Laminectomy

Laminectomy is a medical term formed by the combination of the Latin word lamina, which means: "plate" and Greek ektome - excision.

In surgery, it is used to designate an operative intervention, during which a fragment of the vertebral bone tissue is removed above the nerve root, and a certain part of the intervertebral disc located below it. This surgical operation is also known as open decompression. Due to the use of laminectomy, the nerve remains surrounded by free space, which ensures a better blood flow and leads to elimination of the irritant factor, which in turn helps to ensure that the pain syndrome either completely disappears or decreases its intensity.

Carrying out the lumbar laminectomy mainly has its purpose to eliminate the symptoms arising from the compression of the nerve root during stenosis in the lumbar spine.

Laminectomy is performed in a state of general anesthesia of the patient - under anesthesia, its duration is 1-3 hours. After the access to the spine is provided, the surgeon resects either the spines of the vertebrae or some part of them - which, in fact, is a laminectomy. As a consequence, the nerve root that is hidden behind them becomes visible. Further actions consist in cutting the facet joints, under which the nerve roots are located. This provides an expansion of the surrounding nerve space. To determine the exact degree of damage, the operation process is accompanied by an X-ray contrast study.

Thus, laminectomy is one of the most widespread surgical methods that are used in the treatment of such a disease as spinal stenosis. Its essence boils down to eliminating the pressure on the nerve roots or the spinal cord, which can arise as a result of changes associated with aging of the body or the treatment of other diseases and spinal injuries.

[1], [2], [3], [4], [5], [6]

Indications for laminectomy

There are a number of diseases and pathological changes in the human body, the presence of which may be due to indications for laminectomy.

The need for such an operation can arise due to the narrowing of the spinal spinal canal.

This method of surgical treatment is often justified in the presence of a herniated disc in the intervertebral disk with a large size. In such cases, the aim of the operation is to provide free access to the area that has been affected.

Laminectomy can have, as an indication for its conduct, the detection of bone growths on the spine and actually the arch.

If the result of the fact that the spinal cord or spinal cord is affected is the appearance of intermittent claudication, it is also capable of causing the expediency of carrying out a laminectomy.

Among the clinical cases in which laminectomy is indicated is the process of development in the spine of neoplasms of both malignant and benign nature, as well as the phenomenon of formation of adhesions on the spine.

The reason why a laminectomy can be prescribed is the need to access the yellow ligament of the spine in a situation where this ligament is thickened.

Some cases require the operation to be carried out urgently - urgently. Such a need arises in violation of body motility and sensitivity, if spontaneous compression or infringement of the spinal cord occurred.

Laminectomy as a method of treatment can be used in cases of impaired functioning of organs in the pelvic region, for example, incontinence, or urinary retention caused by spontaneous compression of the spinal cord.

So, the indications for carrying out a laminectomy differ in their great variety, and cover a rather wide field of clinical cases for its possible application.

Preparation for laminectomy

Preparation for laminectomy involves a number of pre-operative measures designed to promote and maximize the effectiveness of this method of surgical treatment, and minimize the likelihood of complications. Both directly during the operative intervention, and in the postoperative recovery period.

The key to the success of any treatment in no small degree is the implementation of thorough comprehensive diagnosis, including the carrying out of all necessary laboratory tests. The characteristics of the blood composition are revealed, both in its general analysis, and on biochemical indices, coagulability, the content of electrolytes, calcium, magnesium, phosphorus. Hepatic functions are investigated, an electrocardiogram and a fluorographic photograph are made.

Great importance is also attached to diagnosing, ascertaining a particular disease, to which the operation is aimed. A variety of technical diagnostic tools are used: X-ray, bone map, computer and magnetic resonance imaging. The surgeon and anaesthesiologist must be well acquainted with the history of the disease, the patient's history, the presence of chronic illnesses, whether he had previous operations, if so, for what reasons, what treatment was prescribed, with what drugs, whether there are allergies or intolerance to medications, and so on.

7 days before surgery, you need to stop taking anticoagulants (aspirin, comadin, etc.), and immediately on the day of surgery should not drink and eat later than 6 hours before the start.

Preparation for laminectomy is a very important factor that is not of the last importance for a successful result of surgical intervention, therefore it is necessary to approach it with all seriousness and to strictly follow all the necessary prescriptions.

How is laminectomy performed?

Laminectomy is essentially an operative procedure, consisting in the removal of the vertebral arc, or in order to gain access to the intervertebral disk if there is a need for its removal. Laminectomy can also act as a surgical method of treatment applied when it is necessary to correct the structural curvature of the spine, in which there is no clamping of nerves.

Consider what actions the surgeon performs during such an operation and how the laminectomy is performed. After the patient is entered into a state of general anesthesia, an incision is made on the back, neck, etc., corresponding to the location of the required operating field. Most often there is a need for laminocytomy in the lumbar and cervical vertebral sections. Such an incision, made in the posterior part, along the arch of the vertebra, one or more at once, provides access to the vertebrae, the arcs of which are to be removed. The severed arch of the vertebra is withdrawn along with the detached bone fragments and disc particles. At the end of the operation, the edges of the cut are sewn together, and the dressing is performed.

In the event that, due to laminectomy, there is a disturbance in the stability of the spine in the area where several arches have been removed, you may need to remove the intervertebral disc and connect several vertebrae together. Such a surgical technique is called Spinal Fusion or spondylodesis.

So, the peculiarities of how the laminectomy is performed consist in the removal of the vertebral arc, and as a result - in eliminating the pressure on the spinal column and on the nerve roots that leave it, which eventually leads to normalization of the functioning of the spine.

Decompressive laminectomy

As the degree of age-related changes in the human body increases, pressure can appear on the spinal cord or its nerve roots. The cause of this phenomenon can also be transferred injuries, the presence of spinal tumors in the spine or a herniated intervertebral disc.

The most common surgical method used to treat spinal stenosis in the lumbar spine is decompressive laminectomy. Such an operative intervention is carried out in order to reduce or completely eliminate the pressure on the nerve roots and spinal cord. The result is a decrease in the intensity of the pain syndrome, which opens up the possibility for patients to again lead an everyday active lifestyle.

During the operation, the vertebral canal is opened. The surgeon's actions are that he removes part of the corresponding vertebral bone along with the densified tissue, which is the factor that led to the fact that the spinal canal, being narrowed, causes compression phenomena in the spinal cord and nerve roots.

Some of the clinical cases require the fixation of certain vertebral parts, for which the decompression laminectomy is performed in conjunction with arthrodesis of the vertebrae. The arthrodesis of the vertebrae can be performed using a variety of methods. The most widespread was the one in which a bone fragment directly from the patient's body is used as a connecting element between adjacent vertebrae, or bone material provided by the laboratory for the preparation and conservation of bone grafts. An engrafted graft causes activation of the growth of a new bone.

To connect the vertebrae, artificial implants made of metal are also used, which look like all sorts of hooks, rods, screws and plates. They stay in the patient's body for the time needed to build up the bone between the vertebrae.

Decompressive laminectomy can be performed using a variety of methods, the choice of which should occur based on a number of factors, including: age, medical history and patient history; features of localization of stenosis - in the lower or upper vertebral part; the existing degree of compression, etc.

[7], [8], [9], [10], [11], [12]

Postoperative period after laminectomy

The postoperative period after laminectomy, first of all, requires that the patient who underwent such surgical intervention lay in the postoperative ward for two hours. This is necessary to control the process of its gradual withdrawal from anesthesia. Then the patient is transferred to the ward in the department, where he should stay for a day. The next morning after the operation, you can get up on your feet.

Laminectomy is a type of surgical treatment, in which the discharge from the hospital becomes possible mainly on the second-third day after it.

After the expiration of one to two weeks after discharge, you can return to work, which is not associated with heavy loads on the body. It is advisable to begin employment with labor that requires considerable physical exertion not earlier than after two to four months of the recovery period.

The time in which a person, after being operated on by the method of laminectomy can return to an active lifestyle, the previous operation is largely determined by the severity of the disease, the vastness of the operating field and the general health of the patient before such a surgical intervention.

The prognosis of a favorable outcome of such treatment is equal to 70-80 percent probability of reducing the symptoms of the disease. After a lapse of one to two weeks after the operation, it is necessary to check with the surgeon and inform him about what the general state of health is, what new sensations may have occurred, and to make complaints that may occur.

In a similar way, it can be stated that the postoperative period after laminectomy in most cases proceeds remotely smoothly, without excesses and significant complications, if it is under proper medical control.

The cost of a laminectomy

Clinic	Operation	Cost	Contacts
SPbSPU of the Ministry of Health and Social Development	Laminectomy without manipulation of the contents of the spinal canal	18500 rub.	194100, St. Petersburg, Lithuanian street., 2
Clinic Top Ichilov	Laminectomy	10000 $	Israel, Tel-Aviv, Weizman, 14, 64239. Tel. + 972-3-605-36-18 fax + 972-3-760-1000
BMA. Berlin Medical Agency GmbH (iMER Germany GmbH)	Laminectomy	From 9000 eur	Windscheidstr. 18 10627 Berlin Germany Hotline, 24 hours: [phone] E-mail: [e-mail]
Graz Ragnitz	Laminectomy with manipulations on the contents of the spinal canal	From 7000 eur	Berthold-Linder-Weg 15 8047, Graz, Austria, Tel. 43 (0) 316 / 596-0 Fax: 43 (0) 316 / 596-1200
Mayo Clinic	Laminectomy	From 18000 $	Arizona - Scottsdale, 13400 E. Shea Blvd., Scottsdale, AZ 85259 Phone / fax: [phone] Florida - Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224 Phone / fax: [phone] Minnesota - Rochester, 200 First Street SW, Rochester, MN 55905 Phone / Fax: [phone]
Clinique Bois-Cerf	Laminectomy	From 20000 eur	Avenue d'Ouchy 31, 1006 Lausanne, Switzerland, TEL .: [phone]
Gelenk-Klinik	Laminectomy	From 5900 eur	Alte Bundesstraße 58, Gundelfingen, 79104, Germany