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12 January 2009

Laminectomy

One of the most common back operations is a laminectomy. Laminectomy literally means “removal of the lamina”. The lamina is part of the spinal canal's bony structure.

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One of the most common back operations is a laminectomy. Laminectomy literally means “removal of the lamina”. The lamina is part of the spinal canal's bony structure.

Why a laminectomy?
A laminectomy is performed to relieve nerve root compression (pinched nerve) on one or more nerve roots in the spinal column. The nerve root compression often causes back and leg pain.

The causes of nerve root compression include:

  • a slipped/ruptured/herniated disc;
  • spondylosis caused by degeneration of discs accompanied by formation of a bony spur formation;
  • scar tissue

How?
Step 1: A laminectomy is performed with the patient lying on his stomach or side and under general anaesthesia. The surgeon (an orthopaedist or a neurosurgeon) reaches the spinal column through a small incision in the back.
Step 2: He will use a retractor to spread the muscles of the back apart in order to expose the bony lamina.
Step 3: He cuts away part of the lamina to uncover the ligamentum flavum - a ligament supporting the spinal column.
Step 4: In the next step he will cut an opening in the ligamentum flavum to reach the delicate spinal canal containing the compressed nerve.
Step 5: The compressed nerve can now be seen as well as the bundle of nerve fibres (known as the cauda equina) to which it is attached. It is now possible to identify the cause of compression: a bulging, ruptured or herniated disc, or perhaps a bone spur.
Step 6: The source of the pressure can now be removed. This may involve removing the bulging portion of the disc or the bony spurs and scar tissue. The herniated disc is removed after the compressed nerve is gently retracted to one side. The surgeon will remove as much of the disc as is necessary to take pressure off the nerve. Sometimes a fragment of disc has moved and presses on the nerve root as it leaves the spinal canal. This will often cause more severe symptoms. Because of the fragment’s location (outside the disc space), a CT scan (computerised x-ray) may be required.
Step 7: With the cause of compression removed, the nerve can now begin to heal. The space created by removal of the disc will gradually fill with connective tissue. The incision is closed in several layers, from inside out.
Step 8: The skin layer will be closed with steri-strips, sutures or skin clips. Then a dressing will be placed over the incision to protect the wound.

The operation will take more or less two hours.

After Surgery
A plastic drain will run from inside the wound to remove any blood accumulating in the wound. In most cases the drain can be removed on the second day after surgery.

An intravenous line to administer medication may remain connected through a vein in your hand or arm for two to three days.

Pain can and should be well controlled. Usually the acute pain subsides after a day or two. Pain may be most severe in the lower back. Leg pain may be caused by swelling of the previously compressed nerve and the trauma of the surgery. Muscle spasms across the back and down the legs are not uncommon and this can be relieved by muscle relaxants.

A physiotherapist will help you begin standing and walking again, and show you how to get in and out of bed, how to sit, stand, and sleep.

Read more:
Cycling may help back

 
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