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Laminectomy Procedure at Our Los Angeles Center

Cervical spine and lumbar spine surgery may be recommended for patients who have spinal stenosis. With this condition, the openings through which nerves exit the spinal column become narrower over time. Bone and other tissues may press on the nerves, causing a variety of unpleasant symptoms. Minimally invasive laminectomy and endoscopic laminotomy are two similar procedures that help “decompress” or relieve pressure on the spinal nerves by removing a section of the lamina (the back portion or “roof” of the spine) and sometimes the surrounding tissues, as well.

Problems Treated with Cervical Spine and Lumbar Spine Surgery

Spinal stenosis is one of the most common indications for laminectomy or laminotomy. Stenosis in the lower (lumbar) spine may cause ongoing pain. The pain can be in the lower back; however, it will often radiate down into the buttocks and legs, or progress upward from the legs into the buttocks. The aching or burning pain is especially severe during activities such as walking. Tingling, weakness, and numbness are other potential symptoms, as is incontinence (in severe cases). Sitting or changing position in a way that relieves pressure on the spine and increases the space available for the nerves will cause the pain to temporarily subside. Stenosis in the upper (cervical) spine is more dangerous since it can compress the spinal cord directly, leading to severe muscle weakness and even paralysis.

What Causes Spinal Stenosis?

This narrowing of the spaces in the spine can occur:

  • As ligaments become thicker and less flexible and as facet joints enlarge and begin impinging on the spinal cord or nerves (this tends to occur with age)
  • As discs slip, bulge, thin out or rupture due to degeneration or trauma (such as hard physical labor or aggressive exercise over many years)
  • Due to Paget’s disease or other factors that can cause bone overgrowth or “spurs” that protrude into the spinal canal
  • From degenerative diseases including rheumatoid arthritis and osteoarthritis
  • After an injury or spinal surgery that causes inflammation or degeneration

 

Spinal stenosis can occur as a birth defect where the spine does not develop correctly. However, it usually develops in older patients (over 50). Almost everyone experiences back pain at some point in their lives. However, the pain caused by spinal stenosis is chronic and tends to become worse over time.

Who Is a Candidate for Laminectomy or Laminotomy?

These procedures are designed to benefit patients who have ongoing neck, back or leg pain that interferes with mobility and quality of life. Diagnostic procedures such as x-rays, CT, electromyogram and MRI may be used to identify whether stenosis is present, what tissues are involved and what areas of the spine are most affected. These imaging techniques are only used to arrive at a diagnosis of spinal stenosis requiring surgery when a patient has symptoms of this condition and other potential causes of back and leg pain have been ruled out. That’s because many patients can have abnormal findings on these tests even if they are not having back pain or mobility problems. Surgical intervention for asymptomatic patients would do more harm than good.

What about patients who do have the classical warning signs of spinal stenosis? These patients will usually undergo several months of oral anti-inflammatories (such as ibuprofen), cortisone injections, physical therapy and other treatments first. Even minimally invasive cervical spine and lumbar spine surgery is reserved for cases where more conservative treatments have failed to deliver sufficient relief or if the problem is getting worse.

Procedure Overview

A traditional or open laminectomy involves making an incision three inches or longer and stripping the muscles away from the spine to access the treatment area. Fortunately, there are much more advanced techniques available today. Minimally invasive laminectomy and endoscopic laminotomy can be done using one or more very small incisions (one-half to one inch long). The muscles are gently stretched away from the spine instead of being cut and pulled away.

Small metal tubes in increasing diameters are used to gradually spread the muscles and create an access port for the instruments used in the spinal surgery. An endoscope (tiny fiber-optic viewing camera) is inserted along with instruments such as tiny scissors, a laser and other tools to flush out and suction the site. These instruments are used to remove a portion of the lamina (spinal bone) and create a small opening in the ligament that surrounds the spinal column to reveal the internal structures. The endoscope helps the surgeon identify exactly which structures are pressing on the nerve. In addition to removing a portion of the lamina, other tissues such as ligament and cartilage may be removed as well. The goal is to create a wider space in the spine so that nerves are not compressed. Some patients require a discectomy or fusion in addition to the laminectomy. This makes the procedure more extensive although it may still be done using a minimally invasive approach in some cases.

Risks, Side Effects and Benefits

Serious complications such as anesthesia reactions, nerve injury, substantial spinal fluid leakage, instability in the spine, infection and extensive bleeding are uncommon with this surgery. Some of these risks are increased in candidates with extensive stenosis and those with chronic health conditions such as high blood pressure or diabetes. Scarring is a somewhat more common side effect of all spinal surgeries. In some cases, internal scarring may require a minimally invasive procedure to reduce adhesions that are compressing the nerves again. Post-operative pain and discomfort is typical for some time after surgery and may be treated with prescription and over-the-counter medications.

As with any spinal surgery, the healing period may take many months. During this time, physical therapy (including at-home exercise as instructed) is vital to gradually restore mobility and ensure the most complete recovery. Not all patients experience full relief of their symptoms. In some cases, the symptoms may persist and laminectomy is only able to stop the progression from bad to worse.

However, in many cases patients can and do experience long lasting relief from pain – especially the sciatic pain that radiates into the legs. A minimally invasive spinal surgery has significant benefits compared to the traditional, open laminectomy. These include:

  • Much less blood loss
  • Minimal trauma to muscles and connective tissue around the surgical site
  • Less need for pain medication in the weeks and months following surgery
  • A smaller scar
  • A much shorter hospital stay (depending on the extent of the surgery)
  • The option of local anesthetic and deep IV sedation rather than general anesthesia (for some patients)
  • Removal of only a small portion of the lamina and other tissues (with laminotomy rather than full laminectomy) reducing the risk of side effects and potentially increasing the success of the surgery
  • Faster recovery

 

These benefits make minimally invasive cervical spine and lumbar spine surgery a more attractive option for patients who have been in pain for a long period of time.

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