A surgical procedure to remove a portion of a vertebra, called the lamina, under which one finds the ruptured disk that is pushing on nerves and causing pain and dysfunction. The ruptured disk is then removed. In other instances the lamina is removed because of pressure caused by bony spurs or other pathology.

Parts of the Body Involved

Back, spinal column, intervertebral disk

Reasons for Procedure

Laminectomy is a surgical method of treating severe pain and disability resulting from compression of spinal nerves by a ruptured intervertebral disk or bony compression. Surgery becomes an option when persistent pain and disability have not been relieved by other means, such as rest, medications, or physical therapy.

The procedure is most often performed to treat progressive neurological problems, such as weakness, numbness, or pain in an arm or leg, or loss of bowel or bladder control, due to nerve compression caused by:

• Spinal stenosis
• Degenerative spondylolisthesis
• Herniated disk

Risk Factors for Complications During the Procedure

• Pre-existing medical condition, particularly heart or lung problems
• Obesity
• Advanced age

What to Expect

Prior to Procedure - Your doctor will likely do the following:

• Physical Exam
• X-rays
• MRI Scan – a test that uses magnetic waves to make pictures of the inside of the body and allows the spinal nerves and the intervertebral disk to be viewed
• 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
• Possibly a CT Scan – a type of x-ray that uses a computer to make pictures of the inside of the body and can show the bones of the spine to see if there is room for the nerves and the spinal cord

In the time leading up to your procedure:

• If you are overweight, lose excess pounds to decrease the amount of stress on your back
• Review your regular medications with the surgeon and follow instructions if asked to discontinue some drugs
• Arrange for a ride to and from the hospital and medical appointments
• Arrange for help at home after returning from the hospital
• The night before, eat a light meal and do not eat or drink anything after midnight the night before unless told otherwise by your doctor

During Procedure - IV fluids, anesthesia, possibly a sedative

Anesthesia - General or spinal

Description of the Procedure - The surgeon makes an incision in the back, spreads the muscles, and removes the lamina, which is the small part of the bone over the area where the nerve is being pinched. Once the bone is removed, the surgeon can see what is compressing the nerve, and will usually remove the offending disk. If it is not a disk problem, the laminectomy allows the surgeon to look for other causes and decompresses the area to reduce pressure on the nerves. Rarely, two adjacent vertebra (bones) may be joined together in a procedure called "spinal fusion." The incision is closed with stitches or staples.

After Procedure - Laboratory examination of removed tissue

How Long Will It Take?

1-3 hours

Will It Hurt?

Anesthesia prevents pain during surgery. You may experience pain during recovery but will receive drugs to relieve this discomfort. You may also feel numbness and tingling in your extremities that previously felt painful.

Possible Complications:

• Infection
• Blood clots in a vein (phlebitis) or traveling to the lungs (embolism)
• Recurrent disk herniations
• Damage to nerves, resulting in pain, numbness, tingling, or paralysis
• Impairment of bladder function
• Anesthesia-related problems

Average Hospital Stay: 0-3 days, depending on the anesthesia used and post-operative pain

Postoperative Care:

• Expect to get up and walk with help the evening after surgery or the next day, possibly while wearing a back brace or support
• Move and exercise your legs while in bed to improve circulation and decrease the risk of blood clots
• Keep the incision area clean and dry
• Stitches or staples will be removed in about two weeks
• Only take medications recommended by your doctor; do not take over-the-counter remedies without your doctor's approval
• Do not lift anything heavy

Outcome

Following the recommended activity and rehabilitation program will speed your recovery. At first, walking may be added to your home-rehabilitation program and, eventually, swimming or other low-impact exercises to improve your general physical condition and stamina.

Some achy pain in your back may persist. Continuing your exercise program and maintaining a healthy weight will help reduce this discomfort.

Call Your Doctor If Any of the Following Occurs

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
• Cough, shortness of breath, chest pain, or nausea or vomiting
• Weakness or paralysis that was not present in the hospital after surgery
• Loss of bowel or bladder function
• Numbness, tingling, pain, or weakness in any extremity or elsewhere in the body