Lumbar Laminectomy

Lumbar Laminectomy, also known as decompression laminectomy, is a surgical procedure involving the removal of the lamina, from lumbar vertebrae, to relieve the pressure over the spinal nerves and alleviate pain. L3, L4 and L5 are most common lumbar vertebrae associated with leg pain, due to stenosis. Lamina is the part of the vertebra covering the back of the spinal canal. Lumbar laminectomy is recommended only when the non-surgical treatment fails to relieve the symptoms.

Procedure

The procedure is performed under general anesthesia. The patient lies face down on the operating table for the procedure. A vertical incision is made over the middle of the lower back. The muscles and the soft tissue are retracted, to expose the spine. The accurate level of the vertebrae is confirmed by an intra-operative X-ray and the lamina is then cut completely from both the sides of the spine leaving an empty segment in the bony ring, around the spinal canal. Most surgeons use a surgical microscope while cutting the lamina to improve their view of the work area. A small part of the ligamentum flavum, compressing the nerve, is also cut and removed. Microsurgical instruments are then used to remove any disc fragments or bony spurs around the spinal nerves. Hence any form of compression around the spinal nerves is completely released. The muscles and the soft tissue are then carefully placed in their normal positions and the incision is closed.

Sometimes a lumbar spinal fusion may also be done along with lumbar laminectomy to stabilize the spine. Stabilization is required when a major portion of the lamina is removed from many lumbar vertebrae, destabilizing the spine, or in patients with spinal instability along with nerve compression.

After the surgery

The patients are generally discharged in a day or two after the surgery. The leg pain is significantly reduced after the surgery although numbness might take a slightly longer time to resolve. Pain around the incision and back muscle spasms may be experienced by some patients but usually resolve within a week or two after the surgery.

The incision should always be kept clean and dry. The bandaged area should be covered properly to prevent it from getting wet, especially while bathing. Patients are advised to avoid lifting, bending or twisting of the back for four to six weeks after the surgery. The patient may be advised to wear a back brace. The patient may resume work, with some restrictions, as early as two to four weeks after the surgery.

Risks and complications      

The risks associated with lumbar laminectomy are low but may include infection, bleeding, nerve damage, spinal cord injury and leakage of spinal fluid.