Spinal Decompression Surgery: Laminotomy and Laminectomy

Spinal decompression surgery could be a treatment option discussed with a doctor to relieve nerve pain brought on by a spinal condition or disorder. Everything to know about the procedures is straight from the experts.

Spinal Decompression Surgery Types: Laminectomy or Laminotomy

Both procedures involve the vertebrae’s lamina, which is an arch of bone that protects the spinal canal.

• In a laminectomy, the lamina is removed almost entirely.
• In a laminotomy, it is a partial removal.

Despite the removal, the large muscles of the back provide sustained protection for the nerves below. Therefore, the spinal nerves are still safe and secure following the procedures. Which one is right depends on the situation.

• A laminectomy is usually performed to treat an arthritic condition of the spinal canal, like spinal stenosis.
• Laminotomy is used almost exclusively to remove a herniated disc.
• A laminectomy removes more bone and sometimes the inner edge of the facet joint.
• Ultimately, a surgeon will determine which of the two procedures is best for the individual’s needs and condition.

Decompression Surgery

Spinal stenosis, or the narrowing of the spinal canal, is usually caused by arthritis and overgrowth of the discs and joints. Similar compression issues respond well to non-surgical treatment. But sometimes surgery is necessary to treat uncommon but potentially severe cases. These include patients with:

• Bowel or bladder problems caused by the pressure on the spinal nerves
• Leg weakness that gets worse
• Inability to walk or move for long periods and distance

Spinal decompression surgery aims to create space around the spinal cord and surrounding nerves by removing the compressing structure/s. When the cord and/or nerve/s are compressed, physical and neurological symptoms are experienced down the nerve’s pathway. This includes:

• Tingling
• Numbness
• Electric shock sensations
• Radiating/spreading pain
• Weakness

Once the compressed nerves have space to relax and move around, symptoms subside.

Laminectomy process

• Lumbar laminectomy is the most common procedure to treat spinal stenosis in the low back.
• It also helps treat herniated discs by allowing the surgeon to easily access them to repair any damage.
• The surgeon removes the lamina and ligaments that have thickened, causing problems and creating more space in the canal.
• The surgery enlarges the spinal canal so that pressure is relieved.
• The pain caused by the compressed nerves is alleviated by removing the source of the pressure.
• An open laminectomy creates an incision of a couple of inches and exposes the spine.
• The spine and back muscles are cut through to expose the bone.
• Another technique that surgeons utilize is operating through a tube.
• They’ve adapted these techniques to be able to decompress both the right and the left sides, although they are only operating on one side.
• Both procedures, minimal and traditional, accomplish the same goals.
• The difference is the minimally invasive approach involves one or more tiny incisions, also known as skin punctures, and small instruments designed to separate muscles and soft tissues instead of cutting through them.
• The traditional approach requires a larger incision and instruments that retract, separate and cut tissues.

Laminectomy surgery

• Laminectomies are performed under general anesthesia using a posterior approach/lying face down during the procedure.
• It can be open or minimally invasive, sometimes called a microlaminectomy.
• The surgeon makes an incision near the affected spinal area in an open laminectomy.
• Once the incision is made, a retractor will move the skin, fat, and muscles to the side so the surgeon can access the spine.
• Next, they remove or trim the lamina and thickened ligaments to enlarge the space surrounding the compressed nerves.
• Once done, the retractor is removed, and the incision is closed with sutures.
• Minimally invasive surgery, or MIS, is performed using special instruments like endoscopes and tubular retractors.
• These instruments allow for smaller incisions and less cutting.
• They will also use special eyewear to have a detailed view of the surgical field.
• Sometimes, the surgeon uses an endoscope, or a microscope focused down the tube to perform the surgery.
• The portion of the lamina is removed, along with any bone overgrowths/osteophytes and ligament tissue.
• The tubular retractors are removed, so the soft tissue moves back into place, and the incision is closed with dissolving sutures.

Other Spinal Procedures Performed Alongside

Laminectomies and laminotomies are typically not performed together. However, a surgeon could perform both if the surgery affects multiple spine levels. They can also be combined with other spinal surgeries, which include:

Foraminotomy

• A foraminotomy is also a decompression procedure. But instead of removing part or all the lamina, the surgeon accesses the nerves through the spine’s foramen or the passageway that nerves pass through on both sides.

Discectomy

• This decompression surgery involves the removal of all or part of the damaged intervertebral disc and is utilized for herniated discs.

Spinal fusion

• Fusion is often performed after spinal decompression surgery, as the space that was created by removing the spinal structure/s can cause instability in the spine.

Candidates for spinal decompression surgery

Both are common procedures performed by neurosurgeons and orthopedic spine surgeons. Laminectomies are considered one of the most effective treatments for spinal stenosis and spinal canal issues like:

• Tumors
• Certain types of infections and abscesses
• Spinal issues involving bowel/bladder dysfunction
• The primary reason for laminectomy is spinal stenosis, most common in individuals over the age of 60.

Other considerations and conditions include:

• Non-invasive treatments that don’t improve the condition that includes medication, massage, and physical therapy
• Fusion surgery failure
• Injection treatment failure
• The presence of tumors in or around the spine
• An infection like an epidural abscess
• Neurologic issues
• Bowel or bladder dysfunction
• Cauda equina syndrome

Ask questions about the procedure to ensure you are comfortable with the operation. Here are some questions:

• What are the risks associated?
• Will the surgery relieve all symptoms?
• Not having the surgery risks?
• What is recovery like?

Recovery

• Open or micro, recovery does take time. Following the doctor’s instructions carefully are essential to make a full, healthy recovery.
• Individuals should be careful for about a month following the surgery. But does not mean laying down or being sedentary. Movement is crucial to recovery.
• The patient should not stay in bed or lie on the sofa.
• Wait a week or two before beginning physical therapy if necessary.
• Most will have a weak core, poor posture, and poor body mechanics; the goal is to help develop and strengthen these areas.

Things to help with recovery include:

• Ice/cold packs will help reduce swelling and pain.
• Try not to sit for too long, as sitting is the least comfortable position after back surgery.
• Body mechanic awareness means avoiding too much bending or lifting and using the right body mechanics when bending or lifting.
• Post-operative body movement after surgery is vital and helps prevent post-surgery issues.

Things to do before surgery:

Quitting smoking

• Especially before surgery. Quitting entirely or at least for at least six weeks before surgery will make recovery easier and healthier.

Losing weight

• Speak with a doctor about weight. Just 5 pounds can make a significant difference during recovery.

Blood sugar

• For individuals with diabetes, having an A1C under eight before surgery is ideal.

Every patient’s recovery is different. Recovery time depends on:

• The complexity of the surgery
• Personal medical history
• Health issues

Recovery typically takes about two to four weeks after the surgery. However, it depends on the reason/s for the surgery.

Questions

Post-laminectomy syndrome

• Post-laminectomy syndrome PLS, also known as failed back surgery syndrome, is a condition where an individual continues to have pain after surgery. Individuals with symptoms should speak with their doctor to determine the next phase of treatment.

How long before exercise?

• Returning to the gym or getting into an exercise routine will take some time. It is important to follow the doctor’s recommendations and complete the full course of physical therapy before regular exercise activity can resume. Discuss workout plans with the doctor to determine the best timeline for the spine.

Full recovery?

• Returning to some activity is possible around four weeks after surgery. Full recovery takes longer, as each patient’s recovery is unique. Depending on the complexity of the surgery, most return to all activities within 6 to 9 months.

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References

American Association of Neurological Surgeons. “Minimally Invasive Spine Surgery.” (n.d.) www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Minimally-Invasive-Spine-Surgery

Foraminotomy. MedlinePlus. medlineplus.gov/ency/article/007390.htm. Reviewed November 27, 2016. Page last updated December 21, 2017. Accessed January 18, 2018.

Laminectomy. medlineplus.gov/ency/article/007389.htm. MedlinePlus. Reviewed November 27, 2016. Page last updated December 21, 2017. Accessed January 18, 2018.

Mayo Clinic. “Laminectomy.” (n.d.) www.mayoclinic.org/tests-procedures/laminectomy/about/pac-20394533

Mayo Clinic. “Laminotomy.” (n.d) www.mayoclinic.org/diseases-conditions/spinal-stenosis/multimedia/img-20149227