Lumbar Laminectomy Surgery
A lumbar laminectomy is also known as an open decompression and typically performed to alleviate pain caused by neural impingement that can result from lumbar spinal stenosis.
A condition that primarily afflicts elderly patients, spinal stenosis is caused by degenerative changes that result in enlargement of the facet joints. The enlarged joints then place pressure on the nerves, and this pressure may be effectively relieved with the laminectomy. We see this in many of our patients in the Dallas, Irving, Red Oak, Plano, Duncanville, Grapevine, Southlake and surrounding Dallas Fort Worth area.
The lumbar laminectomy is designed to remove a small portion of the bone over the nerve root and/or disc material from under the nerve root to give the nerve root more space and a better healing environment.
The lumbar laminectomy (open decompression) differs from a microdiskectomy in that the incision is longer and there is more muscle elevation of the underlying bone.
- First, the back is approached through a two-inch to five-inch long incision in the midline of the back, and the left and right back muscles are dissected off the lamina on both sides and at multiple levels.
- After the spine is approached, the lamina is removed (laminectomy), allowing visualization of the nerve roots.
- The facet joints, which are directly over the nerve roots, may then be undercut (trimmed) to give the nerve roots more room.
Post laminectomy, patients are usually discharged from the hospital on the day of surgery, and the individual patient’s mobilization (return to normal activity) is largely dependent on his/her pre-operative condition and age. Some patients are kept overnight for observation because of other medical comorbidities.
Patients are encouraged to walk directly following a laminectomy for lumbar stenosis. However, it is recommended that patients avoid excessive bending, lifting or twisting for six weeks after this stenosis surgery in order to avoid pulling on the suture line before it heals.
The success rate of a lumbar laminectomy to alleviate pain from spinal stenosis is generally favorable.
Following a laminectomy, approximately 80% to 90% of patients will have significant improvement in their function (ability to perform normal daily activities) and a markedly reduced level of pain and discomfort associated with spinal stenosis.
The surgical results of a lumbar laminectomy are particularly effective for leg pain (sciatica) caused by spinal stenosis, which can be severe. Unfortunately laminectomy surgery is not nearly as reliable for relief of lower back pain.
This is because lumbar stenosis is often created by the facet joints becoming arthritic, and much of the low back pain is from the arthritis.
Although removing the lamina and part of the facet joint can create more room for the nerve roots, it does not eliminate the arthritis. Unfortunately, the symptoms may recur after several years as the degenerative process that originally produced the spinal stenosis continues.
Preparation before SurgeryÂ
Optimizing your physical condition before surgery will certainly improve your recovery and outcome. Maintain a healthy, balanced diet before surgery. Stop Smoking. Smoking can significantly delay healing, increase risks, and adversely affect outcomes. Smoking cessation cannot occur with use of nicotine supplements such as nicotine patches and nicotine gum. Prior to surgery, try to minimize the use opiod pain medications, as decreased preoperative utilization correlates with both better long term outcomes and allows for more reliable postoperative pain management.
Risks of Surgery
A lumbar laminectomy is able to alleviate spinal stenosis pain by removing painful pressure on the nerve root and/or disc space. However, the procedure is not foolproof. Complications from this surgery for lumbar stenosis can result from a variety of factors.
The potential risks and complications with a lumbar laminectomy include:
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- Nerve root damage (1 in 1,000) or bowel/bladder incontinence (1 in 10,000). Paralysis would be extremely unusual since the spinal cord stops at about the T12 or L1 level, and surgery is usually done well below this level.
- Cerebrospinal fluid leak (1% to 3% of the time). If the dural sac is breached, a cerebrospinal fluid link may be encountered but does not change the outcome of the surgery. Generally a patient just needs to lie down for about 48 hours to allow the leak to seal. This could warrant the need for additional surgery.
- Infections (about 1% of any elective cases). Although an infection is a major nuisance and often requires further surgery to clean it up along with IV antibiotics, it generally can be managed and cured effectively.
- Bleeding. While possible, this complication is uncommon as there are no major blood vessels in the area.
- Postoperative instability of the operated level (5 to 10% of cases). This complication can be treated by a spinal fusion surgery for the affected joint at a later date.
General anesthetic complications such as myocardial infarction (heart attack), blood clots, stroke, pneumonia or pulmonary embolism can happen with a lumbar laminectomy as with any surgery.
Although in the general population these complications are rare, laminectomy surgery for spinal stenosis is generally done for elderly patients and therefore the risk of general anesthetic complications is somewhat higher.
Dr. Venkat Sethuraman prides himself in having an extremely low complication rate, far below the published norms. Â He attributes this to having greater than ten years of experience, constantly staying up to date with the spine surgical literature, and the fellowship training he received at the Mayo Clinic in Rochester, Minnesota.
Risks are further minimized by the utilization of Intraoperative Neuromonitoring (IONM). IONM offers insight into the nervous system during spinal surgeries. Use of IONM facilitates the surgical process and can reduce surgical risk by providing critical information and alerts to surgeons of potential harm or compromise to the spinal cord or neural structures.Â IONM provides better insight into a patient’s condition during surgery to support better decision-making that enables the practice of better medicine.Â On the day of your surgery you will meet a member of IONM team that will provide your neuromonitoring for you during your surgery.
Time Away from Work
How much time you need off work primarily depends on the type of work you have.Â After the surgery, you can expect to have a lumbar brace in place.Â I think all patients need some time at home recovering after surgery, usually at least a week. During the postoperative period, you will observe restrictions to your activity level to the level you feel are warranted. During the first six weeks as you are wearing the lumbar brace as you feel is needed. Some patients wear the brace for the entire 6 weeks others rapidly discontinue using it. You should not drive a car for the first 6 weeks. If your job is sedentary, then you may feel comfortable returning to work within a few days. However, if your work is very strenuous, I recommend allowing the back to fully heal which requires an entire 6 weeks off of work. Generally, I advise patients to inform their employers that they are going to require 6 weeks to recover. If post-operatively, you feel you can return sooner, our office will always be happy to provide the proper documentation to you to allow for such. Remember, no one knows your work environment better then you, thus our work release are always based on your consensus.
When you arrive for your surgery, you will meet the anesthesiologist, neuromonitoring technician, and surgical nurses.Â They will discuss with you their procedures and probably make you feel more at ease. Usually, general anesthesia will be given for your surgery. You will be given antibiotics to prevent infection, and support stockings along with sequential compression devices will be placed on your legs. We will then go to operating room and I will perform your procedure. Most lumbar laminectomies require between one to two hours, and postoperatively you spend about an hour in the recovery team. Â During the surgery, I will call out to the waiting room and give your family routine updates. Afterwards, routinely patients are transferred back to the day surgery unit where they started and are discharged home.
When you awaken after surgery, you will receive pain medication and your nurses will closely monitor you. You will have a postoperative in place usually. You will resume a normal diet and be mobilized immediately after surgery. You usually will be discharged the day of surgery. On discharge, you will be given a detail set of discharge instructions and prescription pain medications.
The support stockings you are given in the hospital should be utilized for the first six weeks after surgery. These reduce the risk of blood clots after surgery.
Patients with external stitches will return two weeks post-operatively just for a wound check and to have their stitches removed.Â Otherwise, patients will return for their first postop visit usually six weeks after their date of surgery. I will check radiographs of your back. At that time we will discontinue the brace if you have already not done this on your own.
Successful Lumbar Laminectomy Surgery not only is the result of the procedure, but also very importantly is the result of aftercare and rehabilitation. The initial rehab program is simply composed of performing routine day to day activities while observing your post-operative restrictions. I encourage patients to participate in a daily walking program, progressing at their level of comfort.
We do not start this formal physical therapy until the six week postoperative visit, if warranted.
During this process, please do not hesitate to ask questions. The expert spine team at Spine Physicians Institute is always available to help you. Our goal is to give you best possible care in the most safe and pleasant way possible. Although surgery is not always â€œeasyâ€ for you and requires some work, remember that you are having the surgery because we expect a good result. I wish you a speedy recovery. For any questions about this procedure please call any of ourÂ office locationsÂ conveniently located to theÂ Dallas, Irving, Red Oak, Plano, Southlake, Grapevine, Colleyville and Duncanville areas.
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