Laminectomy

Laminectomy is a medical term formed from the combination of the Latin word lamina, which means “plate”, and the Greek word ektome, meaning excision.

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

The main purpose of performing a lumbar laminectomy is to eliminate symptoms that arise due to compression of the nerve root due to stenosis in the lumbar spine.

Laminectomy is performed under general anesthesia of the patient - under anesthesia, its duration is 1-3 hours. After access to the spine is provided, the surgeon performs a resection of either the vertebral arches or some part of them - which, in fact, is a laminectomy. As a result, the nerve root, which was hidden behind them, becomes visible. Further actions consist of undercutting the facet joints, under which the nerve roots are located. This ensures the expansion of the space surrounding the nerve. To determine the exact degree of damage, the operation is accompanied by an X-ray contrast study.

Thus, laminectomy is one of the most widely used surgical methods used in the treatment of such a disease as spinal stenosis. Its essence is to eliminate pressure on the nerve roots or spinal cord, which can occur as a result of changes associated with aging of the body or treatment of other diseases and injuries of the spine.

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Indications for laminectomy

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

The need for this type of surgical intervention may arise due to narrowing of the spinal canal.

This method of surgical treatment is often justified in the presence of a large hernia in the intervertebral disc. In such cases, the goal of the operation is to provide free access to the affected area.

Laminectomy may be indicated by the detection of bone growths on the spine and the arch itself.

If the result of damage to the spinal cord or spinal roots is the appearance of intermittent claudication, this may also make it advisable to perform a laminectomy.

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

Another reason why a laminectomy may be performed is the need to gain access to the yellow ligament of the spine in a situation where this ligament is thickened.

Some cases require urgent surgery. This need arises when bodily motor skills and sensitivity are impaired, or when spontaneous compression or pinching of the spinal cord occurs.

Laminectomy as a treatment method can be used for dysfunctional organs in the pelvic area, such as incontinence or urinary retention caused by spontaneous compression of the spinal cord.

Thus, indications for laminectomy are very diverse and cover a fairly wide range of clinical cases for its possible use.

Preparing for a Laminectomy

Preparation for laminectomy involves a number of preoperative measures designed to promote and ensure the maximum possible effectiveness of this surgical treatment method and minimize the likelihood of complications. Both directly during the surgical intervention and in the postoperative recovery period.

The key to the success of any treatment is, to a large extent, the implementation of a thorough comprehensive diagnosis, including all necessary laboratory tests. The characteristics of the blood composition are determined, both in its general analysis and for biochemical indicators, coagulability, the content of electrolytes, calcium, magnesium, phosphorus. Liver functions are examined, an electrocardiogram and a fluorographic image are made.

Great importance is also attached to the diagnosis, the establishment of a specific disease, the fight against which the operation is aimed. Various technical diagnostic means are used: X-ray examination, bone map, computer and magnetic resonance imaging. The surgeon and the anesthesiologist must be well acquainted with the patient's medical history, anamnesis, the presence of chronic diseases, whether he has undergone previous operations, if so, for what reasons, what treatment was prescribed, with the use of what drugs, whether there are allergies or intolerance to medications, etc.

7 days before the operation, you should stop taking anticoagulants (aspirin, comadine, etc.), and on the day of the operation, you should not drink or eat later than 6 hours before the start.

Preparation for laminectomy is a very important factor, which is of no small importance for the successful outcome of the surgical intervention, so it should be approached with the utmost seriousness and all necessary instructions should be strictly followed.

How is a laminectomy performed?

Laminectomy is essentially a surgical procedure that involves removing a vertebral arch or performing it to gain access to the intervertebral disc if there is a need to remove it. Laminectomy can also act as a surgical treatment method used when it is necessary to correct a structural curvature of the spine, in which there is no compression of the nerves.

Let's consider what actions the surgeon performs during such an operation and how a laminectomy is performed. After the patient is put under general anesthesia, an incision is made on the back, neck, etc. - according to the location of the required surgical field. Most often, there is a need for a laminotomy in the lumbar and cervical spine. Such an incision, made in the back, along the arch of the vertebra, one or several at once, provides access to the vertebrae, the arches of which are subject to removal. The sawed-off arch of the vertebra is removed together with the separated bone fragments and disc particles. At the end of the operation, the edges of the incision are sutured and a bandage is applied.

If a laminectomy has resulted in a loss of stability in the area of the spine where several arches were removed, it may be necessary to remove the intervertebral disc and fuse several vertebrae together. This surgical technique is called Spinal Fusion or spondylodesis.

So, the specifics of how a laminectomy is performed are the removal of the vertebral arch, and as a result, the elimination of pressure on the spinal column and the nerve roots extending from it, which ultimately leads to the normalization of the functioning of the spine.

Decompressive laminectomy

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

The most common surgical procedure used to treat lumbar spinal stenosis is decompressive laminectomy. This type of surgery is performed to reduce or completely eliminate pressure on the nerve roots and spinal cord. The result is a decrease in pain intensity, which allows patients to resume their daily active lifestyle.

During the operation, the spinal canal is opened. The surgeon's actions consist of removing part of the corresponding vertebral bone along with the compacted tissue, which is the factor that led to the spinal canal being narrowed, causing compression phenomena in the spinal cord and nerve roots.

Some clinical cases require fixation of certain vertebral sections, for which decompression laminectomy is performed in combination with vertebral arthrodesis. Vertebral arthrodesis can be performed using various methods. The most common is the one in which a bone fragment directly from the patient's body or bone material provided by a bone grafting and preservation laboratory is used as a connecting element between adjacent vertebrae. The engrafted graft causes activation of new bone growth.

Artificial metal implants in the form of various hooks, rods, screws and plates are also used to connect the vertebrae. They remain in the patient's body for the time required to build up the bone between the vertebrae.

Decompressive laminectomy can be performed using a variety of methods, the choice of which should be based on a number of factors, including: the patient's age, medical history and history; the location of the stenosis - in the lower or upper spinal region; the existing degree of compression, etc.

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Postoperative period after laminectomy

The postoperative period after laminectomy, first of all, requires that the patient who has undergone such a surgical intervention lie in the postoperative ward for two hours. This is necessary to monitor the process of his gradual recovery from anesthesia. Then the patient is transferred to the ward in the department, where he should stay for 24 hours. The next morning after the operation, you can get up on your feet.

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

After one to two weeks from discharge, you can return to work that is not associated with heavy loads on the body. It is recommended to begin work that requires significant physical exertion no earlier than after two to four months of recovery.

The time frame in which a person who has undergone laminectomy surgery can return to the active lifestyle that preceded the surgery is largely determined by the severity of the disease, the size of the surgical field, and the general health of the patient before such surgery.

The prognosis for a favorable outcome of such treatment is 70-80 percent probability of reducing the symptoms of the disease. One to two weeks after the operation, it is necessary to check with the surgeon and inform him about your general well-being, what new sensations may have arisen, and to express any complaints that may occur.

Thus, it can be stated that the postoperative period after laminectomy in most cases proceeds relatively smoothly, without excesses and significant complications, if it is under proper medical supervision.