Procedure: Lumbar Laminectomy
Part 2: The Procedure
How the Procedure is Done
The patient is usually positioned face down on an operating frame. A small incision (usually about 3-4 inches, though it may be longer depending on how many levels of the spine are affected) is made in the lower back.
The surgeon uses a retractor to spread apart the muscles and fatty tissue of the spine and exposes the lamina. A portion of the lamina is removed to uncover the ligamentum flavum - an elastic ligament that helps connect two vertebrae.
Next an opening is cut in the ligamentum flavum in order to reach the spinal canal. Once the compressed nerve can be seen, the cause of compression can be identified. Most cases of spinal compression are caused by a herniated disc. However, other sources of pressure that can cause compression may include:
1 - A disc fragment (this will often cause more severe symptoms)
2 - An osteophyte or bone spur (a rough protrusion of bone)
3 - Protruding/degenerating discs
4 - Facet arthritis and/or cysts
5 - Tumors
The surgeon retracts the compressed nerve and the source of the compression is removed and pressure on the spinal nerve or nerve components is relieved.
If necessary, the surgeon will perform a spinal fusion with instrumentation to help stabilize the spine. This occurs when a lot of bone needs to be removed and/or when multiple levels are operated on. A spinal fusion involves grafting a small piece of bone (usually taken from the patient's own pelvis) onto the spine and using spinal hardware, such as screws and rods, 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.