Lumbar Laminectomy

Anterior Cervical Discectomy & Fusion :: Posterior Cervical Laminectomy :: Lumbar Laminectomy :: Lumbar Microdiscectomy :: Lumbar Decompression & Fusion :: Fusion for Scoliosis :: Pedicle Subtraction Osteotomy

Lumbar laminectomy is a surgical procedure that is performed in patients who have lumbar spinal stenosis and who have not responded to conservative treatment. To learn more about lumbar spinal stenosis, click here. Lumbar laminectomy is also referred to as “lumbar decompression”. These two terms (laminectomy and decompression) essentially mean the same thing, as the purpose is to relieve pressure off of spinal nerves.

The most important point to understand about lumbar laminectomy is that it involves removing the bone (called lamina), bone spurs, and ligaments that are pinching the nerves. This surgery is very effective in decreasing or relieving symptoms in the buttocks, thigh, calf and foot. Although some patients also have improvement in back pain, the primary purpose of the surgery is to relieve your leg symptoms. If your main complaint is low back pain, this surgery is not a good option.

You may be wondering what happens to the spine if the lamina is removed. A common question is whether anything is put back in its place. The answer is that in the absence of instability, nothing is put back in its place. A fusion is not performed unless the spine is unstable to begin with. For more discussion on spinal instability, click here. Consider the following analogies:

  • Think of the spine as a tripod. The spine has foundations – these foundations are called the facet joints and the disc. Each level in your spine has 2 joints, one on the left and one on the right. You also have the disc in the front. So the foundations of the spine are these 2 joints and the disc. So a spinal level is similar to a tripod – the 3 legs of the tripod are the 2 joints and the disc. As long as the legs of the tripod are not disrupted, the spine remains stable
  • Think of the spine as a house. Now a house has a floor, wall/foundations and a roof. A laminectomy is akin to removing the roof of the house, without disupting its foundations (or joints)

Preparing For Surgery

  • About 2-4 weeks prior to your surgery, you should see your primary care physician for a complete medical examination and for “medical clearance”. Your doctor may order tests prior to your surgery to evaluate your risk of being put under general anesthesia
  • If you take the following medications, stop taking them for 1 week prior to surgery
  • Aspirin, anti-inflammatory drugs (Ibuprofen, Advil, Motrin, Aleve, Naprosyn, Celebrex, Mobic, Arthrotec, Voltaren, etc.), Vitamin E and Glucosamine, all prescription diet medications or herbal supplements
  • If you take Plavix, Persantine, Ticlid, stop these medications 1 week prior to surgery but be certain to notify your primary care physician or cardiologist before you stop taking these medications
  • If you take Coumadin for any reason, you should stop taking Coumadin 5 days prior to surgery, but be certain to notify your primary care physician or cardiologist before your stop taking this medication to ensure it is safe for your situation
  • YOU SHOULD CONTINUE all other medications that you normally take
  • Please let me and the anesthesiologist know about alcohol use. If you drink more than 2 alcoholic beverages a day, you may experience withdrawal symptoms after surgery. Symptoms may include mild shakiness, sweating, hallucinations and other more serious life-threatening side effects. Interventions can be taken before surgery to minimize withdrawal symptoms
  • Do not eat or drink anything (including water) after midnight the night before your surgery
  • You should make plans to have some assistance at home after your surgery. The level of assistance you need depends on the extent of the surgery, your age, and general health

Surgical Risks

A lumbar decompression is generally a very safe and effective surgery for relief of leg pain. Many precautions are taken to prevent or minimize risks but because human biology is at times unpredictable, no surgery is risk free. Risks of the operation include, but are not limited to: infection, anesthesia related complications, pneumonia, blood clots in the legs, tear of the nerve sac (called a “dural tear”), weakness of the legs and injury to the nerves. Some of these complications are more common if you have had previous surgery on your back. The most common complication is a dural tear, especially if you have had previous surgery on your back. If a dural tear does occur, it will be repaired during surgery, and after surgery you will remain flat in bed for a couple of days. The reason you will be flat in bed is to eliminate gravity and thus allow the repair to heal. There are no longterm sequelae from a dural tear if it is treated appropriately, but it will change your postoperative care for the first couple of days after surgery, the main change being the flat bedrest.

Hospital Care

On the day of surgery, I will see you before you go back to the operating room to answer any additional questions you may have. You will then be taken back to the operating room where the anesthesiologist will give you either a general or spinal anesthestic. The surgery itself usually takes between 45 minutes to 2 hours, depending on the severity of stenosis and the number of spine levels involved. The preparation time (positioning, anesthesia) may add another 20-30 minutes to the surgery.

After the surgery, you will be taken to the recovery room where your blood pressure, temperature, pulse and respiration will be checked frequently. You will stay in the recovery room for one to three hours. Meanwhile, I will speak with your family or friends in the waiting room regarding your condition. You will then be transferred to a regular hospital room. You will be given IV fluids until you are able to drink on your own. You will also be given IV pain medication initially, and then oral pain medication depending on your level of pain.

Although the nerves have been freed, they are still injured. The pain, numbness, or tingling in your legs usually begins to improve shortly after the surgery. In some cases, it may take longer (several days to a couple of weeks) before an improvement is noticed. Nerves sometimes heal slowly and the healing rate depends on how long the nerve has been pinched and how much damage there is to it. Every patient experiences this healing process differently.

You will be discharged from the hospital when the following goals have been met:

  • Your pain is reasonably controlled with oral pain medication
  • You are able to eat a meal without nausea or vomiting
  • You are able to walk safely on your own
  • You are able to urinate on your own
  • Your vital signs (temperature, blood pressure, heart rate, respiration) are normal

Depending on how soon the above goals are met, some patients are able to go home the same day or the day after surgery while others require two days in the hospital.

At Home After Surgery

The post-operative instructions outlined below will give you the best chance of having a positive outcome from this surgery:

  • Take short walks as your comfort allows. You can start walking the morning after your surgery. Gradually increase the amount of walking you do each day. Walk 15-30 min three times a day. Your goal is to walk 1 mile by end of one month after surgery
  • Avoid bending over at the waist, twisting or bending motions for the first 4 weeks. Do not bend over to tie your shoe laces. Also avoid lifting anything heavier than 20 lbs for the first month
  • Avoid all strenuous activities for 6 weeks. Do not lift heavy bags or luggage. Use proper lifting technique: when picking an object off the ground, bend at your knees, not at the waist
  • Wound care:
    • On the second day after your surgery, you can take a shower but keep your incision covered with gauze and Tegaderm dressing to keep the incision dry. After showering, pat the incision dry and cover it with a new dressing
    • Keep your incision covered with Tegaderm dressing for 1 week when you take a shower. After that, you can shower without anything covering your dressing as long as there is no drainage from the incision. Do not take baths or soak your incision (swimming, etc.) until your wound is fully healed, usually at around 3 weeks
    • Do not apply any lotions or creams to the incision
  • Reasons to contact us immediately:
    • If there is any redness around the incision
    • If there is any drainage from the incision after the third day.
    • If you have a fever higher than 101 deg F
    • If your leg pain or numbness is significantly worse than before surgery. You should expect some pain and stiffness in your low back from the surgery. This improves with time as the wound heals
    • If you have any problems with bowel or bladder function, you should go to the emergency department right away
      • Returning to work depends on your occupation and your employer’s acceptance of your activity restrictions
      • You may resume sexual activity as your comfort allows. Please keep in mind the activity restrictions listed above
      • I will see you in the office 2-3 weeks after your surgery. If you do not have an appointment, please contact the office
      • After 6 weeks, you may need physical therapy depending on your progress. The therapist will help you strengthen your back muscles with back exercises. These exercises should be part of your lifelong fitness program. The therapist will also teach you about doing everyday tasks with proper body mechanics