Decompressive Laminectomy for Lumbar Spinal Stenosis
Decompressive laminectomy is the most common type of surgery done to treat lumbar (low back) spinal stenosis. This surgery is done to relieve pressure on the spinal nerve roots caused by age-related changes in the spine. It also is done to treat other conditions, such as injuries to the spine, herniated discs, or tumors. In many cases, reducing pressure on the nerve roots can relieve pain and allow you to resume normal daily activities.
Laminectomy removes bone (parts of the vertebrae) and/or thickened tissue that is narrowing the spinal canal and squeezing the spinal nerve roots. This procedure is done by surgically cutting into the back.
In some cases, spinal fusion (arthrodesis) may be done at the same time to help stabilize sections of the spine treated with decompressive laminectomy. Spinal fusion is major surgery, usually lasting several hours. There are different methods of spinal fusion:
There are a variety of specialized techniques that can be used in spinal fusion, although the basic procedure is the same. Techniques vary from what type of bone or metal implants are used to whether the surgery is done from the front (anterior) or back (posterior) of the body. The method chosen depends on a number of things, including your age and health condition, how many vertebrae are involved, the severity of nerve root pressure and associated symptoms, and the surgeon's experience. Spinal fusion increases the possibility of complications and the recovery time after surgery.
What To Expect After Surgery
Depending on your health and the extent of the surgery, it may take several months or more before you are able to return to your normal daily activities.
Why It Is Done
Surgery for spinal stenosis is considered when:
The decision to have surgery is not based on imaging test results alone. Even if the results of imaging tests show increased pressure on the spinal cord and spinal nerve roots, the decision to have surgery also depends on the severity of symptoms and your ability to do normal daily activities.
In some cases, spinal fusion will be done at the same time to stabilize the spine. Spinal fusion might make it easier for you to move around (improve function) and relieve your pain. It can also help keep the bones from moving into positions that squeeze the spinal canal and put pressure on the spinal nerve roots.
How Well It Works
Surgery for spinal stenosis usually is elective but may be recommended if symptoms cannot be relieved with nonsurgical treatment. In general, experts feel that surgery has good results and relieves pain in the lower extremities for people who have severe symptoms of spinal stenosis and who have few other serious health problems.
Research shows that:
But symptoms may return after several years. A second surgery may be needed if:
Spinal fusion may be done at the same time as decompressive laminectomy. Spinal fusion may help to stabilize sections of the spine that have been treated with decompressive laminectomy. In general, fusion is only done if an area of the spine is unstable, which means the bones of the spine (vertebrae) move too much or do not move in a normal way. This extra movement causes wear and tear on the nerves or other soft tissues, leading to irritation and pain. The goal of fusion is to keep the damaged bones in the spine from moving so that the soft tissues are protected.
Complications from spinal stenosis surgery may result from the impact of other existing medical problems and the severity of the spinal problem. Also, all surgery poses risks of complications. These complications may be more serious in an older adult.
Possible complications include:
If you have diabetes or circulation problems or if you are a smoker, you may be at greater risk for complications.
What To Think About
Most experts recommend that people with spinal stenosis try nonsurgical treatments before choosing surgery.
Surgery for lumbar spinal stenosis is most likely to relieve pain, numbness, and weakness that are mostly in your legs. Surgery may not work as well for relieving pain that is mostly in your back.
Surgery is usually effective if you have severe leg pain and numbness and you have not been able to move around well for a long time. But in some cases, the symptoms return after surgery. It is also possible that nerve symptoms, including numbness and clumsiness, may not be relieved or may return.
After a laminectomy and fusion, spinal stenosis may develop directly above or below the surgery site. Repeated surgeries for spinal stenosis increase your risk of complications and instability in the spine.
Age should not be a factor in deciding whether to have decompressive laminectomy. But if you have other medical conditions that will make this procedure and follow-up rehabilitation less successful, surgery may not be recommended.
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