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laminectomy is the most common type of surgery done to treat
stenosis. This surgery is done to relieve pressure on the spinal cord camera
or 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.
If you are
interested in decompressive laminectomy as a treatment for your spine pain,
contact us to determine what option is
best for you, what your insurance will cover and any additional surgery
Laminectomy removes bone (parts of the vertebrae) and/or thickened tissue
that is narrowing the spinal canal and squeezing the spinal cord and nerve
roots. This procedure is done by surgically cutting into the back.
Laminectomy with Spinal Fusion
In some cases, spinal fusion (arthrodesis) may be done at the same time to
help stabilize sections of the spine camera treated with decompressive
Spinal fusion is major surgery, usually lasting several hours.
There are different methods of spinal fusion:
In the most common method, bone is taken from elsewhere in your body or
obtained from a bone bank. This bone is used to make a "bridge" between
adjacent spinal bones (vertebrae). This "living" bone graft stimulates the
growth of new bone.
In some cases an additional fusion method (called instrumented fusion) is
performed, in which metal implants (such as rods, hooks, wires, plates, or
screws) are secured to the vertebrae to hold them together until new bone
grows between them.
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 factors, including your age and health condition, the
location (lower back or neck [cervical]) of stenosis, 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
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
When Should you Consider Surgery
spinal stenosis is considered when:
Severe symptoms restrict normal daily activities and become more severe than
you can manage.
Nonsurgical treatment does not relieve pain, and severe nerve compression
symptoms of spinal stenosis (such as
numbness or weakness) are getting
You are less able to control your bladder or bowels than usual.
You notice sudden changes in your ability to walk in a steady way, or your
movement becomes clumsy.
Most spinal stenosis occurs in the lower (lumbar) back. If you have
in the neck (cervical) area, your doctor may recommend surgery because this
condition can cause spinal cord and nerve damage and paralysis.
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 perform normal daily
In some cases spinal fusion will be done at the same time to stabilize the
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
Laminectomy Surgery Outcome
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:
- Out of 100 people who had this surgery, up to
80 were satisfied with the results. This means that about 20 out of 100
were not satisfied.
- Out of 100 people who have this surgery, 10 to
20 need to have surgery again after several years because their symptoms
come back. This means that 80
to 90 out of 100 don't need a second surgery.
- Surgery may work better than nonsurgical
treatments to relieve pain and help you move better. If nonsurgical
have not worked well enough, surgery
might be able to help you.
- By 3 months, people who had surgery notice more
improvement in their symptoms and can be more active than people
who did not have surgery. This
difference continues for at least 4 years after surgery.
- The benefits of surgery appear to last for many
years. After 8 to 10 years:
- People treated with surgery were as satisfied as those treated without
- People who had surgery were generally able to be more active and had less
leg pain than those who had
But symptoms may return after several years. A second surgery may be needed
Spinal stenosis develops in
another area of the spine.
- An earlier surgical procedure
was not effective in controlling symptoms.
- Instability develops, or
fusion does not occur.
- Regrowth of tissue (lamina)
presses on the spinal cord or spinal nerve roots.
Spinal fusion may be done at the same time as
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 small bones can move too
much. This extra movement causes
wear and tear
on the 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.
Risks of Laminectomy Surgery
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:
Problems from having general anesthesia.
A deep infection in the surgical wound.
A skin infection.
Blood clots in the deep leg or pelvic veins (deep vein thrombosis), which in
rare cases travel to the lungs (pulmonary
An unstable spine (more common after multiple laminectomies are done without
using spinal fusion).
Nerve injury, including weakness, numbness, or paralysis.
Tears in the fibrous tissue that covers the spinal cord and the nerve near
the spinal cord, sometimes requiring a second
Difficulty passing urine or loss of bladder or bowel control.
Death (rare) related to major surgery.
If you have diabetes or circulation problems or if you are a smoker, you may
be at greater risk for complications.
A posterior thoracic
laminectomy is an
operation performed to decompress either a nerve or the spinal cord within
the thoracic area. This procedure may be performed to decompress the spinal
cord or nerves of compression from bone spurs,
(bleeding), or infection. We focus here on the posterior (from the back)
approach. The patient is brought to the operating room, and put to sleep.
Then, once asleep and on a ventilator (breathing apparatus), the patient is
carefully turned into the prone position (face down). Care is taken to
ensure that all "bony" areas are well protected, to prevent pressure sores.
The surgeon will now incise the skin overlying the appropriate levels of the
spine, and push the muscle away from the spine. Retractors hold the
muscle aside, and the surgeon then removes one or more of the lamina (roof
of the spinal cord). Depending on where the nerve or spinal cord
compression is, part of the joint connecting two adjacent vertebral body
levels may also be removed. Often, spinal cord monitoring may be used
during the case, depending upon the degree of spinal cord compression and
the judgment of the
surgeon. After the decompression has been accomplished,
closure of the muscle layer, deep fascia (deep fibrous tissue) and skin is
Posterior thoracic laminectomy is
performed much less frequently than lumbar or cervical laminectomies.
Risks can be broken down into two categories, 1) those related to the
operative site, and 2) those related to the risks of anesthesia.
Risks related to the operative site:
Surgical Exposure: The patient
is placed in the prone position (face down). In this position, there
can be pressure sores, pressure injuries to nerves, and injury to the
eyes as a result of pressure to them. During surgical
injury to muscle surrounding the spine can occur.
Spinal Cord/Nerve Root injuries:
If there is any injury to the spinal cord in the thoracic area, this
could result in paralysis of the lower extremities, as well as loss of
bowel, bladder and sexual function. There may be a spinal fluid
leak, which could occur after a tear of the covering of the spinal cord
or nerve roots. There is a small chance of causing instability.
General Risks: These include
general difficulties, such as bleeding, infection,
coma and death. Incisions on the back generally heal well, but the
incision site could be tender, or may heal in an unpleasant manner,
with scarring. There is also the possibility that the surgery may not
relieve the symptoms for which the procedure was performed. The problem
for which the surgery was performed may recur, requiring additional
surgery in the future. In addition, although every attempt is made to
protect all areas of the body from pressure on nerves, skin and bones,
injuries to these areas can occur, particularly with prolonged cases.
Risks of Anesthesia:
clots in the legs, heart attacks, reaction to the anesthetic,
to blood transfusion, if given.
There shall be no bending, twisting,
or heavy lifting for several weeks after surgery. Physical therapy may
or may not be implicated. Your doctor will gradually ease your work
restrictions, depending on your progress.
Remember to keep the wound dry and
clean. Notify your
surgeon of any drainage or temperatures greater than
The goal of this surgery was to
relieve the pressure on the nerves and/or spinal cord in your back.
The healing process may be a long one, depending on whether nerve root
or spinal cord damage was involved. Some continuing back pain is not
unusual during the first few days and weeks following surgery. Hurt
does not necessarily mean harm. However, it's always better
to be safe than sorry. If you have any concern about your post-operative
recovery, call one of our trained
specialists at United Spine & Joint.