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Decompressive Laminectomy

Decompressive laminectomy is the most common type of surgery done to treat spinal 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, please contact us to determine what option is best for you, what your insurance will cover and any additional surgery costs.

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 laminectomy. 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 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.

When Should you Consider Surgery

Surgery for 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 worse.
            - 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 stenosis 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 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 cord.

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 treatments
        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 surgery.
                  - People who had surgery were generally able to be more active and had less leg pain than those who had
                     nonsurgical treatment.

But symptoms may return after several years. A second surgery may be needed if:

         - 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 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 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.

Thoracic Laminectomy

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, tumor, hemorrhage (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 performed.

Procedure Risks

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 dissection, 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, stroke, paralysis, 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: Blood clots in the legs, heart attacks, reaction to the anesthetic, reaction to blood transfusion, if  given.

Post-operative care:

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 101 Fahrenheit.

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.





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