Lumbar Laminectomy Surgery


 

What are the indications for a lumbar laminectomy?

A lumbar laminectomy surgery is used to address back and leg symptoms from a condition known as lumbar spinal stenosis. As we age, the spinal canal becomes narrower resulting from arthritic changes in the disc, facet joints, and ligaments of the spine. The spinal canal narrowing can irritate the nerves traveling in the spinal canal causing back and leg pain, weakness and numbness. The symptoms tend to be worse with standing or walking posture as opposed to sitting or leaning forward since standing and walking causes the facet joints to further narrow the spinal canal. Lumbar laminectomy surgery removes the lamina and portions of the arthritic joints and ligaments thereby providing more space in the spinal canal and preventing the nerves from being compressed. The surgery works well to relieve back and leg pain symptoms when other conservative options such as medications, physical therapy, and injections have proven unsuccessful.  

How is a lumbar laminectomy surgery performed?

A lumbar laminectomy is performed under general anesthesia. A vertical incision is made in the middle of the low back. The length of the incision will depend on the number of lamina removed, generally ranging from 2-6 inches long. The back muscles are separated (but not cut) from the bony arch of the spine known as the spinous process and lamina. The spinous processes and laminae are then removed to expose the dura, which is the sac that contains the nerves and spinal fluid. A small portion of the ligaments and facet joints is undercut to make room for the exiting nerves. The incision is closed in several layers and typically staples are used to close the skin. A sterile dressing is applied. The surgery can take anywhere from 2-4 hours depending on the number of laminae that need to be removed.  

What is the recovery for a lumbar laminectomy?

The hospital stay usually varies from 2-4 days depending on the extent of surgery and overall condition of the patient. Most patients go home with home care help setup such as a visiting nurse and a physical therapist. There is usually back discomfort from the incisional area. The incisional pain usually significantly improves within 4-6 weeks. The nerve pain (pain involving the buttock and leg) may resolve immediately after the surgery or may persist for a longer period due to inflammation. In most instances, there is a significant improvement in the nerve pain by 4-6 weeks. The nerve pain symptoms can continue to improve for up to 1-2 years after the surgery. Activity recommended for first 2 weeks after surgery is short walks and mainly rest.  Physical therapy guidance is recommended from 2-3 weeks after surgery for 6-8 weeks. Return to work can vary depending on the extent of surgery, rate of recovery, and physical demands of the job. For a nonphysical job, reasonable timeline to return to work is 3-4 weeks to 3 months whereas more labor intensive work may require to be out of work for up to 3-6 months.

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