Decompressive Lumbar Laminectomy

Spinal Stenosis Surgery

Decompressive lumbar laminectomy is a surgical procedure used to treat spinal stenosis, which occurs when spinal nerves are pinched by narrowing at the sides of the spinal column. Low back symptoms may include intense pain as well as numbness and/or weakness in one or both leg.

While most people with lumbar spinal stenosis respond well to non-surgical treatment, surgery may become necessary to treat severe cases. Spine surgery for lumbar spinal stenosis is typically reserved for people who have:

  1. Not responded to non-surgical treatments
  2. Bowel or bladder problems
  3. Worsening leg weakness
  4. An inability to walk distance

lumbar spinal stenosis central foraminal labeledSpinal stenosis in the low back occurs when spinal nerves are pinched by narrowing at the sides of the spinal column.How Decompressive Lumbar Laminectomy Is Performed
Lumbar laminectomy is the most common surgical procedure to treat spinal stenosis in the low back. Your surgeon removes or trims the lamina and thickened ligaments to enlarge the space surrounding or near the compressed nerves. The lamina is the bony arch at the back of a vertebra; cutting through the arch allows access to the spinal canal.

Because laminectomies are a common type of spine surgery, you may have options in terms of where and how you would like your procedure done. A lumbar laminectomy may be performed using a traditional open approach (larger incision). Alternatively, you may be a candidate for a minimally invasive laminectomy, also known as a micro-laminectomy. You may have your surgical procedure in a hospital or at an outpatient spine center. Talk to your surgeon about whether minimally invasive spine surgery is right for you.

Both the minimally invasive and traditional open decompressive lumbar laminectomy procedures accomplish the same goals. The difference is the minimally invasive version involves one or more tiny incisions (or skin punctures) and small instruments designed to separate muscles and soft tissues instead of cutting through them. The traditional open approach requires a larger skin incision and instruments that retract, separate and cut tissues.

Snapshot from an animation depicting lumbar laminectomy to treat spinal stenosis. Copyrighted by Blausen Medical.Snapshot from an animation depicting lumbar laminectomy to treat spinal stenosis. Copyrighted by Blausen Medical.Click here to view the Laminectomy surgical animation.

The procedure is most often performed under general anesthesia. You are positioned either on your side or stomach. In some cases, intraoperative “real-time” imaging is utilized during the operation. The vertebral level in your lower back is identified by the surgeon who makes the skin incision and uses different instruments (eg, probes, retractors) to push aside muscles and tissues to access your spine. A small drill or bone biting instrument is used to remove the lamina, which exposes the ligamentum flavum (connects the laminae of adjacent vertebrae). A cut is made in the ligamentum flavum to access the spinal canal. The surgeon removes any osteophytes (bone spurs) and rough bony edges to enlarge the spinal canal and nerve passageways (neural foramen) creating more room for spinal nerves and/or cauda equina.

Other Procedures May Be Included
A decompressive lumbar decompression may be combined with other surgical procedures to treat related disorders affecting the low back. A herniated disc and/or spondylolisthesis may accompany another disorder causing nerve compression. Surgical treatment of a spondylolisthesis may require the spine to be stabilized at one or more levels.

Lumbar instrumentation and fusion are two procedures that are often combined to stabilize two or more levels of the spinal column. Instrumentation involves implanting screws, rods, and/or interbody devices (eg, cage) to provide immediate stabilization of the spine. Bone graft is added (eg, autograft, patient’s own bone or donated bone) to stimulate bony ingrowth and healing together, which is fusion—enabling two or more vertebral levels to join or fuse together into a solid structure.
Post-operative lateral x-rayPost-operative lateral x-ray after minimally invasive laminectomy and interbody fusion at L4-L5 with pedicle screws treating severe lumbar spinal stenosis and spondylolisthesis.At the end of the surgical procedure, the surgeon closes the internal structures using suture (stitches) that do not require removal. The skin incision may be closed with suture or staples depending on the size of the incision and surgeon preference. The wound is covered with a dressing.

What to Expect After Lumbar Laminectomy Surgery
Lumbar laminectomy is a common procedure, but it is still spine surgery. It’s a major operation that requires rest and careful consideration during the recovery period.

Always follow your surgeon’s post-operative instructions—ignoring recommendations or doing too much too early can set you back in your recovery.

As part of your surgical aftercare, your surgeon may prescribe a course of physical therapy to help you rehabilitate after spine surgery. Each patient’s recovery is different, and depending on the complexity of the surgery, most patients return to all activities within 6 to 9 months.

Be Surgery Smart: Talking to Your Spine Surgeon Before the Procedure
A decompressive lumbar laminectomy may help relieve your severe low back symptoms of spinal stenosis symptoms. However, it’s important to ask your surgeon questions before your procedure to ensure you are comfortable moving forward with the operation.

Below are some good questions to ask your spine surgeon:

  • What are the risks associated with this procedure?
  • Will this surgery relieve all my symptoms?
  • What are the risks if I don’t have surgery?
  • What will my recovery look like?

If you have debilitating nerve pain in your low back or legs associated with lumbar spinal stenosis, talk to your doctor about whether spine surgery is right for you. If it is, a decompressive lumbar laminectomy may help restore your activity level and reduce your symptoms.

Updated on: 04/10/18
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If you are scheduled to have spinal surgery, one way to relieve your anxiety about the procedure is to learn all you can about the procedure. This article includes some sample questions that you can take with you to your next appointment.
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