Introduction:
The spinal canal narrowing is also a possible indication of this procedure. The posterior part of the vertebra or lamina is removed to provide more space for the compressed spinal cord or nerve roots. When non-surgical treatments such as physiotherapy, pain medications, and epidural steroid injections fail to improve after eight to 12 weeks, this procedure may be considered depending on several factors.
What Are the Goals of Laminectomy?
The goals for laminectomy are as follows:
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Relieve Nerve Compression: Stenosis of the spinal canal in the lumbar region may cause compression of the spinal cord, thecal sac, spinal dura, and the cauda equina. When these structures are compressed, symptoms such as leg pain while walking or bending the spine backward typically affect both legs. Widening the spinal canal by laminectomy helps relieve the compression of these neural tissues.
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Improvement of Leg Functionality: Often causes decreased mobility due to pain, and weakness in one or both legs is seen as a result of nerve compression. The pressure on the nerves to reduce leg pain and potentially improve weakness and functionality of the lower back and legs can be achieved by laminectomy. One or more spinal motion levels may be treated together by a single surgery. Laminectomy aims to treat leg symptoms and not lower back pain; thus, back pain may persist after surgery due to pain from the continuing degeneration process or causes unrelated to nerve or spinal cord compression.
What Are the Types of Laminectomy?
Laminectomy can be classified depending on the extent of the lesion:
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Bilateral Laminectomy: In this procedure, both sides of the lamina are removed with or without widening the intervertebral foramina or adjacent tissue and bone removal.
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Unilateral Laminotomy: In this procedure, a part of or the entire lamina of the affected vertebra is removed with or without adjacent tissues only on one side. Unilateral laminotomy may also be endoscope-guided, which is minimally invasive. It requires a smaller incision than open surgery, preserving more tissue and bone and reducing healing time. The overall success rates of open and minimally invasive decompression are usually the same.
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Lumbar Vertebrae: The facets may be wholly or partially removed. In such cases, a fusion of the vertebrae is considered to retain stability.
What Is the Success Rate of Laminectomy Procedure?
Research suggests the success rate of a lumbar laminectomy to alleviate leg pain from spinal stenosis is generally favorable:
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85 % to 90 % of patients find relief from leg pain postoperatively.
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A ten-year follow-up shows that 75 % of patients have satisfactory outcomes.
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10 % to 15 % of patients may require subsequent surgery due to postoperative complications.
Improper diagnosis, physical deconditioning before or after surgery, and smoking cause the procedure to fail. Proper case selection for this surgery can help prevent future complications.
Open laminectomy is performed for spinal stenosis, which can cause various symptoms. Well-selected cases respond to surgery with reportedly good overall outcomes, with almost 85 % to 90 % of patients experiencing a reduction in symptoms.
When Can the Procedure Fail?
The outcome of an open laminectomy surgery may be negatively affected in cases such as:
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Inconsistent physical and medical imaging findings may lead to misdiagnosis and unnecessary procedures.
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Physical deconditioning from a sedentary lifestyle.
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Avoiding physical activity due to lumbar stenosis pain before surgery and the lack of postoperative adequate physical activity.
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On medical imaging, there is chronic low back pain without leg pain with clear evidence of spinal stenosis.
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Smoking.
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Mental health conditions.
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Unrealistic expectations from the surgery.
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Severe infections.
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Heart and lung problems.
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Patients ineligible for general anesthesia due to systemic diseases undergo lumbar laminectomy.
What Are the Preoperative Procedures for Laminectomy?
Laminectomy is an inpatient procedure that depends on the procedure's extensiveness, the patient's age, and other accompanying health conditions. A one to four days of postsurgical hospital stay may be required along with a week or two ahead of the surgery, with certain precautions and preparations being necessary for patient preparation and to avoid future complications or failure of the procedure altogether, such as;
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Quitting smoking.
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Quitting other forms of tobacco.
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Complete physical and medical tests, including imaging and blood investigations.
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Getting clearance from the relevant doctors for heart conditions and diabetes, if present.
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Reviewing current prescription and over-the-counter (OTC) medications, including Nonsteroidal anti-inflammatory drugs (NSAIDs), Anticoagulants, herbal supplements, Vitamins, and Anti-hypertensive/ Anti-diabetic medications, if any, with the doctor.
What Are the Risks of a Laminectomy Procedure?
Any surgical procedure is not free from the risk of intraoperative or postoperative complications such as;
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Bleeding from the surgical site.
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Infection of the surgical site.
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Blood clots in the legs can disseminate to the lungs.
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Injury to the spinal cord or nerve root.
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General anesthesia-related risks.
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Injury to the local nerve or blood vessels in and around the surgical site.
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Rarely the pain may either not subside or be aggravated postoperatively.
What Does Postoperative Recovery Look Like After Laminectomy?
A postoperative hospital stay of one to four days is typically required following laminectomy. The patient is kept under observation by the hospital staff for any complications. In addition, a physical therapist is appointed, who works with the patient during the hospital stay to help with a guided rehabilitation program.
Recovery typically depends on the patient's fitness and level of activity before the surgical procedure is conducted. Physical therapy may be advised to improve presurgical activity levels to encourage better postoperative recovery. It typically takes four to six weeks until normal function is established.
The patient is then relocated to a regular ward with the following procedures:
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Intravenous administration of pain medications may be administered, and oral pain-relieving medications will follow.
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A liquid diet is initially offered.
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Solid foods can be tolerated after a certain period.
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Getting out of bed on one's own accord and sitting on a chair is encouraged by healthcare providers.
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The muscles are kept moving and prevent complete immobilization postoperatively.
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Walking is encouraged once getting up and sitting is done comfortably.
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Strengthening the lower back and leg muscles by walking aids in a faster recovery postoperatively.
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Stairs may be introduced once walking in the halls is practiced.
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A back brace to provide support and help with pain control is used.
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The surgical site is covered with gauze for postoperative bleeding or discharge.
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The surgery site is then usually left open to dry and heal once such discharge and bleeding are no longer present.
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It is important to note that bending or twisting movements are usually not allowed for the initial few weeks after surgery as these activities may strain the incision and the treated segments of the spine.
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Excessive bending or twisting immediately after surgery can cause the disc to re-herniate.
Conclusion:
Laminectomy is a surgical procedure aimed at the treatment of central spinal stenosis. The spinal canal narrowing is also a possible indication of this procedure. The posterior part of the vertebra or lamina is removed to provide more space for the compressed spinal cord or nerve roots. This procedure may be considered when non-surgical treatments such as physiotherapy, pain medications, and epidural steroid injections fail to show improvement after eight to 12 weeks. Research suggests the success rate of a lumbar laminectomy to alleviate leg pain from spinal stenosis is generally favorable, with 10 % to 15 % of cases requiring a revision or repeat surgery.
