Introduction

A laminectomy is a surgical procedure to relieve pressure on the spinal cord due to spinal stenosis. In spinal stenosis, bone spurs press against the spinal cord, leading to a condition called myelopathy. Myelopathy can produce problems with the bowels and bladder, disruptions in the way you walk, and impairments with fine motor skills in the hands. In a laminectomy, a small section of bone covering the back of the spinal cord is removed. "Lamina" refers to the roof of bone over the back of the spinal cord, and "ectomy" means the medical procedure for removing a section of the bony roof to take pressure off the spinal cord.

A laminectomy can alleviate the symptoms of spinal stenosis, a condition that causes the spinal cord to become compressed inside the spinal canal. Wear and tear on the spine from aging and repeated stresses and strains can cause a spinal disc to begin to collapse. This is the first stage of spinal stenosis. As the space between the vertebrae narrows, the posterior longitudinal ligament that attaches behind the vertebral body may buckle and push against the spinal cord. The degenerative process can also cause bone spurs to develop. When these spurs point into the spinal canal, they squeeze the spinal cord. In a laminectomy, the surgeon relieves pressure from the spinal cord by removing a section of the lamina bone, the buckled parts of the posterior longitudinal ligament, and the bone spurs.

Surgical Procedure

Patients are given a general anesthetic to put them to sleep during most spine surgeries. As you sleep, your breathing may be assisted with a ventilator.

This surgery is usually done with the patient lying face down on the operating table. The doctor makes an incision down the middle of the back of the neck. The skin and soft tissues are separated to expose the bones along the back of the spine. Some doctors use a surgical microscope during the procedure to magnify the area they'll be working on.

Doctors have found that complete removal of the laminae loosens the facet joints that connect the back of the spine. This can cause the spine to tilt forward. To avoid this, a hinge can be formed by only cutting partially through the lamina on one side. A second cut is made all the way through the other lamina. This edge is then lifted away from the spinal cord, and the other edge acts like a hinge. The hinged side forms a bone union, which holds the opposite side open and keeps pressure off the spinal cord.

Small cutting instruments may be used to carefully remove soft tissues near the spinal cord. Then the doctor takes out any small disc fragments and scrapes off nearby bone spurs. In this way, additional tension and pressure are taken off the spinal cord.

After Surgery

Patients are usually able to get out of bed within an hour or two after surgery. Your doctor may have you wear a soft neck collar. If not, you will be instructed to move your neck only carefully and comfortably.

Most patients leave the hospital the day after surgery and are able to drive within a week or two. People generally get back to light work by four weeks and can do heavier work and sports within two to three months. Since recovery rates depend on each patient’s individual condition, you should discuss this with your doctor.

Outpatient physical therapy is usually prescribed when patients have extra pain or show significant muscle weakness and deconditioning.

Rehabilitation

Rehabilitation after laminectomy surgery is generally only needed for a short period of time. If you require outpatient physical therapy, you will probably need to attend therapy sessions for two to four weeks. Full recovery may take up to three months.