Spinal Decompression Surgery: Laminotomy and Laminectomy
Spinal Decompression Surgery Types: Laminectomy or LaminotomyBoth procedures involve the vertebraeâ€™s lamina, which is an arch of bone that protects the spinal canal.
- In a laminectomy, the lamina is removed almost entirely.
- In a laminotomy, it is a partial removal.
- A laminectomy is usually performed to treat an arthritic condition of the spinal canal like spinal stenosis.
- Laminotomy is used almost exclusively to remove a herniated disc.
- A laminectomy removes more bone and sometimes the inner edge of the facet joint.
- Ultimately, a surgeon will determine which of the two procedures is best for the individual’s needs and condition.
Decompression SurgerySpinal stenosis or the narrowing of the spinal canal is usually caused by arthritis and overgrowth of the discs and joints. Similar compression issues respond well to non-surgical treatment. But sometimes surgery is necessary to treat uncommon but potentially severe cases. These include patients with:
- Bowel or bladder problems caused by the pressure on the spinal nerves
- Leg weakness that gets worse
- Inability to walk or move for long periods and distance
- Electric shock sensations
- Radiating/spreading pain
- Lumbar laminectomy is the most common procedure to treat spinal stenosis in the low back.
- It also helps treat herniated discs by allowing the surgeon to easily access the discs to repair any damage.
- The surgeon removes the lamina and ligaments that have thickened and are causing problems to create more space in the canal.
- The surgery enlarges the spinal canal so that pressure is relieved.
- By removing the source of the pressure, the pain caused by the compressed nerves is alleviated.
- An open laminectomy creates an incision of a couple of inches and exposes the spine.
- The muscles of the spine and back are cut through to expose the bone.
- Another technique that surgeons utilize is operating through a tube.
- They’ve adapted these techniques to be able to decompress both the right and the left sides although they are only operating on one side.
- Both procedures, minimal and traditional accomplish the same goals.
- The difference is the minimally invasive approach involves one or more tiny incisions also known as skin punctures and small instruments designed to separate muscles and soft tissues instead of cutting through them.
- The traditional approach requires a larger incision and instruments that retract, separate and cut tissues.
- Laminectomies are performed under general anesthesia using a posterior approach/lying face down during the procedure.
- It can be open or minimally invasive sometimes called a microlaminectomy.
- In an open laminectomy, the surgeon makes an incision near the affected spinal area.
- Once the incision is made, a retractor will move the skin, fat, and muscles to the side so the surgeon can access the spine.
- Next, they remove or trim the lamina and thickened ligaments to enlarge the space surrounding the compressed nerves.
- Once done, the retractor is removed and the incision is closed with sutures.
- Minimally invasive surgery or MIS is performed using special instruments like endoscopes and tubular retractors.
- These instruments allow for smaller incisions and less cutting.
- They will also use special eyewear to have a detailed view of the surgical field.
- Sometimes, the surgeon uses an endoscope or a microscope focused down the tube to perform the surgery.
- The portion of the lamina is removed, along with any bone overgrowths/osteophytes and ligament tissue.
- The tubular retractors are taken out so the soft tissue moves back into place, and the incision is closed with dissolving sutures.
Other spinal procedures performed alongsideLaminectomies and laminotomies are typically not performed together. However, a surgeon could perform both if the surgery affects multiple levels of the spine. They can also be combined with other spinal surgeries, that include:
- A foraminotomy is also a decompression procedure. But instead of removing part or all the lamina, the surgeon accesses the nerves through the spineâ€™s foramen or the passageway that nerves pass through on both sides.
- This decompression surgery involves the removal of all or part of the damaged intervertebral disc and is utilized for herniated discs.
- Fusion is often performed after spinal decompression surgery, as the space that was created by removing spinal structure/s can cause instability to the spine.
Candidates for spinal decompression surgeryBoth are common procedures performed by neurosurgeons and orthopedic spine surgeons. Laminectomies are considered one of the most effective treatments for spinal stenosis and spinal canal issues like:
- Certain types of infections and abscesses
- Spinal issues involving bowel/bladder dysfunction
- The primary reason for laminectomy is spinal stenosis, most common in individuals over the age of 60.
- Non-invasive treatments that don’t improve the condition that includes medication, massage, and physical therapy
- Fusion surgery failure
- Injection treatment failure
- The presence of tumors in or around the spine
- An infection like an epidural abscess
- Neurologic issues
- Bowel or bladder dysfunction
- Cauda equina syndrome
- What are the risks associated?
- Will the surgery relieve all symptoms?
- Not having the surgery risks?
- What is recovery like?
- Open or micro, recovery does take time. Following the doctorâ€™s instructions carefully are essential to make a full, healthy recovery.
- Individuals should be careful for about a month following the surgery. But does not mean laying down or being sedentary. Movement is crucial to recovery.
- The patient should not stay in bed or lie on the sofa.
- Wait a week or two before beginning physical therapy if necessary.
- Most will have a weak core, poor posture, and poor body mechanics, the goal is to help develop and strengthen these areas.
- Ice/cold packs will help reduce swelling and pain.
- Try not to sit for too long, as sitting is the least comfortable position after back surgery.
- Body mechanic awareness means avoiding too much bending or lifting and using the right body mechanics when bending or lifting.
- Post-operative body movement after surgery is vital and helps prevent post-surgery issues.
- Especially before surgery. Quitting entirely or at least for at least six weeks before surgery will make recovery easier and healthier.
- Speak with a doctor about weight. Just 5 pounds can make a significant difference during recovery.
- For individuals with diabetes, having an A1C under eight before surgery is ideal.
- The complexity of the surgery
- Personal medical history
- Health issues
- Post-laminectomy syndrome PLS also known as failed back surgery syndrome is a condition where an individual continues to have pain after surgery. Individuals still having symptoms after should speak with their doctor to determine the next phase of treatment.
How long before exercise?
- Returning to the gym or getting into an exercise routine will take some time. It is important to follow the doctorâ€™s recommendations and complete the full course of physical therapy before regular exercise activity can resume. Discuss workout plans with the doctor to determine the best timeline for the spine.
- Returning to some activity is possible around four weeks after surgery. Full recovery takes longer as each patientâ€™s recovery is unique. Depending on the complexity of the surgery, most return to all activities within 6 to 9 months.
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ReferencesAmerican Association of Neurological Surgeons. â€œMinimally Invasive Spine Surgery.â€ (n.d.)Â https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Minimally-Invasive-Spine-Surgery Foraminotomy. MedlinePlus. https://medlineplus.gov/ency/article/007390.htm. Reviewed November 27, 2016. Page last updated December 21, 2017. Accessed January 18, 2018. Laminectomy. https://medlineplus.gov/ency/article/007389.htm. MedlinePlus. Reviewed November 27, 2016. Page last updated December 21, 2017. Accessed January 18, 2018. Mayo Clinic. â€œLaminectomy.â€ (n.d.)Â https://www.mayoclinic.org/tests-procedures/laminectomy/about/pac-20394533 Mayo Clinic. â€œLaminotomy.â€ (n.d)Â https://www.mayoclinic.org/diseases-conditions/spinal-stenosis/multimedia/img-20149227
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