What is a Laminectomy?

Laminectomy is a kind of surgical treatment used by patients suffering from back pain. Laminectomy, also known as decompression surgery or rachiotomy, can be done:

• to relieve pressure on spinal nerves; 
• treat a disc problem; 
• or remove a tumor from the spine. 

One of the most common causes of laminectomy is a herniated disc. The disc may shift or become damaged due to injury or wear.

The method of laminectomy consists of removing the arch of the vertebra. 

1. As a result, the nerve root is released (decompression occurs), the squeezing of which leads to pain. The cause of such pain is the narrowing of the spinal canal, resulting in compression of the nerve roots. 
2. Pain in the legs, weakness in the joints, and problems with the pelvic organs are often added to acute pain in the lumbar spine. 
3. After a period of rehabilitation, the patient can return to a full life.

During surgery, there are significant risks, and, after, potential complications. However, surgery must be done if other treatments fail.

Rachiotomy is the name given to various types of surgical resection of the spine to relieve compression of the spinal cord. This type of surgery consists of two main parts: laminotomy and rachiotomy. The difference is that with laminotomy, part of the plate is removed, and with rachiotomy, the entire plate is removed.

Laminectomy Preparation

Laminectomy is preceded by a thorough examination and an individual approach to each patient. The survey begins with a conversation. The doctor listens to complaints and asks in detail about the symptoms that the patient observes.

The specialist examines and palpates the areas of the body in which painful sensations arise. The next stage of diagnostics before laminectomy includes examinations using special equipment.

• Radiography. This completely painless research method allows you to see the entire bone structure of the spine, including its damage, and determine what exactly caused the compression of the nerve roots in the lumbar spine. However, radiography will not provide an opportunity to examine soft tissue. Therefore, the doctor may prescribe the passage of another study – MRI (magnetic resonance imaging).

• The MRI method is based on nuclear magnetic resonance and allows you to see possible pathological changes in soft tissues to determine, for example, diseases such as a herniated disc, which also leads to compression of the nerve roots, and back pain.

• Computed tomography (CT). This method also uses X-rays but with a layer-by-layer display of the slices. CT allows you to see what is not available with X-rays due to the overlap of tissues and organs.

• Lumbar puncture. It is carried out according to the testimony of a doctor and is a collection of cerebrospinal fluid for analysis using a syringe with a thick needle.

Surgical Procedures and Types of Laminectomy

Surgical procedures for laminectomy

  Laminectomy is performed in one of the following ways:

• Mini-invasive discectomy (minidiscectomy) is a minimally invasive surgery to remove osteophytes or herniated discs that put pressure on the spinal cord. The operation is carried out in a modern operating room under a microsurgical microscope.
• Decompression. This surgery is carried out in two stages under the control of an X-ray machine. First, the surgeon makes a small incision in the place where the nerve root was squeezed and removes part of its arch, having gained access to the affected vertebra. This manipulation is carried out to gain access to the spinal canal. After that, the formations that put pressure on the spinal cord are removed.

Types of surgeries with laminectomy

It is divided into four types: cervical, thoracic, lumbar, and sacral, depending on the situation in which the operation is performed.

1. Thoracic laminectomy

It is performed in the upper and middle lower back. Removing the tumor or reducing the compression of the spinal cord is the most common reason for this procedure.

Some tumors can form inside the spinal cord – for example, ependymomas, neural sheath tumors, meningiomas, hemangioblastomas, and astrocytomas. The surgeon must perform a breast laminectomy to gain access to the tumor and remove it.

2. Laminectomy of the cervix

This procedure removes the bony lining of the spinal cord and other soft tissues that are compressing the spine. This relieves the compression of the nerves behind the neck and spinal canal:

• the procedure can last from one to three hours;
• only used when non-invasive methods do not help;
• if rest, pain relievers, physical therapy, and an epidural injection do not relieve pain, a cervical laminectomy is performed.

Sometimes the pain is accompanied by: 

• weakness;
• numbness in the limbs;
• noise;
• difficulty walking;
• loss of bladder and bowel control.

In these cases, a cervical laminectomy is necessary.

3. Sacral laminectomy

It is the removal of the dorsal plate between the pelvis and the femur (sacral spine). This surgery relieves compression on the spinal nerves.

4. Lumbar laminectomy

It is often performed to relieve the sequelae of spinal stenosis. It can be caused by:

• Tumors in the spine
• Spinal stenosis. During the operation, the compression of the spinal cord in the thoracolumbar region is reduced
• Congenital or congenital defects such as abnormal growth of the spine
• Shrinking of intervertebral discs and swelling of bones and ligaments that occur with age
• Shock injury
• Achondroplasia, which is a type of dwarfism
• Herniated disc
• Paget’s disease, a condition in which bones do not grow properly
• Spinal osteoarthritis, which is more common in older people.

Process, Risks, and Recovery of Laminectomy

Laminectomy process

Laminectomy is performed with general anesthesia and lasts from one to three hours. During the operation, not only the vertebral arches are cut off, but also the parts of the intervertebral disc located under the nerve root. Sometimes the operation can take place without damaging the bone structures. It is enough to make a hole in the yellow ligament of the spine to “release” the nerve root.

1. During the laminectomy, the patient lies on their stomach or side. 
2. The surgeon cuts the skin (3-4 cm) above the place where the squeezed root is located and gains access to the back wall of the spine. 
3. It is important to determine which vertebra needs treatment. Therefore, during the operation, the doctor makes contrast radiography. 
4. When the “diseased” vertebra is found, the surgeon cuts off parts of its arch – and the spinal canal is open for manipulation. 
5. Often during the operation, the surgeon not only cuts off the vertebral arches, freeing the nerve root but also removes pathological formations that the patient has: disc herniation, bone spurs, etc.

Then the doctor sutures the dissected tissue in layers. The final stage of laminectomy is the stabilization of the spine. Damage to the joints connecting the vertebrae can injure the structure of the spine. It is possible to restore it with the help of implants.

Laminectomy risks

Spine surgery can have certain risks:

• Unsuccessful surgery, which can lead to continued pain after surgery
• Infection at the site of the surgery or in the bones of the vertebrae
• Cerebrospinal fluid leaks due to rupture of the membrane surrounding the spinal canal
• Spinal nerve damage
• Back pain, especially after fusion.

Some risks threaten the patient in all operations; these include blood clots in the legs and pulmonary embolism, breathing problems, infection, blood loss, heart attack, stroke, and drug reactions.

Causes of post-laminectomy syndrome

Determining the causes of post-laminectomy syndrome is difficult to find out. But the formation of scar tissue after surgery can cause compression of the nerve roots and may explain the chronic pain that patients with post-laminectomy syndrome experience.

There are several other acceptable explanations for post-laminectomy syndrome, including:

• incomplete removal of the vertebral arch;
• inflammation in structures adjacent to the spinal cord;
• surgical intervention on the incorrect spinal motion segment.

Other reasons that can affect the outcome of surgical treatment, include mental health problems of the patient.

Laminectomy recovering

This time depends on the scope of the operation and the patient’s condition. 

1. If the laminectomy is minor, the patient will usually be able to do light housework and non-flexion work after a few days or a few weeks. 
2. But if this operation is accompanied by a merge, the recovery time is longer; this can take anywhere from two to four months.

As soon as the doctor deems it appropriate, he will prescribe physical therapy exercises to accelerate recovery. In any case, you cannot be sure of your complete recovery until six weeks later.

FAQs

• What is the most common reason for laminectomy?

One of the most common causes of laminectomy is a herniated disc. The disc may shift or become damaged due to injury or wear.

• What is the name of back pain surgery?

Laminectomy refers to decompression surgery on the spine, which has a wide range of indications, including spinal cord injuries. It allows you to eliminate the pressure of other anatomical structures on the spinal cord and nerve endings by resecting the arches of the vertebrae in the affected area, their spinous processes, intervertebral discs, and the yellow ligament.

• What drugs should be used for a laminectomy?

A course of physiotherapeutic treatment and a number of drugs, including:

• • antibiotics – prevent the development of infectious and inflammatory complications;
  • drugs from the NSAID group – relieve pain and help eliminate the inflammatory process;
  • anti-thrombotic drugs – reduce the risk of blood clots; calcium preparations – help to strengthen bone tissue.

• What are the different techniques for performing laminectomy?

1. Hemilaminectomy – the operation consists in resecting one or both arches of only one vertebra while its spinous processes are preserved.
2. Interlaminar laminectomy – surgical intervention involves partial resection of the ligamentum flavum, the arch of the affected vertebra, as well as the arches of the vertebral bodies belonging to it.
3. Total laminectomy – the essence of the operation is to remove the vertebral arch together with the spinous process.
4. Osteoplastic laminectomy is a radical operation that implies further closure of the formed defect with a bone graft taken from a patient, an allograft (obtained from a donor), or artificial materials.