Laminectomy

Laminectomy is surgery to remove all or part of the lamina, which is part of a spinal bone (vertebra). Removing this bone and tissue make the spinal canal larger and can take pressure off the spinal cord or compressed or pinched nerves in the spine. Laminectomy is a type of spinal decompression surgery.

Your doctor may recommend laminectomy if you are having symptoms caused by a pinched nerve in your spine. These symptoms can include pain, weakness, numbness, or problems controlling the bladder or bowels.

Conditions that may cause pinched nerves can include stenosis (narrowing of the spine), bone spurs, bulging or herniated discs, bones out of alignment, or a degenerative disease like arthritis.

Laminectomy can be combined with other surgeries, such as spinal fusion or discectomy (surgery to remove the herniated part of a disc).

Possible risks of a laminectomy include:

• Blood loss. Blood loss is usually very small. But as with any surgery, there is always the potential for major or even life-threatening blood loss.
• Infection. Even with antibiotics and careful sterile techniques, there is still a very small risk of developing a wound infection.
• Damage to the sac covering the spinal cord, with leak of spinal fluid (2 to 5 people out of 100). If the sac covering the spinal cord is unintentionally opened during surgery, it will be repaired. This should not have any effect on your long-term outcome, but you may have to spend a day or two flat in bed to allow the repair to strengthen. Rarely, further treatment may be necessary.
• Damage to spinal nerves or the spinal cord. In the event of damage to your nerves or spinal cord, you could be left with permanent pain, numbness, or weakness in your legs.
• Spinal instability (rare). To relieve pressure on your nerves, the surgeon removes the bone and soft tissues causing the pressure. This will weaken your spine a little. Most patients have enough reserve strength in the spine to tolerate this. But in a few patients, it can cause spinal instability. If this happens, you may need more surgery to fuse the weakened disc.
• Failure to relieve symptoms. Your surgeon will do everything possible to give you the best results. Even so, surgery may not relieve all your symptoms.

Possible benefits of a laminectomy include:

• Improving or eliminating pain caused by a pinched nerve.
• Preventing numbness or weakness from getting worse.
• Improving range of motion in the back.

You can take these steps to help your surgery and recovery go better:

• Stop smoking. If you smoke, try to stop before your surgery. Non-smokers have fewer complications related to surgery. More importantly, smoking slows bone healing and could cause your surgery to fail.
• Stop certain medicines. Be sure to discuss all medicines you take with your surgeon (including over-the-counter medicines, patches, and vitamins). You may need to stop taking certain medicines before your surgery including:
• Aspirin 2 weeks before surgery.
• Anti-inflammatory medicines, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), 1 week before surgery.
• Blood thinners (your surgeon can tell you when to stop based on the medicine).
• Ask for time off work. Ask your doctor how long you may need to be off work, and make arrangements with your employer.
• Ask for someone to drive you home. Arrange for someone to drive you home from the hospital and to help you at home for the first few days.
• Follow all instructions on when to stop eating and drinking before your surgery. This will help prevent anesthesia complications.

Your leg pain will likely be better or gone when you wake up from the surgery. However, you may feel new back pain in the area where the surgery was done. You will be given medicine for the pain.

By the time you go home, you should be able to get around on your own and take care of your own personal needs. Your pain should be well controlled with medicines. Most patients go home within 1 to 2 days. More complex cases may require a longer hospital stay.

Your surgeon will instruct you when to come in for follow-up appointments.

• Use pain medicine as directed. When you leave the hospital, your pain should be under control. Your doctor will talk to you about continuing to manage your pain with medicines. Follow these safety measures:
• Don’t take aspirin for 5 days after surgery.
• Take your pain medicine as soon as you need it. Don’t wait for the pain to get too bad.
• Follow your doctor’s instructions for wound care.
• Avoid strenuous activity. Most people can resume many of their regular activities within just a few days after surgery. However, you should avoid strenuous activities (heavy lifting and bending or twisting at the waist) for about 3 months after surgery. If you can’t lift something easily with one hand, then don’t lift it. After 3 months, you should be able to resume almost all of your normal activities.
• Return to work when your surgeon advises. Expect to be off work at least several days to weeks, depending on the type of work you do. If your work is physically strenuous and a light duty assignment is not available, you may need to be off work for up to 3 months. Most patients return to work much sooner.

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