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Decompressive Lumbar Laminectomy

A Surgical Option for Spinal Stenosis

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Decompressive lumbar laminectomy is a surgical procedure used to treat a condition referred to as lateral recess stenosis, which occurs when spinal nerves are pinched by narrowing of the sides of the spinal canal. Symptoms include intense pain as well as numbness and/or weakness in one leg.

This surgical procedure can also be used to treat lumbar canal stenosis, which occurs when the spinal canal becomes narrowed and the cauda equina becomes compressed. This condition has similar symptoms as lateral recess stenosis.

Quick Anatomy Lesson:

Helpful in Understanding Spine Surgery

The human spine extends from the skull to the pelvis and is made up of individual bones called vertebrae. The vertebrae, which are stacked on top of each other, are grouped into 4 regions:

  1. the cervical spine or neck (which is made up of 7 vertebrae)
  2. the thoracic spine or chest area (which is made up of 12 vertebrae)
  3. the lumbar spine or low back (which is made up of 5 vertebrae)
  4. the sacrum or pelvis area (which has 5 vertebrae)

The base of the spine (called the coccyx) includes naturally fused vertebrae and is often called the tailbone.

?normal

The vertebrae are separated from one another by soft pads, called intervertebral discs, which allow the spine to bend and flex and act as shock absorbers during regular activity. These discs also prevent the vertebrae from rubbing up against each other. Each disc is made up of 2 parts, a soft center called the nucleus and a tough outer band called the annulus.

?lateral

Throughout the length of the spine is an arch of bone called the spinal canal. Inside the spinal canal are the spinal cord and spinal nerves. The spinal cord begins at the base of the brain and ends in the upper lumbar spine area in a bundle of nerves known as the cauda equina. A pair of spinal nerves branch out (one to the left and one to the right) at each vertebral level. Each nerve exits the spinal canal through an opening between the vertebrae called a foramen.

?disc

What Causes Spinal Stenosis:

Breakdown of Normal Spinal Anatomy

Healthy discs help to cushion the vertebrae and keep the opening of the foramina wide enough for the spinal nerve roots to pass through without being pinched.

However, as the body ages, the intervertebral discs begin to break down and the vertebrae become much closer to one another. This can result in the formation of bone spurs and cause the spinal canal and the foramina to become narrowed. It also increases the chances that spinal nerves may eventually become pinched. This leads to the need for a decompressive lumbar laminectomy.

How Decompressive Laminectomy Is Done

The patient is placed under anesthesia and positioned on his or her stomach or side. A small incision is made in the lower back in order for the surgeon to see the pinched spinal nerves and/or the compressed cauda equina.

The surgeon then uses a retractor to expose the vertebrae by spreading apart the muscles and fatty tissue of the spine. A small drill or bone biting instruments are used to remove a section of the vertebra. An opening is cut in the ligamentum flavum in order to reach the spinal canal.

The surgeon removes bone spurs (osteophytes) and any rough edges on the intervertebral disc. This enlarges the foramen and the spinal canal and helps relieve pressure on the spinal nerves.

If necessary, the surgeon will perform a spinal fusion with instrumentation to help stabilize the spine. A spinal fusion involves grafting a small piece of bone (usually taken from the patient's own hip) onto the spine and using spinal hardware, such as screws, rods, or other metal implants, to support the spine and provide stability.

Then the procedure is finished! The surgeon will close the incision either using absorbable sutures (stitches), which absorb on their own and do not need to be removed, or skin sutures, which will have to be removed by the surgeon after the incision has healed.

Updated on: 01/23/13
Hallett H. Mathews, MD
Spinal stenosis is one of the most common problems spine care physicians will encounter in the aging population. A degenerating disc and the development of spinal instability will create subarticular stenosis or compression of spinal nerves as they try to leave the spinal canal through the foramen. This is a very common cause of numbness and tingling and difficulty walking in our older patients. Dr. Vince Traynelis has provided an excellent description of the mechanisms of spinal stenosis and how different disc disease processes affect the spinal canal. His depiction of the different stages of disc degeneration to frank herniation is one of the best and most simplistic ways to see how this simple structure affects so much anatomy and function as the degenerative process continues through life. This two-part article depicts surgical considerations based on trying to alleviate spinal nerve compression after this degenerative process has become quite pronounced and severe. I would recommend this reference for anyone undergoing spinal decompression procedures as an excellent educational reference for those seeking to understand more about their pathology.
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