Laminectomy

A laminectomy is a type of surgery where a part or all of the lamina (vertebral bone) is removed. This surgery is performed to treat a prolapsed or herniated intervertebral disc (age-related degeneration of spinal discs in the spinal cord). It helps in easing pressure on the spinal cord or the nerve roots of the spine. The surgery is done only after other medical treatments have failed to work.

Laminectomy can be performed to relieve the patient from the presence of several symptoms of back and neck problems such as:

1. Persistent pain in the lower back, neck, and spine. Severe pain in the leg can cause a disability to move and function.
2. Prolapsed lumbar region (falling out of discs in lower region of back).
3. Herniated intervertebral disc (a gradual, age-related degeneration of discs, in the vertebral column).
4. Sciatic nerve (a nerve present in the lower spinal region) pressure, which radiates pain down the leg.
5. Weakening of leg muscles and loss of sensation down the leg and foot.
6. Severe pain in the back that is affecting the quality of life.
7. Spinal canal stenosis (a condition characterised by the pressure on the nerves within the spine and spinal cord).
8. Degenerative spondylolisthesis (a condition that causes pain in the lower back).

Severe outcomes can be expected if laminectomy is delayed, such as:

1. Severe scoliosis (sideways curvature of the spine).
2. Severe kyphosis (hunchback, curved spine).
3. Chronic and acute back pain.
4. Nerve tissue injury and sprain in the spine.
5. Long term disability caused by back pain.
6. Spondylolysis. (stress fracture or weakness of the facet joints, which are pairs of small joints between the vertebrae at the end of the spine).
7. Herniation (a gradual, ageing-related degeneration of discs in the vertebral column).
8. Narrowing of the spinal canal, which can cause severe pain (spinal stenosis).
9. Vertebral fracture(s).
10. Osteoporosis (a disease that weakens bones).

1. The surgeon will clean the skin at the surgical site with an antiseptic solution.
2. Your skin on the selected vertebra will be marked for an incision.
3. The surgeon first makes a cut through the skin.
4. The muscle is then cut, stripped back from the vertebrae, and kept in place with retractors equipment (an instrument used to separate the edges of a surgical incision or wound). 
5. The lamina, which is situated between the bony projections of the vertebrae and the transverse process (a small bony projection off the right and left side of each vertebra), is either removed or drilled with small holes.
6. The vertebrae are the ‘points’ you can feel with your fingers on your back.
7. The surgeon might remove all or a part of the lamina to release the tension on the spinal cord or nerves.
8. In some cases, the surgeon performs spinal fusion at the same time. In this step, they will connect two or more bones in your spine.
9. The surgeon may trim the protruding heads of the herniated disc.
10. Once the surgery is completed, the surgeon makes sure the nerves are not compressed.
11. The muscle and skin are sutured and closed.
12. A sterile, clean dressing or bandage will be applied after the surgery.

1. The doctors will take your complete medical history.
2. They will perform a physical exam to make sure you're fit before undergoing the procedure.
3. They may do some diagnostic and blood tests, and laboratory and urine tests.
4. Tests are usually performed before surgery to help in diagnosis. These tests may include: 
   1. Plain spinal X-rays myelogram (rarely performed)
   2. Computerised tomography (CT) scan 
   3. Magnetic resonance imaging (MRI) scan
5. You should consult your doctors about all the over-the-counter and prescrand ibed medicines, herbal supplements that you're taking.
6. Inform your doctors about any history of bleeding diseases or if you are taking any blood-thinning (anticoagulant) medicines such as aspirin. They may advise you to stop these before the surgery.
7. Several hours before the surgery, you will not eat anything. A pre-anaesthetic medication is usually given to make you feel drowsy and dry up some internal secretions.

 

On the day of the surgery, the hospital staff will take you to the pre-operative room where you can expect the following:

1. The anesthesiologist will go through your pre-anaesthesia check-up reports to confirm that you are fit for surgery.
2. You will be requested to wear a hospital gown and provided with an identity bracelet and allergy bracelet on your wrist that will have your name and the name of the hospital on it.
3. The healthcare staff will ask you to remove your clothing, jewellery, glasses, hairpins, contact lenses or any objects that may interfere with the surgery. Dentures and loose teeth also need to be removed prior to the surgery to prevent any dental damage or risks.
4. The healthcare staff will note the following information:
   1. The time of your last meal and fluids.
   2. Medical history, current symptoms and allergies
   3.  Vital signs like body temperature, blood pressure and heart rate
5. The healthcare staff will trim the hair on the surgical site if needed.
6. They will place a soft, thin tube called an intravenous line into a vein in your hand or arm so that medicines can be given directly into your blood vessel.
7. You will be placed lying on the side or on your belly on the operating table.
8. The staff will clean the surgical site with an antiseptic solution.

1. You will be transferred to an operating room.
2. An IV (intravenous) line is inserted into your arm or hand.
3. Once you are under anaesthesia, a urinary drainage catheter may be inserted.
4. During surgery, you will be monitored continuously for heart rate, breathing, blood pressure, and blood oxygen levels by the anesthesiologist.
5. You will not feel any distress or pain during the surgery as you will be under anaesthesia during the entire surgery.
6. The surgical area will be bandaged, and dressing will be applied.
7. After the surgery, you will be moved to the recovery area for observation.
8. The procedure will be finished within two hours. However, it can also take longer if many problems are needed to be addressed during this one surgery.

At the Hospital:

1. After the surgery, you will be moved from the operating room to the recovery room (also called the post-operative room) where the healthcare staff will closely monitor your condition for a few hours.
2. Once your pulse, blood pressure, and breathing pattern are regular and stable, you will be moved back to your hospital room. 
3. This surgery usually requires that you stay in the hospital for one or more days.
4. At first, you will be instructed how to roll over in bed. You are taught the proper way of rolling your body to maintain an appropriate body alignment. It is essential for the first 48 hours or so.
5. You will most likely get out of bed and start walking slowly on the evening of the surgery. The physiotherapist will aid you to get out of the bed properly to avoid strain on the surgical site.
6. You will be provided with medicines to manage your pain.Your healthcare staff will provide you with an exercise chart to follow at the hospital and after discharge.
7. Your wound will be checked regularly for any kind of redness, swelling or infection. 
8. The doctors may record your ability to pass the urine. It may sometimes get affected following the surgery.
9. You will be given intravenous fluids for a few days, which may contain an antibiotic.

At Home:

1. Once you are at home, it's essential to keep the surgical incision area clean and dry. 
2. Your doctor will give you particular bathing instructions. 
3. The surgical staples or stitches are removed during a follow-up office visit.
4. You should continue to take prescribed medications such as a pain reliever for soreness.
5. Avoid activities that put a strain on the back – such as sitting or standing for too long, bending at the waist, flexing your spine, or climbing too many stairs.
6. Sleep on a firm mattress.
7. Avoid wearing high heel shoes.
8. Gradually increase your exercises, although if you develop pain, stop the activity.
9. Be careful while lifting, twisting, or bending. 
10. Follow specific instructions by your doctors about activities you can and can't do, including walking and driving.

You will have a follow-up appointment at the hospital six to eight weeks after the surgery. Your doctor may suggest getting an X-Ray done on the day of your appointment.

Additionally, you should reach out to the doctor for the following symptoms after surgery:

1. Any signs of infections
2. Foul odour, inflammation or swelling at the incision site
3. Tenderness and leg swelling
4. Difficulty in swallowing or breathing
5. You have a high fever
6. You are experiencing dizziness
7. Pain that worsens at the incision site, belly, or shoulder
8. Bowel or bladder control problems.