Decompressive Lumbar Laminectomy

A Lumbar Laminectomy is where the Lamina and sometimes part of the Facet Joints are removed to allow room for the Lumbar nerves. They are usually compressed because of a degenerative process in the spine.

The most common reason to consider this procedure is to treat spinal stenosis, or it may be used to treat Sciatica which causes numbness or weakness in your leg(s).

If you are having surgery it usually means that the symptoms have not gone away with other treatments such as physiotherapy, rest, anti-inflamatory medications in either oral or injectable form.

The cause of these symptoms is usually a progressive degenerative process in the spine where the facet joints enlarge, the disc bulges and the ligament becomes thicker. When things like this occur, they compress the nerves to the legs and can cause some serious symptoms.

In the operating room, you are given a general anaesthetic and then positioned face down on a special frame. An incision is drawn on with a special pen, and the entire area is cleansed with an antiseptic solution. You are then covered in drapes so that only the incision can be seen. The level is checked with Xray. An incision is made through the skin down to the spinous process and the muscles moved out of the way. A retractor is used to keep them aside. The bone of the spinous process is removed using a special bone drill. The bone of the lamina and part of the facet joint might also be removed. This leaves the yellow ligament which is also removed to expose the dura and the compressed nerves.

Special attention is given to make sure that the nerves are completely decompressed. The openings under the facet joints that let the nerves out of the spine are checked and decompressed also if necessary.

Once this has been done and all bleeding is stopped the layers are then stitched back into their normal place. The skin will be closed with staples or sutures that will either have to be removed or dissolve on their own.

You will wake up in recovery and after about an hour be moved to your room. The nurses will continually monitor your vital signs and leg strength looking for any signs of complications. During the first night you will be awakened by the nurses to check your vitals and look for signs of complications. You will also have injections if needed for pain. This will be explained before surgery. Occassionally you will have trouble urinating and may require a catheter. You will also be encouraged to get up and walk a little.

The next day the IV will be removed from your arm after your next walk and then you will be given regular oral medication for pain. Gradually over the next 1 to 2 days you will be able to get around normally. When you are comfortable you will be able to go home.

It is important after surgery to walk as much as possible. Prolonged rest in bed can produce hip pain and blood clots in the legs. Sometimes a couple of days post-operative, the discomfort in your legs may return, this is due to swelling and usually settles with anti-inflamatory medication. If you have removable stitches then they will be removed between 7 and 10 days post-operative.

You will be admitted on the day of surgery or the day before and you must be NPO from midnight the night before surgery. You will most likely be discharged about 2 to 3 days post-operatively. On discharge you should be able to perform most daily tasks such as showering and dressing. Should you experience any of the following symptoms you should notify your doctor immediately:

• Weakness in the legs
• Difficulty passing your urine
• Abdominal pain
• Increasing back pain
• Swelling or infection in the wound

When you go home you will be able to do most things, however you should avoid heavy lifting, twisting, and prolonged sitting.You will not be able to drive for 3 to 6 weeks, but you should be able to return to some sort of work between 6 to 8 weeks post-operatively. It is very important to walk as much as is comfortable.

The most common risks are infection (treated with antibiotics), damaging the nerves that are compressed, damage to the dural sac containing the nerves and producing a fluid leak that will stop with bed rest, post operative blood clot requiring drainage, paraplegia with or without loss of bowel or bladder function (very rare), clot in the legs (can travel to the lungs; uncommon). Complications not directly related to the specific procedure are pneumonia, heart attack, and urinary track infection.

Your prognosis will depend on the reason for the procedure. In general, if you had weakness or pain this should improve, but your numbness may not. With these types of problems, you are not likely to be perfect again. Most people do have ongoing discomfort and this varies from person to person, and may improve with anti-inflammatory medications.