Laminectomy in India

Laminectomy is a surgical procedure that involves the removal of a portion of the vertebral bone called the lamina. The lamina is a bony structure that covers the spinal cord and provides protection to the nerves. Laminectomy is typically performed to relieve pressure on the spinal cord or nerves caused by conditions such as spinal stenosis, herniated discs, or tumours.

Laminectomy is also performed in cases:

• Spinal stenosis or narrowing of the spinal canal
• Bone spurs or abnormalities in the bone growths of a vertebra
• Traumatic compressed nerve roots in the spine
• Wearing off the discs
• Spinal slipped disc
• Tumours in the spine
• Degenerative disc disease or loss of cushioning or fragmentation of the discs between vertebrae.
• Herniated spinal disc or displacement in the vertebrae of the cushioning discs.
• Sciatica or the pain in the leg and buttock arising due to compression
• Spondylosis or osteoarthritis in the spine

Alternate Name

Decompression surgery

Body Location

Spine

Preparation

When considering undergoing laminectomy, preparatory steps include the following:

• Pre-operative Surgery: Before getting into the surgical procedure, some pre-operative details should be considered. These include:
• X-ray: imaging of joints and vertebrae.
• Computed tomography: CAT or CT detailed images of the spine and the surrounding structures.
• Magnetic resonance imaging (MRI): 3-D images of nerve roots, discs, and the spine.
• Nerve conduction studies and Electromyography (NCS/EMG): Electrical, nerve, and muscle impulses

When one needs to be admitted to the hospital?

A person opts for laminectomy only after considering the following measures of treatment:

• Exercise
• Pain relievers
• Steroid injections
• Nonsteroidal anti-inflammatories
• Physical therapy
• Rest

Even after the above-mentioned path of care, if there is:

• Persistent or alleviation of pain in your spine
• Pain interferes with the quality of life
• Experiencing a lack of bladder control or loss of bowel
• Facing issues such as numbness or muscle weakness

Diet before the procedure:

Patients are advised to observe overnight fast before the surgery. They cannot take in food or water from midnight on the day of surgery.

How is it Performed?

Laminectomy is a surgical procedure that is typically performed in a hospital or surgical center. The following is a general overview of how a laminectomy is performed:

• Anesthesia: The patient is given anaesthesia, which may be general anaesthesia or local anaesthesia with sedation.
• Incision: The surgeon makes an incision in the back over the affected vertebrae. The size and location of the incision will depend on the extent of the surgery.
• Removal of the lamina: Using specialised instruments, the surgeon removes the lamina from the affected vertebrae. In some cases, the surgeon may also need to remove part of the facet joint or other structures that are causing compression of the nerves.
• Decompression of the nerves: After removing the lamina and other structures, the surgeon will carefully identify and decompress the nerves that were being compressed or pinched.
• Closure: Once the surgeon has completed the decompression, they will close the incision using stitches or surgical staples. A sterile bandage will be applied to the wound.

After the surgery, the patient will be monitored closely in the hospital for a few days to ensure that there are no complications.

Procedure Type

Surgical

Follow up

After the laminectomy, you will be shifted into the recovery room. Here the healthcare team will watch over over effects of anaesthesia and surgery. After some time, you will be asked to move your arms and legs. Your doctor will also prescribe you some painkillers. Further, you will be required to stay in the hospital for one to three days. In the hospital, aftercare also includes watching patients for risk of venous thromboembolism (VTE). It is the formation of a blood clot in the deep veins in the leg region. The prevention involves medication, compression boots, or stockings. Your doctor may prefer to see you a week after the surgery to check on postoperative complications. You may also be asked to undertake physiotherapy. This will improve your flexibility and strength. You may be able to return to work based on the amount of walking, lifting, and sitting your job involves. If you have undergone a laminectomy for spinal fusion, your time taken for recovery will be more.

Risks

Like any other major surgery, laminectomy is associated with procedure-specific risk. Some of the short and long-term risks related to the procedure are:

• Bleeding or blood clots: Bleeding from the site of surgery can occur. There are also chances that blood clots may form.
• Infection: The surgery site also faces the risk of infection.
• Spinal cord injury: There is a risk that the spinal cord may get damaged by any mistake in the surgery.
• Cerebrospinal fluid leakage: As a result of tears in the spinal cord, the cerebrospinal fluid can be leaked.
• Bladder problems: There might be bowel or bladder regulation failure
• Pulmonary Embolism: Blood clots can occur after the surgery. In case these clots travel to the lungs, they may lead to pulmonary embolism
• Reactions: There might occur allergies from the drugs or anaesthesia used in the surgery.

Recovery

Recovery from laminectomy involves healing of the nerve, muscle, and bone tissue. You will have to attain your recovery goal with a strong and positive attitude working towards small improvement goals. Some activities you can take up at home to make your recovery fast include not driving for a week or two. You can also refrain from it as long as you are on medications that may make you drowsy. You also need to have someone to help in case you need to run errands or complete some tasks. Remember to move toiletries, groceries, and other supplies where you can reach them without bending. Hence, the supplies need to be kept on your shoulder and hip level. Also, take short walks daily to reduce your back pain. This would also speed up the process of recovery. You may choose to wear slip-on shoes. Select the ones with closed backs. This will help you minimise bending over and also make dressing easier.