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Lumbar LaminectomyLumbar Laminectomy

What is a Lumbar Laminectomy?

The lumbar area of the spine is better known as the lower back. The lamina is a part of each vertebra. A lumbar laminectomy is the surgical removal of the lamina or part of the lamina on one or more of the vertebrae in the lower back. This is usually done to relieve pressure on nerves that may become inflamed from pressure caused by a narrowed spinal canal, bone spurs, or a herniated disc. Once the lamina is removed, the surgeon can then access the spinal canal and remove the source of irritation or pressure.

Who is a Candidate for a  Lumbar Laminectomy? 

Those who suffer from frequent lower back pain, leg pain and or numbness may have a condition known as spinal stenosis. Spinal stenosis describes the narrowing of the spinal canal in the area where the nerves and nerve roots exit the spinal column. This narrowing can occur as a result of arthritis bone spurs or by simply the wear and tear that occurs from repetitive stress on the lower spine. In addition, some people are born with a narrow spinal canal that becomes symptomatic as they age.

The narrowing of the spinal canal may eventually cause pressure on the nerves and nerve roots that emerge from the spinal column. This irritation can result in pain and numbness, particularly after sitting or standing for extended lengths of time. Lumbar laminectomy may be recommended in order to make more room for the nerves or nerve roots.

Another condition that is often treated with a lumbar laminectomy is a herniated disc. The discs act as cushions or “shock absorbers” between the vertebrae. Part of the disc may herniate or bulge into the canal, again putting pressure on the nerves. Once the laminectomy is performed, the surgeon may trim or remove whatever material is causing the irritation.

What are the Alternatives to a Lumbar Laminectomy?

Surgery is usually the last option considered. If your symptoms are mild, you may not require any treatment at all. Other conservative treatments such as physical therapy, medications, and steroid injections may relieve symptoms for a time; however they usually do not permanently change the underlying cause of the problem – the narrowing of the spinal canal. In some cases, lumbar laminectomy may be the best solution to remove irritation and create more space for the nerves.

How are Back Problems Evaluated? 

Your doctor will use a number of approaches to evaluate and diagnose back problems such as spinal stenosis or a herniated disc. These include:

A Detailed History – Your role in providing a detailed history is very important. Your doctor will need to know where and when it hurts, if there was a recent injury or fall, and a description of the symptoms. Are there positions or activities that make it feel worse? What makes it feel better? All of these details can help your doctor pinpoint the problem.

A Physical Exam – Once your history is given, a thorough exam by a back expert is another important step in getting a good diagnosis.

Diagnostic Imaging – Xrays can show the structure and alignment of the vertebrae as well as the presence and size of bone spurs or other bony abnormalities.

CT or “computerized tomography” – This is a special kind of xray machine. Rather than a single xray, a CT scanner sends out a number of beams at different angles. These images are then read by a computer, producing detailed cross-sections or “slices” that can show the shape and size of the spinal canal and the surrounding structures.

MRI or “magnetic resonance imaging” – MRI is probably the most utilized study for disc evaluation. MRI uses a powerful magnet and radio waves. The images produced are very helpful in visualizing the soft tissues such as the spinal cord, as well as the discs and nerve roots.

Bone Scans – These are useful in revealing abnormalities such as infections, fractures, tumors and arthritis. Because bone scans are unable to differentiate between these problems, they are usually performed in conjunction with other diagnostic tests.

How Long is the Hospital Stay? 

The time spent in the hospital depends on several factors, including your overall health and the extent of our particular surgery. Some people may be able to return home the same day while others may spend one to two days in the hospital.

How Long Will it Take to Recover? 

Recovery time after a lumbar laminectomy varies depending on your particular situation, the number of levels involved, as well as your general health. The key to a successful recovery is maintaining a positive attitude. You will be able to take short walks while in the hospital, and need to gradually increase the distance and frequency of your walks once at home. Avoid standing or sitting for prolonged periods and change your position frequently to help minimize back spasms and discomfort. Your doctor will give you specific instructions on activity levels, including when you can resume driving and return to work.

Frequently Asked Questions

Lumbar Laminectomy / Discectomy

What is wrong with my back?

You have a “pinched nerve.” This can be produced by one or more herniated discs and/or areas of arthritis in your back. The discs are rubbery shock absorbers between the vertebrae, and are close to nerves that originate in the spine and then travel down to the legs. If the disc is damaged, part of it may bulge (herniate) or even burst free into the spinal canal, putting pressure on the nerve and causing leg pain, numbness or weakness. Bone spurs associated with arthritis may cause similar pressure.

What is required to fix the problem?

The discs or bone spurs pressing on your nerve can be removed. This is done by making an incision (usually about two inches long) in the middle of your lower back, moving the muscles covering your spine to the side, and making a small window into your spinal canal. The nerve is exposed, moved aside and protected; and the protruding disc or bone spur is then removed. This decompresses the nerve and, in most cases, leads to improvement in nerve pain, numbness and/or weakness. Sometimes the abnormality may be more extensive, extending over several disc segments, requiring a longer incision for decompression.

Who is a candidate for lumbar decompression and when is it necessary?

The primary reason for this operation is pain that is intolerable to the patient. Sometimes increasing nerve dysfunction (particularly weakness) or loss of bowel or bladder control may make the surgery necessary even if pain is not severe. In most cases, nerve dysfunction is not severe and pain can be controlled by non-surgical means. If this doesn't happen, and if the pain and subsequent disability become intolerable, surgery is a reliable way to address the problem. Since the patient is the one feeling the pain, the patient is usually the one who decides when he or she is ready for surgery.

Who performs this surgery? Is my entire disc removed?

Both orthopedic surgeons and neurosurgeons are trained in spinal surgery and both specialists may perform this surgery. It is important that your surgeon specialize in this type of procedure.

No, only the ruptured part and any other obviously abnormal disc material are removed. This generally amounts to no more than 10 percent of the entire disc.

How long will I be in the hospital? Will I need a blood transfusion?

Laminectomy patients are usually out of bed within an hour or two after their operation, and some can go home on the day of surgery. The remainder almost always goes home the next morning. Disectomy patients usually go home the day of surgery.

Transfusions are rarely needed after this kind of surgery. We do not recommend pre-operative donation of your own blood.

What can I do after surgery?

You may get up and move around as soon as you feel like it, and may drive short distances when you feel able and are no longer taking pain medication. You are encouraged to get up and walk a half mile every day. You should avoid back bending, twisting and lifting anything greater than 5 to 10 pounds for 4-6 weeks to allow for healing of the surgical area.

When can I go back to work? Could this ever happen to me again?

That depends on the kind of work you do, and how long you have to drive to get there. Surgical patients can return to sedentary (desk) jobs that they can reach with a drive of 15 minutes or less whenever they feel comfortable, (usually two or three weeks). You should not drive long distances (30 minutes or more) for about one month after surgery. If your job requires physical labor, you should consult your surgeon.

Unfortunately, yes, it could happen again. As mentioned above, only part of the disc is removed and there is no way to return the disc to normal again, which means recurrent herniations do occasionally occur. Also, adjacent discs may be abnormal, too, and could rupture in the future. This procedure, unfortunately, cannot prevent future problems.

What is the likelihood that I will be relieved of my pain? Will my back be normal after surgery?

The primary objective of these procedures is to improve leg symptoms. 90-95 percent of patients get relief of their leg pain. Back pain is less reliably improved with these procedures and may require additional treatment.

Though you may have excellent relief of pain, a disc is never completely normal after it has herniated, and if your problem has been caused by arthritis, the arthritis cannot be cured even if the bone spurs have been removed and the nerves decompressed. You may have residual back pain, and there is an increased risk of re-herniation of the damaged disc or a different disc. However, most people can resume almost all of their normal activities after recovering from surgery.

Could I be paralyzed? What other risks are there?

The chances of neurological injury with spine surgery are very low; and the possibility of catastrophic injury, such as paralysis, impotence or loss of bowel or bladder control are highly unlikely. However, injury to a nerve root with isolated numbness and/or weakness in the leg is possible.

There are general risks with any type of surgery. These include, but are not limited to, the possibility of wound infection, uncontrollable bleeding, collections of blood clots in the wound or in the veins of the leg, dural tear/spinal fluid leak, pulmonary embolism (a blood clot to the lungs) or heart attack. The chances of any of these happening, particularly to a healthy patient, are low. Rarely, death may occur during or after any surgical procedure.

What should I do after surgery? What shouldn't I do after surgery?

You should resume low-impact activities as soon as possible, starting with walking. Try to walk a little farther each day, building up to a brisk three-mile walk each day by six weeks after surgery. Once your wound is healed, which can take up to a month, you may swim, which is very back friendly. Talk to your surgeon about aerobics and jogging. Physical activity is good for you, if done properly.

You should avoid lifting greater than 5 to 10 pounds, back bending, twisting and high impact physical activities, including contact sports. Consult your surgeon for details.

Should I avoid vigorous physical activity?

No. Exercise is good for you! You should get some sort of vigorous, low-impact aerobic exercise at least three times a week, once you are fully healed. Walking either outside or on a treadmill, using an exercise bike and swimming are all examples of exercise that is appropriate for spine patients.

Contact Us

Make an appointment with our Spine Care Coordinator to learn more about our patient-centered process for back surgery or to schedule a tour.

Dave Smith, Spine Care Coordinator

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