve compression on the spinal cord. It removes the lamina (part of the bone that forms the vertebral arch in the spine) and/or bone spurs. These structures can put pressure on the spinal cord or nerve roots and cause:

  • mild to severe back pain
  • numbness or weakness in the legs
  • difficulty walking
  • difficulty controlling bladder or bowel movements

A laminectomy is only used if your symptoms interfere with daily life. It is performed when less invasive treatments have failed.
The surgery is also called:

  • lumbar laminectomy
  • cervical laminectomy
  • decompressive laminectomy

Laminectomy is often done to relieve the effects of spinal stenosis. In this condition, your spinal column narrows and puts pressure on the spinal cord or nerves. Spinal stenosis may be caused by:

  • aging
  • arthritis of the spine
  • congenital defect such as abnormal spine growth
  • Paget’s disease of bone
  • achondroplasia / dwarfism
  • tumors in the spine
  • traumatic injury
  • herniated or slipped disc

A laminectomy is performed while you are under anesthesia. You may be asleep during the procedure (general anesthesia). You may be also be awake under spinal anesthesia. Either way, you will feel no pain during the procedure. An anesthesiologist will monitor you throughout the surgery.
During the surgery, your surgeon will generally:

  • clean the skin over the surgical site with an antiseptic solution to help prevent a bacterial infection
  • make a small incision in the middle of your back or neck
  • move your skin, muscles, and ligaments to the side to get a better view
  • remove part or all of the lamina bones on your spine
  • remove bone spurs or small disk fragments
  • close the incision with stitches
  • cover the incision with sterile bandages

During the procedure, your surgeon may also perform spinal fusion, in which two or more bones are connected in the back to better stabilize the spine, or foraminotomy, in which the area where the nerve roots go through the spine is widened.

Risks of spine surgery include:

  • damage to a spinal nerve
  • unsuccessful treatment -pain persists after surgery
  • return of back pain
  • infection in the surgical site or vertebral bones

Tell your healthcare provider if you:

  • take any drugs, vitamins, or supplements, whether prescription or over-the-counter
  • are pregnant or think you could be pregnant
  • are sensitive or allergic to any medications, anesthetic agents, tape, or latex

Before the surgery, your healthcare provider may ask you to:

  • stop taking blood-thinning medications, such as aspirin
  • stop smoking if you are a smoker
  • not eat or drink anything after midnight the evening before the surgery

You should arrange for someone to pick you up and take you home after the surgery. You may also need to arrange for someone to help you around the house while you heal.

When you wake up after surgery, your healthcare provider will usually ask you to get up and walk around a bit. You will probably stay in the hospital for one to three days.
While you are recovering, you should:

  • avoid strenuous activity and heavy lifting
  • climb stairs carefully
  • walk and increase your activities gradually
  • schedule and go to all follow-up appointments

While showering, do not scrub over the incision site. Do not apply any lotions or creams near the incision. Avoid bathtubs, hot tubs, and swimming pools until otherwise notified. These increase the risk of infection.
Your healthcare provider will give you specific instructions on how to take care of your wound.
Call your healthcare provider immediately if you experience:

  • swelling on or near the incision site
  • draining, heat, or redness on the incision site
  • difficulty breathing or chest pain
  • fever of 100° Fahrenheit or higher
  • tenderness or swelling in your legs
  • difficulty urinating
  • loss of bowel or urination control

Laminectomy will often relieve many symptoms of spinal stenosis. It cannot prevent spine problems in the future, however. It may also not completely relieve pain in all patients.
Patients who also have a spinal fusion are more likely to have spinal problems in the future.

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