Definition and Overview
Laminectomy, or decompression surgery, is a surgical procedure that completely removes the lamina, a portion of the vertebral bone. The lamina is located at the back part of the vertebral bone and covers the spinal canal. The purpose of this procedure is to enlarge the spinal canal to relieve the pain caused by the pressure on the nerves and the spinal cord.
It is important to note that laminectomy is not the first line of treatment recommended for people experiencing painful pressure in their backs. It is ideal for those who have already gone through more conservative forms of treatment, including prescription medication, physical therapy, or steroid injections, which have failed to relieve the symptoms.
There are two general types of laminectomy, namely:
- Lumbar laminectomy, which involves the removal of the lamina in the vertebral bone of the lower back
- Cervical laminectomy, which removes the lamina from the back portion of the vertebral bone of the neck
The laminectomy procedure can be used to remove bone spurs in the spine, especially in cases of spinal arthritis or as a complementary procedure to a discectomy (a surgical procedure that removes the disks, or the “cushions” of tissues separating the vertebrae), a foraminotomy (a procedure that widens the openings in the back, right where the nerve roots “leave” the spinal canal), or a spinal fusion (a surgical procedure that permanently fuses two or more vertebral bones together to prevent movement between them).
Who Should Undergo and Expected Results
Laminectomy or decompression surgery is recommended for patients who:
- Experience pain in their necks or lower backs and with symptoms that have not responded to more conservative forms of treatment
- Have bony overgrowths, which resemble spurs, in the spinal canal that makes the nerves and spinal cord very narrow
- Experience weakness and numbness that radiate down the extremities making standing, sitting, or walking extremely difficult
- Experience incontinence of the bladder or bowels due to a narrowed spinal canal
A laminectomy results in relief from the disabling symptoms and increased mobility of the patient.
How Does the Procedure Work?
For a decompression surgery procedure, the patient will be put under general anaesthesia, which means that he will be asleep for the whole duration of the surgery.
After the patient lies face down on the surgical table, the surgeon will make an incision in the middle of the neck or the lower back. The skin, muscles, and ligaments covering the vertebral bone will be moved to one side, providing the surgeon access to the spinal bones.
The surgeon will then remove the lamina from both sides of the spinous process, or the sharp part of the spinal bones. Small disk fragments, soft tissues, and bone spurs will also be removed to widen the spinal canal. During this step, the surgeon may also elect to perform a foraminotomy to widen the opening right where the roots of the nerves leave the spine. An additional procedure, called a spinal fusion, may also be necessary to stabilize the spine.
The skin, muscles, and ligaments moved to one side will be put back in their proper place. Small sutures will be made in the area to close the incision up.
The entire surgery will take around one to three hours. Recovery from a laminectomy typically takes a couple of weeks, but additional procedures such as a spinal fusion might extend the recovery period up to several months. The patient can go home after one to three days in the hospital.
Possible Risks and Complications
While laminectomy is a generally safe procedure, there are also a number of risks and complications the patient might experience. As not all patients respond well to general anesthesia, some of them might experience adverse allergic reactions and breathing problems.
Common risks of surgical procedures are also present in decompression surgery, such as the formation blood clots, infection, and bleeding.
Surgical procedures performed on the patient’s cervical and lumbar vertebrae also entail some specific risks, including the following:
- Infection at the incision site
- Infection in the vertebral bones
- Spinal nerve damage, which can cause loss of sensation, pain, or weakness
- Insignificant relief from the pain or symptoms after the procedure
Future recurrence of pain and other symptoms
Bell GR, Connolly ES. Laminotomy, laminectomy, laminoplasty, and foraminotomy. In: Benzel EC, ed. Spine Surgery. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 53.