Sarah Lewis, PharmD
What is a laminectomy?
Laminectomy is the surgical removal of a bony area of the spine called the lamina. The lamina is the back part of each vertebra of your spine and forms the back wall of your spinal canal. Your spinal cord runs through your spinal canal in the center of your vertebrae. Certain conditions of the spine can compress the spinal cord and cause pain. A laminectomy can relieve pressure in your spinal canal and on spinal nerves by opening up your spinal canal. This surgery is also known as decompressive laminectomy.
The word laminectomy is often used interchangeably with laminotomy. However, laminectomy is the removal of most of the lamina, while laminotomy is the removal of part of the lamina.
Laminectomy is an alternative to laminoplasty. Laminoplasty hinges the lamina like a door to create more space in your spinal canal without removing the lamina. However, because a laminectomy removes more bone, it may increase the need for spinal fusion, which can limit the movement of your spine.
Laminectomy is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options available. Consider getting a second opinion about all of your treatment choices before having a laminectomy.
Types of laminectomy
When laminectomy involves one vertebra, it is called single level. When it involves more than one vertebra, it is called multilevel.
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The types of laminectomy procedures include:
Cervical laminectomy is the removal of lamina in the neck area (cervical spine).
Lumbar laminectomy is the removal of lamina in the lower back (lumbar spine).
Sacral laminectomy is the removal of lamina in the back between your pelvic, or hip bones (sacral spine).
Thoracic laminectomy is the removal of lamina in the middle part of the back (thoracic spine).
Other procedures that may be performed
Your doctor may perform one or more other procedures in addition to a laminectomy:
Discectomy is the surgical removal of part or all of a spinal disc. A discectomy treats degenerated, herniated or ruptured spinal discs.
Foraminotomy is the widening of the opening where the nerve roots leave the spinal canal. Your doctor may use this procedure when the opening (foramina) is narrowed causing pressure on the spinal nerves.
Spinal fusion is the permanent joining together of two vertebrae. This procedure permanently stops movement between the two vertebrae and limits the motion of your spine. Spinal fusion is usually needed with multilevel laminectomy to stabilize your spine.
Why is a laminectomy performed?
Your doctor may recommend a laminectomy to treat a variety of diseases and conditions of the spine.
Your doctor may only consider a laminectomy if other treatment options with less risk of complications are not working. Ask your doctor about all of your treatment options and consider getting a second opinion.
Your doctor may recommend laminectomy when you have spinal cord compression with symptoms of myelopathy or spinal stenosis. Myelopathy is impaired function of the spinal cord. Symptoms include weakness, pain, numbness, clumsiness, poor balance, difficulty walking, and stiffness in the extremities. The goal of laminectomy is to relieve spinal pressure to stop myelopathy progression and allow healing.
Laminectomy relieves pressure on your spinal cord. However, completely removing the lamina makes your spine less stable. This increases the need for spinal fusion and the resulting loss of movement.
Your doctor may recommend laminectomy for persistent spinal or leg pain or other symptoms caused by:
Bone spurs, abnormal growths of bone on a vertebra, which can lead to compression of the spinal cord and nerves
Degenerative disc disease, a breakdown of the cushioning discs between the vertebrae, which can lead to compression of the spinal cord and nerves
Herniated spinal disc, displacement of the cushioning disc between the vertebrae
Sciatica, pain that runs down the buttock and leg due to compression of a nerve in the lower back
Spinal stenosis, a narrowing of the spinal column causing pressure on the spinal cord and nerves
Spondylosis, also called spinal osteoarthritis, which is caused by wear and tear on the discs in your spine
Who performs a laminectomy?
An orthopedic surgeon or a neurosurgeon will lead a surgical team to perform your laminectomy. Orthopedic surgeons specialize in the surgical treatment of diseases and conditions of the muscles and bones, including the spine. Neurosurgeons specialize in the surgical treatment of diseases and conditions of the nervous system, including the nerves of the spine.
How is a laminectomy performed?
Your surgeon will perform your laminectomy by taking out the lamina, the back part of your vertebra. This relieves pressure in your spinal canal or on the spinal nerves in your neck or back. A laminectomy is performed in a hospital or surgical center.
Surgical approaches to laminectomy
Laminectomy is performed using one of the following approaches:
Microlaminectomy is a minimally invasive procedure. It involves inserting special instruments and an arthroscope through small incisions in your back or neck. An arthroscope is a thin, lighted camera that transmits pictures of the inside of your body to a video screen viewed by your surgeon as he or she performs the surgery. Microlaminectomy generally involves a faster recovery and less pain. This is because it causes less damage to tissues and organs. Your surgeon will make small incisions instead of a larger one used in open surgery. He or she can then thread surgical tools around muscles and other structures instead of cutting through or displacing them as in open surgery.
Open surgery uses a large incision in your back or neck over the affected vertebra. The length of the incision will depend on how many vertebrae need treatment. Open surgery allows your surgeon to directly view and access the surgical area. Open surgery requires a larger incision and involves more cutting and displacement of muscle and other tissues. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery because it causes more trauma to tissues. Despite the potential for damage, open surgery may be a safer or more effective method for certain patients.
Your surgeon will determine which type of laminectomy is best for you and how long you need to stay in the hospital or surgical center based on a variety of factors. These include your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different laminectomy procedures and ask why your surgeon will use a particular type of procedure for you.
Types of anesthesia that may be used
Your surgeon will perform your laminectomy using either regional anesthesia or general anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around the nerves in the spine that transmit pain signals from the surgical area. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your laminectomy
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you understand and sign the surgical consent.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control your breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a laminectomy?
As with all surgeries, a laminectomy involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during the procedure or throughout your recovery.
General risks of surgery
The general risks of surgical procedures include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of laminectomy
Complications of laminectomy can be serious and include:
Bone infection of the vertebra
Injury to the esophagus or intestines
Nerve and blood vessel damage
No pain relief or little pain relief following surgery
Recurrent symptoms, including back and leg pain
Spinal nerve injuries causing weakness, numbness or pain
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my laminectomy?
You are an important member of your own healthcare team. The steps you take before surgery can improve your outcome after the procedure. You can prepare for a laminectomy by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing weight before the surgery through a healthy diet and exercise plan
Not eating or drinking just prior to surgery as directed. Your doctor may cancel your surgery if you eat or drink too close to the start of the procedure because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. For laminectomy, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during their doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need a laminectomy? Are there any other options for treating my condition?
Which type of laminectomy will I need?
How long will the surgery take? When can I go home?
What kind of restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What kind of rehabilitation program or physical therapy will I need?
What medications will I need before and after the surgery?
How will you manage my pain?
When should follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my laminectomy?
Knowing what to expect can help make your road to recovery after laminectomy as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. In most cases, your care team will have you up and walking once you are alert. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
Laminectomy may be an outpatient procedure in which you go home the same day. However, you may need to stay in the hospital for up to four days if you have both a laminectomy and spinal fusion.
Recovery after surgery is a gradual process. Recovery time varies depending on the specific procedure and type of anesthesia, your general health, age, and other factors. Your doctor will likely recommend a course of physical therapy to help you recover. Full recovery times range from four to six weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor and care team will manage your pain so you are comfortable and can get the rest you need. Contact your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a laminectomy. Call your doctor if you have questions or concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication, worsening pain, or pain that is different or occurs in a new area, such as in your arm or leg
Unexpected drainage, pus, redness, tenderness or swelling of your incision
Weakness, numbness or difficulty moving a part of your body
How might a laminectomy affect my everyday life?
Laminectomy may reduce your symptoms so you can lead an active, normal life. For example, laminectomy may relieve or lessen your back pain. However, laminectomy will not cure your spine problems or reverse permanent nerve damage caused by long-term spinal cord compression.
You can help prevent further spine problems by:
Following your doctor’s instructions about how to move, walk, sit and stand
Maintaining a healthy lifestyle including an appropriate body weight
Practicing good posture
Strengthening your back and leg muscles with exercises as recommended by your healthcare provider
Using proper body mechanics when lifting or carrying objects
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- Eidelson SG, Fessler RG, Garfin SR, et al. Save Your Aching Back and Neck: A Patient’s Guide. 2nd ed. San Diego, CA: SYA Press and Research Inc.; 2002:76-80. http://www.amazon.com/Save-Your-Aching-Patients-Guide/dp/0966925211..
- Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf
- Spinal Decompression: Laminectomy and Laminotomy. Mayfield Clinic and Spine Institute. http://www.mayfieldclinic.com/pdf/pe-decompression.pdf.