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  • Laminectomy

    (Lamina Removal; Removal of the Lamina)

    Click here to view an animated version of this procedure.

    Definition

    A laminectomy is a surgery to remove a small portion of a vertebra (back bone). The part removed is called the lamina.
    Ruptured Disc in Neck Pushing on Nerves
    cervical disc herniation small
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    A laminectomy is usually done to help take pressure off your spinal cord or a nerve running out from your spinal cord. It is also done to gain access to the spinal cord, bones, and discs that are below the lamina. Ruptured discs, bony spurs, or other problems can cause narrowing of the canals that the nerves and spinal cord run through. This can irritate the nerve if it gets too narrow. Often, a laminectomy is done along with a disk removal to help make the canal larger and take pressure off the nerve being irritated.
    When the spinal cord or other nerves get irritated, they can cause:
    • Weakness
    • Numbness
    • Pain in an arm or leg
    Physical therapy and medicine will be tried first. The surgery is done when other treatments have not worked. It is most often done to treat symptoms that keep getting worse.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a laminectomy, your doctor will review a list of possible complications, which may include:
    • Infection
    • Bleeding
    • Blood clots
    • Damage to nerves, resulting in pain, numbness, tingling, or paralysis
    • Problems related to anesthesia
    Factors that may increase the risk of complications include:
    • Another medical condition, particularly heart or lung problems
    • Obesity
    • Advanced age
    • Smoking
    Be sure to discuss these risks with your doctor before surgery.

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam
    • X-ray—a test that uses radiation to take a picture of structures inside the body, especially bones
    • MRI scan—a test that uses magnetic waves to make pictures of the inside of the body
    • Myelogram—a specialized type of x-ray that requires dye to be inserted near the spinal cord and shows if there is pressure on the cord or the nerves
    • CT scan—a type of x-ray that uses a computer to make pictures of the inside of the body
    In the time leading up to your surgery:
    • If you are overweight, try to lose weight. This will decrease the amount of stress on your back.
    • Talk to you doctor about your medicines. You may need to stop taking aspirin or other anti-inflammatory drugs for one week before surgery. You may also need to stop blood-thinning drugs, like clopidogrel (Plavix) or warfarin (Coumadin).
    • Arrange for a ride home and for help at home.
    • Eat a light meal the night before. Avoid eating or drinking anything after midnight.

    Anesthesia

    Possible types of anesthesia for this operation include:
    • General anesthesia—blocks pain and keeps you asleep during the surgery; given through an IV in your hand or arm
    • Spinal anesthesia—numbs the area from the chest down to the legs; given as an injection in your back

    Description of the Procedure

    If the surgery is done with minimally invasive techniques, you will only need a few small incisions. The doctor will insert a scope and small instruments into these incisions. The lamina will then be removed using a drill or other tools. Once the lamina is removed, the doctor can inspect the spinal cord and discs that were hidden under the lamina.
    In some cases, the doctor will do an open surgery. This involves making a larger cut in the skin over the area in the back that needs attention.
    The disc often needs to be removed as well to take pressure off the spinal cord. If it is not a disc problem, the doctor will try to fix the other problems causing the nerve irritation. In rare cases, the doctor may do a spinal fusion. A spinal fusion will involve joining two vertebrae. Lastly, the incision will be closed with stitches or staples.
    Laparoscopic Removal of Disc Tissue
    laparoscopic discectomy small
    Copyright © Nucleus Medical Media, Inc.

    How Long Will It Take?

    1-3 hours

    How Much Will It Hurt?

    You will have pain during recovery. Your doctor will give you pain medicine.

    Average Hospital Stay

    This surgery is done in a hospital setting. The usual length of stay is 1-3 days. Your doctor may choose to keep you longer if there are complications.

    Post-procedure Care

    At the Hospital
    While you are recovering at the hospital, you may receive the following care:
    • You will have to walk with assistance the evening after surgery or the next day.
    • You may need to wear a back or neck brace.
    • You may need to wear special socks or boots. These will help to prevent blood clots.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Be sure to follow your doctor's instructions.
    • Keep the incision area clean and dry.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Exercise your legs while in bed. This is to improve circulation and decrease the risk of blood clots.
    • Do not lift anything heavy.
    • Work with a physical therapist. You will slowly progress from walking to other low-impact activities, like swimming.
    • Only take medicine recommended by your doctor. Ask your doctor before taking any over-the-counter medicine.
    • Have the stitches or staples removed in two weeks.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
    • Pain that you cannot control with the medicines you have been given
    • Cough, shortness of breath, chest pain
    • Trouble urinating or having a bowel movement
    • New numbness or weakness in the hips, groin, or legs
    • Joint pain, fatigue, stiffness, rash, or other new symptoms
    In case of an emergency, call for medical help right away.

    RESOURCES

    Family Doctor http://familydoctor.org

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

    CANADIAN RESOURCES

    College of Family Physicians of Canada http://www.cfpc.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Allen RT, Garfin SR. The economics of minimally invasive spine surgery: the value perspective. Spine. 2010 Dec 15;35(26 Suppl).:S375-82.

    Djurasovic M, Glassman SD, et al. Contemporary management of symptomatic lumbar spinal stenosis. Orthop Clin North Am. 2010 Apr;41(2):183-191.

    Herniated disc. American Association of Neurological Surgeons website. Available at: http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Herniated%20Disc.aspx. Updated September 2005. Accessed June 13, 2008.

    Laminectomy or laminotomy. North American Spine Society website. Available at: http://www.spine.org/Pages/ConsumerHealth/SpineConditionsAndTreatments/CommonProblemsCorrectiveActions/CommonSurgicalProcedures/LaminectomyorLaminotomy.aspx. Accessed June 13, 2008.

    Lindström D, Azodi O, et al. Effects of a Perioperative Smoking Cessation Intervention on Postoperative Complications: A Randomized Trial. Ann Surg. 2008 Nov;248(5):739-745.

    Pain: hope through research. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/chronic%5Fpain/detail%5Fchronic%5Fpain.htm#Treatment. Updated May 2008. Accessed June 13, 2008.

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