A Look at Laminectomy Surgery

Lower back pain is a debilitating and unfortunately common problem among adults. A 2022 study published in The Journal of Pain, using data from the 2019 National Health Interview Survey, found that 8.2 percent of American adults experience chronic severe back pain. Moreover, nearly 75 percent of those people have issues with mobility and social and work participation; back pain is the most prevalent reason for job-related disability.

Medication and physical therapy can help to alleviate pain in the lower back, but some people may require surgical intervention. There are several effective pain relief procedures, each targeting different areas of the spine. These include an anterior cervical discectomy, spinal fusion surgery, and laminectomy, the latter of which involves removing the lamina bone from the affected vertebra to reduce pressure on the spinal column and nerves.

Laminectomy surgery has about a 90 percent success rate, with roughly three-quarters of patients reporting satisfaction with the results. Here's a complete breakdown of the procedure.

Reasons Why People Require a Laminectomy

There are many reasons one might require a laminectomy, including spinal stenosis and degenerative disc disease. Spinal stenosis is a condition associated with pain or numbness in the legs, due to compression on the spinal cord and nerves caused by a narrowing spinal canal. This occurs over time and mostly affects people over 50, with lumbar spinal stenosis being the most common reason people over 65 undergo spine surgery.

A laminectomy can also be an effective treatment for herniated discs, spinal tumors, bone fractures, bone spurs, and arthritis. While it primarily relieves pain in the lower back, it can also help reduce symptoms in the mid-back (thoracic laminectomy) and neck (cervical laminectomy).

Diagnosis

Surgeons will generally recommend a laminectomy if their patients experience back, neck, or shoulder pain, weakness or tingling in their legs and/or arms, and bowel or bladder issues. However, they will first conduct a physical exam and perform imaging tests, such as an X-ray, MRI, or CT scan. An MRI can highlight disc and ligament damage, as well as the presence of tumors, whereas a CT scan can accurately detect tumors, bone spurs, and herniated discs.

Before recommending a laminectomy, surgeons may also suggest non-surgical treatments and inquire about the patient's medical history and their objectives.

Other Treatment Options

Non-surgical treatment options for spinal stenosis and other forms of back pain include nonsteroidal anti-inflammatory drugs, oxycodone (with caution), steroid shots, and a minimally-invasive needle procedure to remove ligament and create additional space in the spinal canal. Some anti-depressants and anti-seizure drugs have also been shown to alleviate chronic back pain.

Preparing for Surgery

Before undergoing laminectomy surgery, patients should inform their surgeon about any medication they're taking. Some prescription drugs can increase the risk of complications. The surgeon might also suggest cutting back on or avoiding all nicotine products, as they can negatively impact the healing process.

Patients may also have to perform pre-op physical therapy and should arrange to have someone pick them up following the surgery. If the surgeon performs the procedure using small, specialized tools, the patient has a better chance of going home the same day, whereas they may need to stay in the hospital longer for observation if the surgeon makes large incisions.

How it Works

An anesthesiologist administers general anesthesia prior to surgery so that they will be asleep—and feel no pain—for the entire duration, which generally lasts between one and three hours. The surgeon begins by making an incision in the patient's back and moving aside skin, ligaments, and muscles to access the spine, after which they use a surgical microscope to closely examine the affected area.

The surgeon then carefully removes all or a part of the lamina in addition to bone spurs, disk fragments, or soft tissue causing issues. If needed, they will perform complementary procedures, including a spinal fusion to stabilize the bones in the spine or a foraminotomy to create more room in the spine for nerve roots. Finally, the surgeon puts everything back in place and stitches or sews the skin at the site of the incision.

The Recovery Process

Once the surgery is finished, patients can take medication to relieve any pain or discomfort they may feel. Generally, they also have to follow guidelines on how and when to start returning to their regular routine. It can take up to six weeks to fully recover from a minimally invasive laminectomy and upwards of six months to heal from a laminectomy with spinal fusion. With guidance from their healthcare provider, patients should gradually increase the amount they move each day.

Physical therapy can expedite the recovery process, allowing patients to move more freely with less pain. Straight leg raises, prone press-ups, and wall squats can help strengthen and improve the stability of the lower back and surrounding muscles, including the core, thighs, and glutes. Bridges, hamstring stretches, heel slides, and ankle pumps are also helpful.