What is a Laminectomy?
By definition, a laminectomy surgery “creates space by removing the lamina — the back part of the vertebra that covers your spinal canal”. Another name for it is decompression surgery. The purpose of the surgery is to enlarge the canal to relieve the pressure on the nerves or spinal cord. The pressure is usually caused by “bony overgrowths within the spinal canal”, typically in patients with arthritis. Laminectomy is a last resort after conservative treatment (medication, injections, physiotherapy) have failed. The kinds of symptoms that patients experience, prior to surgery, are numbness, pain, and weakness that radiate down the extremities. In general, this type of surgery is better at relieving those symptoms than resolving back pain. If the symptoms do not improve with conservative measures, if the patient has trouble standing or walking due to the numbness or weakness, or if there is a loss of bowel or bladder control, then doctors typically recommend surgery. There are always risks with surgery, though, including clots, bleeding, infection, spinal fluid leakage, or nerve injury.1
About the Surgery
The laminectomy is performed with general anesthesia. The surgeon makes the incision and moves the muscles away, and then the appropriate lamina is removed. If a herniated disc is involved, then that is addressed as well in a procedure called discectomy. Some patients may have had a vertebrae slip over another or perhaps a curved spine. If this is the case, spinal fusion may be necessary. In spinal fusion, the surgeon “permanently connects two or more of your vertebrae together”. For some patients, the incision may be minimally invasive. After the surgery, the patient recovers from the anesthesia and then is asked to move the legs and arms. Pain mediation may be needed, and some patients can go home the same day. Typically, physiotherapy is recommended for flexibility and strength. Patients should be careful about bending and lifting. Many patients return to work in a few weeks, but if spinal fusion occurred, the recovery could be up to six months.2 There are a couple of laminectomy types: cervical laminectomy and lumbar laminectomy. Lumbar laminectomy, also known as open decompression, is different from a microdiscectomy because “the incision is longer and there is more muscle stripping”.3 For patients with cervical stenosis, a cervical laminectomy may be performed. In this surgery, the incision is made along “the midline of the back of the neck”. Afterwards, most patients will regain some more spinal cord function, improvement in walking and hand function, and lessened numbness in the hands.4
Laminectomy Recovery and Complications
While many people report improvement after the surgery, the benefits may wane over time and the patient ages or if arthritis recurs.5 Some patients develop post-laminectomy syndrome, or failed back syndrome (failed back surgery syndrome). This refers to the “chronic back and/or leg pain that occurs after back (spinal) surgery”. Patients most likely to have this chronic pain syndrome are those with recurrent disc herniation, post-op pressure on a nerve, joint instability, scar tissue, depression and anxiety, and sleeplessness. People with vascular disease, diabetes or an autoimmune disease may be predisposed to this complication. Post-laminectomy syndrome symptoms include “diffuse, dull and aching pain involving the back and/or legs” or “sharp, pricking, and stabbing pain in the extremities”. Some of the treatments for post-laminectomy syndrome are chiropractic care, physical therapy, TENS (electrical nerve stimulation), NSAID medications, behavioral medicine, antidepressants, spinal cord stimulation, nerve blocks, steroid injections, or an intrathecal morphine pump. In general, patients who have failed surgeries either are “those in whom surgery was never indicated” or those “who had incomplete or inadequate operations”. Recently, it was found that “cigarette smokers will routinely fail all spinal surgery” because nicotine interferes with “bone metabolism” and restricts the diameter of small blood vessels, which leads to scarring.6
Surgery vs. Alternatives
Because surgery should be a last resort, it is important to consider other types of treatment for back pain, such as chiropractic. For many people, lower back pain can resolve within three months. Non-surgical treatments aim to reduce spasm and pain, “provide conditioning for the back”, and assist with depression, sleeplessness, and other issues that are “associated with back pain”. Chiropractic treatment is one of the conservative options a patient can consider before going under the knife. Patients for whom conservative treatments are not an option are those who have lost bowel and bladder control, or who have “progressive weakness in the legs”, as this would indicate a medical emergency. On the other hand, surgery is not advisable for patients who have lower back pain, but where no “anatomical cause of the pain” can be identified.7 Chiropractic is a drug-free treatment that involves spinal manipulation, and it is meant to “reduce the subluxation” and improve range of motion and function, while “reducing nerve irritability”.8
Find out more about spinal decompression.