What is a laminectomy?
A laminectomy is a surgical procedure on the spine. In it, the surgeon removes parts of the bony vertebral body to eliminate narrowing (stenosis) of the spinal canal.
When is a laminectomy performed?
Roughly speaking, the purpose of a laminectomy is to relieve pressure on the spinal canal and the spinal cord running through it. A common reason is spinal stenosis – a narrowing of the spinal canal in which the spinal cord runs. Its function is to transmit signals between the brain and the rest of the body.
Accordingly, spinal stenosis can lead to pain or paralysis, for example. They usually occur in the area of the lumbar spine and can be caused, among other things, by tumors or bony attachments.
Sometimes, however, a laminectomy cannot be avoided, for example if paralysis or sensory disturbances already occur – a possible indication of a significant entrapment of the spinal cord or nerves originating from it (nerve roots). Surgery should then be performed promptly to save the affected nerve tissue.
Combination with vertebral blocking
In cases of long-stretch spinal stenosis (i.e., narrowing over a longer area along the spine), the doctor sometimes has to remove parts of several vertebral bodies. This often causes the spine to become unstable. To prevent this, the laminectomy is combined in such cases with vertebral blocking (spondylodesis). In this case, the affected section of the spine is stiffened with plates and screws.
What is done during a laminectomy?
Using an X-ray, the surgeon locates the exact site of the stenosis and marks it on the skin with a felt-tip pen. After a small skin incision, the surgeon exposes the spinal column by carefully detaching the muscles. Now he removes the vertebral arch(s) with small bone chisels or milling instruments. If the narrowing exists on only one side, a hemilaminectomy is usually sufficient. Otherwise, the physician removes the entire vertebral arch together with the ligaments.
Before the wound is closed, the surgeon places a drain in the surgical area to allow blood and wound fluid to drain away. It is usually removed on the first or second day after the laminectomy.
What are the risks of a laminectomy?
Other risks of laminectomy that the patient should be aware of include:
- Loss of cerebrospinal fluid syndrome (leakage of neural fluid).
- Formation of a tubular connection between the neural fluid space and the surface of the skin (cerebrospinal fluid fistula)
- Infections and wound healing disorders
- Inflammation of the intervertebral disc and vertebral bodies (diszitis and spondylodiscitis, respectively)
- instability of the spine
- chronic back pain, for example due to scarring adhesions
- renewed narrowing of the spinal canal (may require further surgery)
What do I need to be aware of after a laminectomy?
Surgery on the spine sometimes leads to a disturbance of the bladder function. For this reason, a bladder catheter will be placed in you before the operation. It will be removed in the first days after the laminectomy.
After four to six weeks, you can usually move the spine again to a normal extent. However, weight-bearing is not permitted until about three months after the laminectomy.