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Updated 18 September 2015

Lumbar laminectomy

A laminectomy or laminotomy is a procedure whereby the lamina is removed.

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What is it?
A laminectomy or laminotomy (a partial laminectomy) is a procedure whereby the lamina (the bony plate covering the spinal canal) is removed to give access to the spinal canal in any area.

How is it performed?
An incision is made in the midline of the back or neck and the muscle is loosened and parted from the posterior elements of the vertebra so that the laminas are exposed. The lamina forms a roof over the neural canal and can be removed in part or in total at one or more levels to expose a single nerve root, multiple nerve roots or the spinal cord.

In the case of disc herniation, a laminotomy is typically sufficient to gain access to the affected nerve root. The nerve root is usually visible just beneath the lamina with the disc herniation underneath it. The nerve root is held out of the way with a retractor so that the herniated disc can be accessed and removed.

In the case of a spinal stenosis, a more extensive laminectomy is performed. It may require the removal of an entire lamina or laminas. This allows the surgeon to uncover the canal containing the nerves and to extend the decompressive laminectomy to the area of the facet joints, where bony spurs can be removed. Occasionally, it may be necessary to remove the entire lamina and a portion of the facet joint.

In cases of extensive laminectomy and where the facet joints are removed as well, a fusion to add stability to that part of the spinal column will be required.

When is it performed?
Laminectomy is performed to treat the causes of spinal-nerve-root compression that may cause arm or leg pain and/or neurological deficits.

It is performed:

  1. if there is significant narrowing of the spinal canal (spinal stenosis) with spinal cord or spinal-nerve-root -related symptoms or signs;
  2. when entry needs to be gained into the spinal canal to remove tumours, infections, cysts and vascular abnormalities;
  3. when entry needs to be gained into the spinal canal to remove significant bone fragments in the spinal canal following trauma and fractures of the spine.

Preparation
Several weeks before surgery, a doctor will determine whether you are physically fit for surgery. A few days before surgery, a meeting with an anaesthesiologist is necessary to determine your anaesthetic options.

You will be admitted on the day or the day before the operation. Do not forget to inform your doctor of any medication that you are taking. It is very important to discuss the use of any anti-clotting medication such as disprin, aspirin, plavix, warfarin etc. with the surgeon as these must be stopped some time before surgery to prevent excessive bleeding during or after surgery.

After surgery
You will experience pain but will be given appropriate pain treatment after the operation.

Compression stockings to prevent clots from forming in the veins of the legs are often used. Placing pillows under your neck and knees may prove to be helpful and make you comfortable. You will also have to sleep on your side or back.

A catheter may be attached to your bladder to collect/measure urine output.

A suction drain will be present under the skin at the site of the operation to drain excessive free blood. The drain is usually removed within 48 hours after the operation.

Walking is encouraged along with breathing exercises. This helps to prevent pneumonia or collapse of the small air sacs in your lungs. In most instances, breathing exercises will be supervised by a physiotherapist and nursing staff.

About a week after surgery, you will have all sutures and staples that were applied during surgery removed. Discharge from hospital will usually be within the first week following the operation, but is dependent on the extent of surgery and the speed of recovery.

You will be required to see your surgeon about one month after the surgery.

 
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