Laminectomy is a surgical procedure for the treatment of the spine. The method is used to remove the vertebral arch along with the spinous process.
What is laminectomy?
Laminectomy is a surgical procedure for the treatment of the spine. The method is used to remove the vertebral arch along with the spinous process. Laminectomy (spinal canal surgery) is one of the surgical procedures on the spine. In this surgical treatment, the vertebral arch is operated out together with the spinous process of one or more vertebrae. In this way, space can be made for a surgical intervention on the intervertebral discs or the spinal cord. In the case of an existing tumor within the spinal canal, it is possible to reduce the resulting high pressure. The term laminectomy is composed of the Latin term lamina arcus vertebrae and the Greek term ectomy. Translated into German, the term means “removal of the vertebral arch”. If only one half of the vertebral arch is removed, the procedure is referred to as a hemilaminectomy. The first laminectomies were performed by the British physicians William McEwen (1848-1924) and Victor Alexander Haden Horsley (1857-1916) in 1886 in London at University College. During World War 1, laminectomies were frequently performed in field hospitals to treat spinal cord wounds such as puncture wounds or gunshot wounds.
Function, effect, and goals
One of the uses of a laminectomy is for advancing spinal stenosis, in which the spinal canal narrows. The goal of the procedure is to reduce the pressure exerted on the nerve root and the draining nerves in the spinal canal region. In this way, the associated complaints such as back pain can be effectively combated. To relieve the pressure on the nerve cords, the constricting structures are removed during laminectomy. In recent years, however, minimally invasive procedures such as microsurgical decompression have increasingly taken the place of laminectomy. These methods have the advantage of having less negative impact on spinal stability. Thus, the vertebral arch as well as the vertebral joints on the side remain for the most part. Laminectomy is always performed only when conservative treatment, which mostly consists of physiotherapeutic measures and the administration of painkillers, is unsuccessful and the back pain does not improve. When a laminectomy is performed, the patient lies on his stomach. He also receives general anesthesia. Through an X-ray examination, the surgeon is able to determine the exact location of the spinal stenosis. He draws this location on the skin before the procedure. The first treatment step of laminectomy is to make a skin incision. Then, the back of the spine is exposed. For this purpose, the surgeon detaches the muscles from the vertebral arches. By using high-speed bone cutters, bone chisels and punches, the structures that narrow the spinal canal can be removed. To relieve sufficient pressure, the surgeon operates to remove portions of the vertebral arch as well as the spinous process. If there is nerve constriction on both sides, it is usually necessary to remove the entire vertebral arch together with the ligaments in order to successfully improve the back pain. On the other hand, if there is only a unilateral narrowing, a hemilaminectomy is usually considered sufficient. It is also possible to remove an additional herniated disc. At the end of the laminectomy, a drainage tube is usually inserted into the treated region. This allows wound fluids to drain even after the procedure. The tube can be removed just one day later. Microsurgical decompression is a variant of laminectomy. In this case, only a very small skin incision is made. The surgeon uses special angled instruments and a surgical microscope. With this procedure, the muscle attachments located at the vertebral arches can be spared. Another difference to laminectomy is that only a small part of the vertebral arch has to be removed. Using tiny punches and chisels, the surgeon hollows out the vertebral canal from the inside. In addition, all constricting parts are removed.
Risks, side effects and dangers
Following laminectomy, it is necessary to empty the patient’s bladder with a catheter for the first few days. However, after one to three days, bladder and bowel functions have usually returned to normal. The patient can usually get up again just one day after the operation. However, the patient must practice standing up correctly with the help of doctors and physiotherapists to prevent the spine from twisting. The spine can be further stabilized by means of a support girdle with an elastic effect. The patient’s full physical capacity is restored after about six weeks. During this period, he should perform important physiotherapeutic exercises. As with most surgical procedures, laminectomy carries a risk of complications. These include, first and foremost, injuries to the nerves. These become noticeable in the form of movement disorders, sensory disturbances, functional disturbances of the bowel and urinary bladder, and sexual problems. However, these side effects occur in only about one percent of all patients. Furthermore, laminectomy is only performed anyway if there is already damage to the nerves due to the narrowing. Other possible complications include wound healing disorders and infections, which are among the general risks of surgical procedures. With a microsurgical operation procedure, this risk is significantly lower. In rare cases, a new narrowing of the spinal canal occurs after laminectomy. Physicians then speak of a postlaminectomy syndrome.
Typical and common spinal disorders
- Spinal curvature
- Spinal injury (spinal trauma)
- Vertebral body fracture (vertebral body fracture)
- Vertebral joint arthritis
