Lumbar Laminectomy

A lumbar laminectomy removes most of the bony arch, or lamina, of a vertebra when other medical treatments fail to relieve back pain.

Back pain can grow progressively worse and more disabling, depending on the cause. At some point, your doctor may suggest surgery as one of the alternatives.

The lumbar laminectomy may be one option. Despite medical breakthroughs, back pain has been a common problem through the centuries, often with no simple solutions.

Facts about back pain

• Back pain results in more lost work productivity than any other medical condition. It is the second leading cause of missed workdays (behind the common cold).
• Back pain is more common in men than women.
• Back pain is more common among whites than among other racial groups.
• Most back pain occurs among people 45-64 years of age.
• A common cause of acute back pain is muscle strain. A common cause of chronic back pain is degeneration of the lumbar spine and lumbar disk disease.
• Discussion of back pain has been found on Egyptian papyrus dating 3,500 years ago. Through the centuries, thousands of physicians have evaluated it and recommended treatments for it.

Back pain that can lead to surgery

• The most common site of back pain is in the lower back.
• A significant percentage of people who have back pain have a herniated disk with nerve pain transmitted down a lower extremity. This pain is called sciatica because the problem once was believed to stem from pressure on the sciatic nerve. Sciatica causes pain to radiate through your buttocks into one or both legs.
• A disk acts as a shock absorber for your spine. It is made up of a tough outer ring of cartilage with an inner sac filled with a jelly-like substance. When a disk herniates, the jellylike nucleus pushes through the harder outer ring (annulus), putting pressure on the adjacent nerve root.
• A herniated disk can cause varying degrees of pain and complications. The most serious complication is cauda equina syndrome, compression at the point where the roots of all the lumbar spinal nerves are located.
  • People may lose all nerve function below the area of compression, including loss of bowel and bladder control.
  • This condition is a true surgical emergency requiring immediate decompression of the entrapped nerves if you are to preserve bowel and bladder function. The longer the delay, the less recovery can be expected.

Surgery for back pain

• As with other back pain, doctors first attempt conservative medical treatment for a herniated disc. If conservative treatment fails, surgery often produces gratifying relief.
• Surgery may be considered for anyone with frequently recurring sciatica, usually if the pain interferes with your ability to work or do daily activities.
• Doctors decide to perform surgery, however, only after they have tried a variety of treatments. Doctors usually reserve surgery for chronic sciatica. In general, most medical experts do not recommend considering surgery in acute sciatica. The decision to have surgery should be a joint decision you make with your doctor.
• Another indication for surgery is a progressive loss of nerve function. For example, you may lose a certain reflex and later begin to lose strength gradually.
  • Far more commonly, people go to a doctor with an acute lack of nerve function.
  • Usually, these function losses are minor and may come and go. They respond well to conservative medical treatment.
  • If the deficit is severe -- you cannot bend a knee or move a foot -- surgery is an option.
  • Many people may not regain full nerve function after surgery, however.
• Men are twice as likely to need surgery as women.
• The average age for surgery is 40-45 years.
• More than 95% of disk operations are performed on the fourth and fifth lumbar vertebrae.

Types of back surgery

Doctors perform three common surgeries on the back to relieve nerve root compression. These procedures are sometimes referred to as decompressive operations. They often are done in combination with each other.

• Lumbar laminotomy - Removal of part of the bony lamina above and below a nerve that is getting "pinched."
• Lumbar laminectomy - Removal of most of the bony arch, or lamina, of a vertebra (Laminectomy is most often done when back pain fails to improve with more conservative medical treatment.)
• Lumbar discectomy- Removal, or partial removal, of a spinal disk

• Lumbar laminectomies are performed by orthopedic surgeons or neurosurgeons.
• Sometimes neurologists or physiatrists are involved with neurologic monitoring during the operation.
• Physiatrists and physical therapists are often involved in postop recovery and assistance with therapeutic exercises.

All operations have risks. Complications occur rarely, but include the following:

• Nerve damage
• Blood clots
• Spinal fluid leak
• Bleeding
• Infection
• Worsening of the chronic back pain
• Risks associated with anesthesia

Weeks before your surgery is scheduled, both your doctor and a neurosurgeon or orthopedic surgeon will examine you to make sure you are healthy enough for the surgery.

A few days before the surgery, you will meet with the anesthesiologist to discuss your options. Usually you will have either a general anesthesia or spinal anesthesia.

• You should give the surgeon and anesthesiologist a list of all prescriptions and over-the-counter medications you are taking.
• The doctor may instruct you to stop taking anti-inflammatory medications such as aspirin and ibuprofen (Advil, Motrin) before surgery.
• If you smoke, you should stop or at least cut down before surgery.
• Imaging tests such as X-rays and MRIs will be done. Many hospitals and surgeons require other tests such as ECGs (a heart tracing) and routine blood work before surgery. Depending on your age and medical conditions, these tests can vary.
• You will be instructed to take no food or drink by mouth after midnight on the day of surgery. Most surgeons do allow you to brush your teeth and take medicine.

Usually, you will be placed on your abdomen, in a kneeling position to reduce the weight of your abdomen on your spine.

• The surgeon will make a straight incision over the desired vertebrae and down to the lamina, the bony arches of your vertebrae.
• The doctor removes the ligament joining the vertebrae along with all or part of the lamina. The goal is to see the involved nerve root.
• The doctor gently moves the nerve root back toward the center of your spinal column and removes the disk or part of the disk.
• The doctor closes the incision. Your large back muscle now protects your spine or nerve roots.
• The surgery takes one to three hours. You lose very little blood.

• Recovery: You will be moved to a recovery area until you are fully awake, and then you will return to your hospital room.
  • Normally you will lie on your side or back.
  • You may have a catheter in your bladder.
  • You should expect to have some pain at first. Nurses will provide pain medicine as needed.
  • You likely will wear compression stockings or compression boots to reduce the chance of blood clots developing in the legs.
• Hospital room: Once you return to your hospital room, nurses will check your vital signs and help with pain control.
  • Depending on the surgeon's preferences and your needs, you may be given pain medicine orally or by IV injection.
  • The medication will not make you pain-free, but it should make the pain tolerable.
  • Sometimes the surgeon will give you a machine that allows you to provide pain medicine as needed, within certain limits. Patient-controlled analgesia (PCA) pumps allow you a little more control over managing your pain.
• Walking: Usually, you will begin to walk within hours of the surgery. To avoid certain pulmonary complications or pneumonia, you may be asked to do a variety of breathing exercises.
• Protection while moving: A few simple techniques will help reduce postsurgical pain and injury. The goal is to protect your back.
  • Tighten your abdominal muscles to help support your spine. Stand up straight, keeping your ears, shoulders, and hips in a straight line.
  • Always bend at the hip and not at the waist. Move your body as a unit and do not twist at the hips or shoulders.
• Sleeping and getting in and out of bed: You may have difficulty sleeping for the first few nights, especially if the recommended positions are different from your normal sleeping positions. Some options include the following:
  • Sleep on your back with pillows under your neck and your knees.
  • Lie on your side with your knees slightly bent and a pillow between your knees.
  • Getting out of bed also can be tricky initially, but with some simple techniques, you can minimize possible injury or pain.
  • Tighten your abdominal muscles and roll on to your side, making sure to move your body as a unit.
  • Scoot to the edge of the bed and press down with your arms to raise your body. As you raise your body, gently swing your legs to the floor.
  • Place one foot behind the other, tighten your abdominal muscles, and raise your body with your legs.
  • To get into bed, back up to the edge of the bed, tighten your abdominal muscles, and lower yourself into bed with your legs.
  • Once sitting on the bed, use your arms to lower your body onto the bed while you lift your feet into the bed.
  • Roll your body as one unit onto your back.

• Most surgeons prefer to see you about one week after your operation to make sure that the incision is healing well and that you are not having any postoperative complications.
• If stitches or staples were used, the doctor usually frequently will take them out at this time.
• Most surgeons like to do a more comprehensive follow-up in four to eight weeks.
• Often, your personal doctor also wants to see you during the first month or two after surgery.

Call your surgeon or doctor if you have any of these symptoms:

• Drainage from the incision
• Redness at the incision
• If stitches or staples come out
• The bandage becomes soaked with blood
• Fever over 100.4 F
• Increasing pain or numbness in your legs, back, or buttocks
• Inability to urinate
• Loss of control of bladder or bowels, with loss of urine or stool, or both
• Pain, swelling, or redness in one of your legs
• A severe headache
• If you have any other questions about the way you are recovering

Go to the hospital's emergency department immediately if you develop any of these conditions or complications:

• Sudden shortness of breath, which may or may not be accompanied by pain in the chest. This could be a sign of pulmonary embolism (blood clot in lungs), pneumonia, or other heart and lung problems.
• If you lose control of your bowel or bladder, or if you are unable to urinate
• If you are unable to move your legs (This is a serious sign of spinal cord or nerve compression.)

You can do several things to make your recovery at home easier.

• Move groceries, toiletries, and other supplies to places between the level of your hip and shoulder where you can reach them without bending over.
• Make sure someone can drive you around for one to two weeks after surgery and to help with chores and errands.
• Buy a pair of slip-on shoes with closed backs to make dressing easier and to minimize bending over.
• Short frequent walks each day may reduce your pain as well as speed your recovery.
• Typically, if you have a sedentary job, you may return to work in one to two weeks. A person with a more strenuous job may have to remain off work for two to four months.
• As your back heals, you may feel ready to have sex. This is usually fine. Choose a position that puts as little pressure on your back as possible.
  • Side positions or lying on your back are generally acceptable.
  • Avoid putting pressure on your back or arching your back during sex.
• Do not drive a car for one to two weeks, or as long as you are taking any medication that makes you drowsy.
• Do physical therapy as guided by a healthcare professional.