Back pain that interferes with normal daily activities may require surgery for treatment. Laminectomy is a type of surgery in which a surgeon removes part or all of the vertebral bone (lamina) to relieve compression of the spinal cord or the nerve roots that may be caused by injury, herniated disk, spinal stenosis (narrowing of the canal), or tumors. A laminectomy is considered only after medical treatments have proven to be ineffective.
Other related procedures that may be used to help diagnose back problems include CT scan, X-ray, MRI, electromyogram (EMG), and myelogram.
Reasons for the Procedure
Low back pain can range from mild, dull, annoying pain, to persistent, severe, and disabling pain. Pain in the lower back can keep you from moving and get in the way of your daily life. Laminectomy may be needed to relieve pressure on the spinal nerves, treat a disk problem, or remove a tumor from the spine.
One common reason for having a laminectomy is a herniated disk in the spine. A disk may be moved or damaged because of injury or wear and tear. When the disk presses on the spinal nerves, this causes pain, and sometimes numbness or weakness. The numbness or weakness will be felt in the body part where the nerve is involved, often the arms or legs. The most common symptom of a herniated disk is sciatica. Sciatica is a sharp, shooting pain along the sciatic nerve which runs from the buttocks to the thigh and down the back of the leg.
If medical treatments don’t help, back surgery may be a good option. Laminectomy is usually done when back pain that continues after medical treatment, or when the back pain is accompanied by symptoms of nerve damage, such as numbness or weakness in the legs.
There may be other reasons for your health care provider to recommend a laminectomy.
During the Procedure
A laminectomy usually requires a stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.
A laminectomy may be performed while you are asleep under general anesthesia, or while you are awake under spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Newer techniques are being developed that may allow a laminectomy to be done under local anesthesia on an outpatient basis. Your doctor will discuss this with you in advance.
Generally, a laminectomy follows this process:
- You will be asked to remove clothing and will be given a gown to wear.
- An intravenous (IV) line may be started in your arm or hand.
- Once you are under anesthesia, a urinary drainage catheter may be inserted.
- If the surgical site is covered with excessive hair, the hair may be clipped off.
- You will be positioned either on your side or abdomen on the operating table.
- The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over the surgical site will be cleansed with an antiseptic solution.
- The surgeon will make an incision over the selected vertebra.
- The surgeon will spread the back muscles apart.
- The lamina (bony arch of the posterior part of the vertebra) is removed to relieve the pressure on the nerves in the area. This may involve removing bone spurs or growths, or removing all or part of a disk.
- In some cases, spinal fusion may be performed at the same time. During a spinal fusion, the surgeon will connect 2 or more bones in the back to help stabilize the spine.
- The incision will be closed with stitches or surgical staples.
- A sterile bandage or dressing will be applied.
During a surgical procedure called a discectomy, the surgeon removes all or part of the disk and/or bone over the nerve root that is pressing on a nerve root to relieve pain – typically leg pain due to a herniated disc in the lower back – and provide more room for the nerve to heal.
This procedure is usually performed on an outpatient basis, with a one-inch incision in the middle of the lower back.