What Is a Laminectomy?
A laminectomy, also known as spinal decompression, is a procedure in which a small piece of the vertebra is removed to relieve pressure on nerve roots in the spine, or treat a condition called spinal stenosis. The laminectomy is sometimes done in conjunction with a smaller procedure, called foraminotomy.
The spine consists of 24 vertebrae, or backbones. Each vertebra has a body, which houses the spinal cord, nerve roots and an intervertebral disc that acts as a shock absorber, as well as a lamina that provides support and protection on the rear of the vertebra.
Over time, the lamina can develop bony growths called bone spurs, often due to arthritis. These spurs can crowd the spinal canal, putting pressure on nerve roots and causing pain, weakness or numbness to radiate from the spinal cord to the areas the compressed nerves serve (a phenomenon known as radiculopathy). Removing the lamina creates more room in the spinal canal, often leading to a reduction in radiculopathy symptoms.
Common Reasons for a Laminectomy
A laminectomy can be an effective treatment for a number of conditions. In nearly all cases, laminectomies are performed only after other treatments like medication or physical therapy has proven ineffective. Because laminectomies most often relieve pressure on nerves, the procedure has better results when it’s used to treat radiculopathy rather than direct back or neck pain.
Laminectomies can be used treat:
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Bulging or herniated discs, in conjunction with discectomy, when the inner layer of an intervertebral disc punches through the outer layer and can put pressure on nerve roots
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Paget’s disease, a condition that causes bone regeneration abnormalities
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Spinal stenosis, a narrowing of the spinal canal
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Spinal tumors
Candidates for a Laminectomy
Most of the time a laminectomy is reserved for cases that have not improved with other, more conservative treatment. Laminectomy alternatives will vary depending on the cause of the pain, but in general, can include:
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Analgesics (pain medicine)
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Anti-inflammatory medication
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Changes in activity
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Exercise or physical therapy
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Lifestyle changes, like losing weight
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Steroid injections
Good candidates for a laminectomy include people who:
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Have an imaging study that shows spinal stenosis or a herniated disc
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Have developed bladder or bowel incontinence, indicating a serious compression in the lumbar spine (lower back)
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Have pain and other symptoms that have not been lessened by other means
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Have peripheral pain that is worse than back pain
The Procedure
A laminectomy can be an open procedure, during which surgeons will use a comparatively large incision to access the vertebra directly. In some cases, the procedure can be done using a minimally invasive technique, with small tools, smaller incisions and a camera attached to a video monitor.
First, an incision is made and the muscles over the vertebrae are moved. In an open procedure, the muscle may have to be cut. That is rarely necessary during minimally invasive surgery, where the muscle is usually retracted or pulled aside to access the backbone.
Next, the lamina is removed. Depending upon the root cause of the back pain, surgeons may perform other procedures at this point, such as a microdiscectomy or spinal fusion. Then the muscle is put back into place and the incisions are sewn up.
Laminectomies are done under general anesthesia, meaning the patient is asleep during the procedure. The surgery itself usually takes about one to three hours.
Recovery
According to the Cleveland Clinic, the laminectomy success rate is somewhere between 70 and 80 percent. This procedure is sometimes, but not always, an outpatient procedure, meaning the patient may leave the hospital the same day as the surgery. In other cases, a short hospital stay is necessary.
Recovery takes place over a matter of weeks. In the beginning, the patient will be restricted from driving, lifting anything heavier than about 10 pounds or bending or twisting at the waist. The patient may need help to perform daily activities such as washing.
Gradually the pain will subside, and mobility will increase. Depending upon the job, patients can usually return to work in about a month. Surgeons may recommend physical therapy for a period after the surgery to help speed recovery.
If you have back or neck pain that has not gone away despite conservative treatment, request an appointment with one of our spine specialists. We will discuss your diagnosis and your options for treatment.