The Purpose of this Information

This information is being provided to you in order to prepare you to make decisions about your own health care. If you should ultimately decide that surgery is the best treatment option for you, this section will help you understand what happens during a lumbar laminectomy and will help you prepare for your role in the healing and recovery process. Read it thoroughly and answer the questions before making your final decision about your treatment options.

The Health Care Team's Role

The duty of your health care team is to:

1. evaluate your condition;
2. establish a diagnosis;
3. present the various treatment options;
4. offer a specific treatment recommendation;
5. provide you with the information you need to make a decision; and then
6. support you in the decision you make.

The Patient's Responsibilities

You are the only one who can decide to have surgery. It is important that you take ownership of this decision, recognizing the limitations your particular physical condition places on the potential success of each of the treatment options.

If you choose to have surgery, your physical condition and your mental attitude will determine your body's ability to heal. You must approach your surgery with confidence, a positive attitude, and a thorough understanding of the anticipated outcome. You should have realistic goals - and work steadily to achieve those goals.

The decision to have or not to have surgery includes weighing the risks and benefits involved. You will make the final decision, so ask questions about anything you do not understand.

Since medical care is tailored to each person's needs and differences, not all information presented here will apply to the patient's treatment or its outcome. Seek the advice of your physician and other members of the health care team for specific information about the patient's medical condition.

Anatomy of the Back

The spinal column, or backbone, consists of 33 bones (vertebrae) and can be divided into five segments (Fig. 1A). The uppermost 24 vertebrae are separated from one another by fibrous cartilage pads, called intervertebral discs (Fig. 1B), which provide flexibility to the spine and act as shock absorbers during activity. In the lowest part of the spine, the vertebrae are naturally fused to form the sacrum and the coccyx (tail bone).

 

Protruding from the back of each vertebral body is an arch of bone that forms the large, vertical opening (the spinal canal) through which runs the spinal cord and nerve bundles. A fluid-filled protective membrane, the dura, covers the contents of the spinal canal from where the cord begins at the base of the skull to where it ends (in a bundle of nerve fibers known as the cauda equina).

A pair of spinal nerves branches at each vertebral level (one to the left and one to the right), providing sensation and movement to all parts of the body.

Three large, bony projections, or processes, arise from the vertebra's arch - one to each side (transverse) and one straight toward the back of the body (spinous). Strong ligaments and muscles attached to the vertebra's body and processes support the spine and further protect the delicate spinal cord and nerves encased within.

Back and leg pain, among other symptoms, may occur when an intervertebral disc herniates (Fig. 1B, above). This happens when some of the disc's jellylike center (the nucleus pulposus) bulges or ruptures through its tough, fibrous outer ring (the annulus fibrosis) to press upon a nerve. (Fig. 1C, above).

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What is It?

Lumbar laminectomy is an operation performed on the lower spine to relieve pressure on one or more nerve roots. The term is derived from lumbar (lower spine), lamina (part of the spinal canal's bony roof), and -ectomy (removal).

Why is it Done? Pressure on a nerve root in the lower spine, often called nerve root compression, causes back and leg pain. In this operation the surgeon reaches the lumbar spine through a small incision in the lower back. After the muscles of the spine are spread, a portion of the lamina is removed (Fig. 2) to expose the compressed nerve root(s).

Pressure is relieved by removal of the source of compression part of the herniated disc, a disc fragment, a tumor, or a rough protrusion of bone, called a bone spur.

What Happens Afterwards?

Successful recovery from lumbar laminectomy requires that you approach the operation and recovery period with confidence based on a thorough understanding of the process. Your surgeon has the training and expertise to correct physical defects by performing the operation; he and the rest of the health care team will support your recovery. Your body is able to heal the involved muscle, nerve, and bone tissues. Full recovery, however, will also depend on your having a strong, positive attitude, setting small goals for improvement, and working steadily to accomplish each goal.