Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine
Laminectomy is a term increasingly used in discussions between patients and doctors. It is indeed a surgical procedure recommended for certain patients suffering from back pain.
Your doctor may have diagnosed you with a cervical or lumbar condition that requires this surgery. What is laminectomy? In what cases should it be considered? Is this a safe operation? How is recovery going?
This article aims to shed more light on laminectomy, and will serve as a guide if you ever consider this operation.
Definition of laminectomy
Laminectomy is a surgical procedure consisting of removing one (or more) spinal laminae. For your information, the vertebral laminae are found at the back of the vertebrae, and notably allow the passage of the spinal cord through the spinal canal, as well as the protection of the nerve roots.
Sometimes the spinal canal is narrowed, causing potential compression of the spinal cord and irritation of the corresponding nerve roots. It is to this extent that laminectomy, by removing the vertebral laminae, will reduce nerve compression and widen the size of the spinal canal.
The most common indication for laminectomy is narrow lumbar canal. This is a condition where the size of the spinal canal is narrowed for one reason or another (we will see the causes below). This operation then makes it possible to widen the lumbar canal, and thus reduce the nerve compression causing the symptoms of back pain and others (numbness, tingling, weakness, feeling of electric shock in the legs, etc.).
How can the spinal canal be narrowed? spinal osteoarthritis, degenerative disc disease, spondylolisthesis, the herniated disc, these are common causes of narrow lumbar canal. It is important to emphasize that they depend on each individual. This narrowing, or “stenosis” of the spinal canal most often manifests itself in back pain and radiation to the legs. These pains may be accompanied by numbness, tingling, sensation of electric shock, etc.
When this disease is diagnosed, the doctor does not necessarily resort to laminectomy straight away. He first prescribes the patient a conservative medical treatment including the taking of analgesics and anti-inflammatories. He also refers to kinesitherapy (physiotherapy) or osteopathy for treatment. Then, an infiltration is often proposed to relieve the symptoms.
On the other hand, if the evil is at an advanced stage and that the conservative treatments offer no relief, the surgical intervention remains the ultimate alternative to enlarge the diameter of the spinal canal.
Note, however, that some situations require urgent medical intervention. They usually occur when the spinal cord or cauda equina is compressed, and cause symptoms as described in this article.
Other types of decompressive surgery
Alternatives to laminectomy include:
- Laminoplasty
- Discectomy
- Corpectomy
- Foraminotomy
- Arthrodesis
- Flavectomy
It should be noted that the optimal surgical technique to treat spinal or nerve root compression remains controversial. One approach is not necessarily superior in all circumstances, and the best option will depend on patient-specific anatomical and symptomatic factors.
How is the operation going?
The intervention essentially aims to remove the compression of the nervous elements. Like any surgical operation, its realization takes place in several stages.
The operation takes place under general anesthesia. The patient is then placed on his stomach, resting on cushions. A urinary catheter is generally placed at the start of anesthesia. The surgeon makes an incision in the lumbar region after a short radiological examination. Said examination makes it possible to identify the part of the narrowed spinal canal, and to locate the precise location of the skin incision.
The size of the incision depends on several factors, such as the number of vertebral levels to be operated on, or whether or not the vertebrae need to be fixed. Once the incision is made, the surgeon spreads the muscle masses of the back to gain access to the spinal canal.
The operation will consist in removing the blades which participate in compressing the nervous elements responsible for the symptoms. However, in certain situations (such as lumbar instability), an arthrodesis can be performed. It allows bone fragments to be fixed using screws, plates, nails or pins.
Once the nerves and spinal cord are no longer under any pressure, the operation is completed by putting the muscles back in place and closing the incision.
Possible Complications of a Laminectomy
Like any procedure, laminectomy has its own limitations. Under no circumstances does it restore your spinal canal to its original state. The doctor cannot 100% guarantee you a result in advance, even with the most reliable and widely used techniques. Among the possible complications following a laminectomy, we can cite:
- Failure of the intervention carried out, scar disunity, delayed or impaired healing, skin necrosis, unsightly or painful scar;
- A hematoma may occur during the procedure. When the volume of this hematoma is large, it can cause compression of the spinal cord contained in the cervical canal:
- Superficial infection of the surgical site is possible, but remains very rare. Thanks to appropriate care, it can be regulated;
- The occurrence of vascular, nerve or ocular compression;
- The occurrence of phlebitis: blood clots can form in the legs. This is a common complication after surgery;
- The onset of a pulmonary embolism when blood clots formed in the legs travel to the lungs. A direct consequence of phlebitis;
- Occurrence of paralysis, rupture or failure of implant or osteosynthesis material, delayed consolidation, pseudarthrosis.
Be still without fear, the majority of these complications heal (sometimes with sequelae). Others, on the contrary, require appropriate treatment. In some arguably worse scenarios, such as deep surgical site infections, further surgery is required.
Recovery after lumbar laminectomy
Once the narrow lumbar canal operation has been performed, you will first be kept in hospital for a few days before returning home. So how does this hospitalization and convalescence from the aftermath of a laminectomy take place?
It is customary for the patient to be kept in the recovery room 1 to 3 hours after surgery, where he thus benefits from close monitoring. When you wake up (up to several days after the operation), it is completely normal to feel some back pain. The doctor will most often prescribe medication to help you control it.
On the day of the procedure, and your first night, you will stay in bed. You will be able to adopt your usual sleeping positions, unless you normally sleep on your stomach. The nursing staff will make sure to help you, especially with your minor needs.
The day after the procedure, you can hope to get up and try a few steps. The physiotherapist or nurses will be of great help to you in this process. Over the next few days, you will gradually regain your autonomy. You will then be able to move through the corridors, take the elevator then the stairs on your own. However, the physiotherapist will always be there to show you the right actions.
After hospitalization, which lasts an average of 3 to 5 days, your discharge will be possible. If you must return by car, it is recommended to avoid lying down during the journey. And for this, straighten the seat so that you are in the correct sitting position. For long distances, choose an ambulance to take you home.
Stopping work following a laminectomy is mandatory. The duration will depend on your situation (job, medical condition, rehabilitation, etc.). The work stoppage can then cover 6 to 12 weeks. 4 to 5 weeks after the operation¸ you will go to the hospital for a check-up. In addition, the physiotherapist or occupational therapist will support you in your return to normal life (home chores, work, sports activities, etc.).
Conclusion
Lumbar laminectomy is used to treat certain conditions like narrow spinal canal. Obviously, a conservative treatment should be established beforehand, and the operation must remain the ultimate solution (except in certain exceptional cases).
During the operation, the objective will be to remove the vertebral laminae in order to remove the pressure on the nerves and the spinal cord which cause the pain and neurological symptoms (numbness, tingling, feeling of electric shock, weakness, etc.) .
Although it carries potential risks, laminectomy is frequently used, and remains a relatively safe surgery. Convalescence and rehabilitation accompanied by health professionals generally allows a return to normal life.
Good recovery !
Resources
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