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Procedure: Decompressive Lumbar Laminectomy

Part 2: The Procedure

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How the Procedure 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.

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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.



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Updated on: 02/01/10
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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