Laminectomy

What is a laminectomy?

A laminectomy is a type of back surgery used to treat a herniated disk or an area of spinal stenosis.

• A herniated disk is a small, circular cushion between the bones of your spine (vertebrae) that has bulged out (ruptured) from its proper place in your back. A herniated disk may press on nearby nerves and cause severe pain.
• Spinal stenosis happens when, as a result of aging or injury, the spinal canal becomes narrowed and pushes on the nerves of the spinal cord.

In this surgery the surgeon removes a small part of bone from the back of the vertebra. This part of the vertebra is called the lamina. After the piece of bone is gone, the surgeon can remove the ruptured part of the disk that is pressing on the nerves. This should lessen the pain caused by the herniated disk, and it may allow the return of nerve function so that weakness, numbness, or tingling may go away.

When is it used?

A laminectomy may be done when a herniated disk causes one or more of these problems:

• arm or leg pain that limits what you can do
• weakness or numbness in your arms, hands, legs, or feet
• problems controlling urine or bowel movements.

Some alternatives to surgery include:

• waiting to see if the symptoms get better with time
• taking medicine to help with the pain or to reduce inflammation
• gentle exercise prescribed for your specific condition
• physical therapy, which can sometimes relieve the pressure on the nerve.

How do I prepare for the procedure?

• Ask any questions you have before the surgery. You should understand what the surgeon is going to do, understand how long your recovery is likely to take, and feel good about your decision to have the operation. A positive mental attitude will help you to recover more quickly.
• Plan for your care and recovery after the operation. Allow for time to rest. Find people to help you with your day-to-day duties.
• Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.
• Take a shower and wash your hair the night before surgery.
• Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.
• Follow any instructions your healthcare provider may give you.

What happens during the procedure?

You will be given a regional or general anesthetic. A regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles, puts you to sleep, and also prevents you from feeling pain.

Guided by the X-ray tests you have had, the surgeon will make a cut and remove a small part of the bone over the area where the nerve is pinched. The surgeon will then remove the ruptured part of the disk, repair the layers of tissue that have been cut, and close the wound.

What happens after the procedure?

You may go home later in the day, or you may need to spend a couple of days in the hospital. It depends on how quickly you recover from the anesthetic and how much pain you have. Older adults may need some extra time to recover.

You may have feelings of numbness or tingling in the part of the arm, hand, leg, or foot where you had pain before surgery. Although you'll be given medicine for pain, you should still expect some pain after surgery. You may also need medicines to relieve back spasms and inflammation.

Everyone heals at his or her own rate. How quickly you heal will depend partly on your health, physical fitness, nutrition, and mental attitude. Healing takes time. Be patient but persistent. You'll need to watch your weight, become more physically active to prevent problems in the future (talk with your healthcare provider about an exercise program), and keep your back in shape by strengthening it with special exercises. In the long run, regular aerobic exercise and careful lifting, using proper technique, are the most important things you can do for your back.

Get specific instructions from your healthcare provider about:

• how soon you can drive
• how much you should lift while you are healing
• when you can start exercising
• what and how much exercise you should do

Ask your provider when you should come back for a checkup.

What are the benefits of the procedure?

The goal of surgery is to relieve pressure on the nerve. This surgery should improve the symptoms you've been having. It may help relieve your pain. It may help you regain some of the mobility you may have lost in your arms or legs.

What are the risks associated with the procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases regional anesthesia is considered safer than general anesthesia.
• There is a risk of infection.
• There is a risk of excessive bleeding.
• The surgery may not relieve your pain. It may even be worse after surgery.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• The wound is bleeding or oozing fluid.
• You develop a fever.
• One of your legs swells or becomes painful.
• You become short of breath.
• You are in a lot of pain even though you are taking your pain medicine.
• You develop numbness or weakness.
• You lose control of your bowel or bladder.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.