Introduction to Lumbar laminectomy
Back pain is one of the major medical problems. It is the leading cause of loss of productivity at work and second to common cold in terms of loss of working days. Almost 70% of people in the United State suffer from back pain in their life time. Though there are many medical breakthroughs, back pain continues to be a problem with no easy and sure solution. Back pain may progress to very severe stage and involve legs as well. At that stage patient may require surgical procedure and lumbar laminectomy is one of them.
What is Lumbar laminectomy?
Lumbar laminectomy is a spinal surgical procedure in which posterior part of the spinal canal (called laminae) of the affected vertebras is removed. It creates more space and alleviates pressure on compressed spinal nerves. Thus it relieves pain and other symptoms associated with compression of nerves in spinal stenosis and otherwise.
When lumbar laminectomy is indicated?
Spinal stenosis is the major indication for lumbar laminectomy. Spinal stenosis in simple terms means narrowing of spinal canal. The nerves in the narrowed spinal canal are compressed and may undergo degenerative changes. It results into symptoms like pain, numbness and sometimes weakness of the muscles in the area supplied by the affected nerves. The spinal stenosis may result from wear and tear from repeated stress or aging. It may also be a result of age related enlargement of the ligament between laminae and the facets joint of vertebra. Margins of bone may grow as spur and narrow down the canal in some people. Spinal stenosis may rarely be present since birth.
Other indications for lumbar laminectomy are:
- Back pain only
- Repeat laminectomy.
How lumbar laminectomy procedure is done?
Lumber laminectomy is one of the major surgeries. It is generally done under general anesthesia but sometimes under spinal anesthesia. In general anesthesia the patient is fully unconscious and breathing is assisted through ventilator. In spinal anesthesia only the lower part of the body is anesthetized while the patient remains conscious.
Patient is placed in a spinal frame kneeling face down during the surgery. This position gives provide better access to the parts to be operated and check excess blood loss during surgery.
A small incision is made in the middle of the lower part of back through which the affected part is exposed. In a complete laminectomy surgeon removes lamina and the bony projections on the back of the vertebra in the area of spinal stenosis. In order to do this an area along the inner edge of the facet joint on each side is cut and the lamina bone is detached from the pedicle bones. Thus a section in the bony ring is opened. A part of the ligamentum flavum is removed to exposes the nerves inside the spinal canal. Sometime other adjacent structures may also be removed. It makes the spinal canal more spacious and relieves the pressure on the spinal nerves passing through the spinal canal.
What are the complications of lumbar laminectomy?
Lumbar laminectomy is one of major surgical procedure and may be associated with many untoward outcomes. The complication may start with anesthesia in terms of reaction to drug, respiratory difficulties and unexplained individual specific effects of anesthesia that is called idiosyncrasies.
The structure which we intend relieve of pressure such as nerves may get damaged and the part of the spinal canal undergoing surgery may become loose and unstable which may further exacerbate the problem which may become difficult to handle. There may be clotting in the vessels which travel to other parts and clog the vessels in heart, lung and brain and cause destruction of tissue and result into infarctions in these organs which affect their normal function.
Though infection may be associated with any open procedure, in spinal cord and around that infection is far more dangerous. It may travel to other parts of central nervous system through cerebrospinal fluid, which sound brain and spinal cord. Such infections are difficult to treat. Other complications include tear of dura matter, a sheath around brain and spinal tissue.
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What can be expected from lumbar laminectomy?
Lumbar laminectomy relieves symptoms like numbness, tingling, aching, heaviness, weakness in buttocks and legs. It also improves walking. It is unlikely to strengthen the legs if there is weakness before the surgery. It may not be the right procedure if you have only low back pain and no leg symptoms.
What happens after surgery?
Though this is major surgery, patients generally recover faster. They are able to sit in the bed within a few hours after surgery and return home in 2-3 days. They can return to their work within four to twelve weeks depending upon the nature of work. If the patient is involved in strenuous manual work before surgery, there is a possibility that he may not be able to do the same work again after the surgery.
What is the success rate of lumber laminectomy?
Overall success rate depend upon the underlying pathology. The success rate is about 80-85%. However it does not mean that these many patients are symptom free. Some symptoms may remain and efforts need to be put to be able to walk properly after the procedure. In 10-15% of the patients improvement may not be to their satisfaction and a small proportion of cases may even be worse after the procedure.
Physio therapy is recommended after lumbar laminectomy. In the postoperative period it helps in post relieving pain and inflammation. At this stage ice and electric stimulation is generally used. Other techniques may also be used to ease muscle spasm. Exercises are also recommended for improving heart and lung function. Once the conditions improve, physiotherapy is oriented towards making the patient ready to go back to work. According to the amount and type of work you are able to do, you may be advised to go back to your work change your work.