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Spine_surgery

Spine Surgery – Laminectomy

Lumbar laminectomy is a surgical procedure most often performed to treat leg pain related to herniated discs, spinal stenosis, and other related conditions. Stenosisoccurs as people age and the ligaments of the spine thicken and harden, discs bulge, bones and joints enlarge, and bone spurs or osteophytes form. Spondylolisthesis (the slipping of one vertebra onto another) also can lead to compression.

The goal of a laminectomy is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing or trimming the lamina (roof) of the vertebrae to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. Various devices (like screws or rods) may be used to enhance the ability to obtain a solid fusion and support unstable areas of the spine.

Indications:

Laminectomy is most commonly performed to relieve the pressure spinal stenosis places on your spinal cord or nerves. This pressure can cause pain, weakness or numbness that can radiate down your arms or legs. Laminectomy is usually better at relieving these types of radiating symptoms than it is at relieving actual back pain.

Your doctor may recommend laminectomy if:

  • Conservative treatment, such as medication or physical therapy, fails to improve your symptoms
  • You have muscle weakness or numbness that makes standing or walking difficult
  • You experience loss of bowel or bladder control

In some cases, laminectomy may be necessary as part of surgery to treat a herniated spinal disk. Your surgeon may need to remove part of the lamina to gain access to the damaged disk.

How is the Procedure 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:

  • A disc fragment (this will often cause more severe symptoms)
  • An osteophyte or bone spur (a rough protrusion of bone)
  • Protruding/degenerating discs
  • Facet arthritis and/or cysts
  • 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.

Risks:

Laminectomy is generally a safe procedure. But as with any surgery, laminectomy carries a risk of complications. Potential complications include:

  • Bleeding
  • Infection
  • Blood clots
  • Nerve injury
  • Spinal fluid leak

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