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Laminectomy is a surgical procedure which creates room by removing the lamina, the posterior region of the vertebra that covers our spinal canal. Also referred to as decompression surgery, laminectomy enlarges the spinal canal to mitigate pressure from the spinal cord or nerves. This discomfort is most commonly caused due to bony overgrowths within the spinal canal which can affect the people who have arthritis in their spines. Laminectomy is commonly performed only when traditional and conservative treatments such as physical therapy, medication, or injections have failed to relieve symptoms. Laminectomy may also be recommended if symptoms are severe or worsening quickly. The surgery is performed under general anesthesia. The patient breathes through a breathing tube using a ventilator during the surgery. Directly over the area of stenosis, an incision is made along the middle of the low back. The lamina portion of bone is completely removed, allowing the nerves to return to their normal size and shape when the compressive lesions are removed. The nerve roots and neurologic structures are protected and carefully retracted, so that the bone spurs can be seen and removed. Small grasping instruments are used to remove the arthritic, overgrown bone spurs. All surrounding areas are also checked to ensure no compressive spurs or disc fragments are remaining. The surgery takes approximately t to 3 hours, depending on the number of spinal levels involved.
Why is it done?
Skeletal overgrowths within the spinal canal can taper the space available in the spinal cord and nerves. The pressure can cause pain, discomfort, weakness, numbness that may radiate towards the arms or legs. Laminectomy is generally better at relieving these types of radiating symptoms than it is at relieving actual back pain.
Laminectomy is recommended when:
- Traditional treatment like physical therapy, or medication fails to improve or alleviate symptoms
- Suffering from muscle weakness or numbness making standing or walking difficult
- Experiencing loss of bowel or bladder control
In certain cases, laminectomy may be necessary as part of surgery to treat a spinal disc herniation. The surgeon may need to remove part of the lamina to gain access to the damaged disk.
Before the procedure
Avoid eating and drinking for a certain amount of time before surgery. The attending surgeon will furnish specific instructions regarding the types of medications one should and shouldn't take before the surgery. The patient may have to undergo an MRI or CT scan before the procedure to confirm spinal stenosis. Tell the doctor or nurse what medicines you have been taking, including supplements, or herbs you bought without a prescription.
Days before the surgery:
- Prepare your home for when you leave the hospital.
- If you are a smoker, stop immediately. People suffering from spinal fusion who continue to smoke may not heal well. Ask your doctor for guidance.
- Two weeks prior to the surgery, the doctor or nurse may ask you to stop taking medicines that make it harder for the blood to clot.
- Patients of diabetes, heart disease, or any other medical problems, may be recommended to see their regular doctor.
- Ask the doctor which medicines you can still take on the day of the surgery.
- If you get a cold, flu, fever, herpes breakout, or other illnesses, let your doctor know right away.
- Visit a physical therapist to learn some exercises to do before surgery and to practice using crutches.
- The doctor or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.
- On the day of the surgery, the patient will be asked not to drink or eat anything for 6 - 12 hours before the procedure.
- Take the prescribed medicines with a small sip of water.
After the procedure
On gaining consciousness after the surgery, your healthcare provider will ask you to get up and walk around a bit. You might need to stay in the hospital for one to three days. While recovering avoid demanding activities and heavy lifting, climb stairs slowly and carefully, walk and increase activities gradually , schedule and go for all follow-up appointments. While taking a shower, do not scrub over the incision site. Do not apply any cream near the incision. Avoid bathtubs, hot tubs, and swimming pools until otherwise notified as they increase the risk of infection.
In case of the following problems, call your healthprovider:
- swelling on or near the incision site
- draining, heat, or redness of the incision site
- difficulty in breathing or chest pain
- fever of 100 degrees Fahrenheit or higher
- tenderness or swelling in the legs
- difficulty in urinating
- loss of bowel or urination control
What to expect after Laminectomy
Surgeons generally perform laminectomy under general anesthesia, so the patient is unconscious during the procedure. The surgical team monitors heart rate, blood pressure and blood oxygen throughout the procedure. The surgeon makes an incision in the back over the affected vertebrae and moves the muscles away from the spine as needed. Small instruments are used to remove the appropriate lamina.
After the surgery, the patient is moved to a recovery room where the medical team watches for complications from the surgery and anesthesia. The patient may also be asked to move his/her arms and legs. The doctor may prescribe medication to relieve pain at the incision site. The patient might go home the same day as the surgery, although in certain cases, her/she may need a short hospital stay. The doctor may recommend physical therapy after a laminectomy to improve strength and flexibility. Restrict the activities that involve lifting, bending and stooping for several months after laminectomy. Depending on the amount of physical activity, the patient may be able to return to work within a few weeks. If the patient has also had spinal fusion, the recovery time may be longer. In certain cases after laminectomy and spinal fusion, it may be six months before one can return to normal activities.
FAQ - Laminectomy
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