Information for Laminectomy Patients
The following is a series of the most frequently asked questions regarding laminectomy operations. The answers are for the average case, with the understanding that there may be unusual circumstances, which would cause any one of these answers to be changed significantly. You need to understand from your orthopedic surgeon whether there is anything unusual about your particular case and have him/her explain why the answers to some of these questions might be different in your case.
What is a laminectomy?
A laminectomy is an operation performed on individuals who spinal stenosis (enlarged, thickened bone and ligaments that compress the nerves or spinal sack. The operation consists of removing part of the bone, which is pressing against the nerve. Depending on the amount of narrowing, varying amounts of bone may need to be removed. Also, if disc material presses on the nerve, it may need to be removed. For this reason, the term decompression is often interchanged. This bone removal may lead to instability which may require a fusion operation.
A small incision of 1 – 3 inches is made in the back (the length of the incision depends on the number o disc levels involved). The muscles are carefully moved away from the bone and a small hole is cut in the lamina and the ligaments between the laminae are moved away from the spinal sack. The herniated disc material that compresses the nerve, if present, is then removed and the incision is closed.
What is a microdiscectomy?
Microdiscectomy is a newer procedure in which a small incision of approximately one inch is made over the involved area of the spine. The surgery is performed using an operating microscope or other magnification with special lighting. The disc material that has “squirted out” is removed using special instruments. The indications for surgery, risks of the operation and outcome are essentially the same as with the standard laminectomy.
What are the risks?
1. Anesthetic Complications: You must be fully anesthetized.
2. Infection: There is a chance of infection with any operation.
3. Bleeding/Blood Clots: There is always some blood loss and a chance of post- operative blood clots with any operation.
4. Spinal Damage: Damage to the spinal cord producing paraplegia. .
5. Nerve Damage: This can occur, but happens in less than one percent of our cases. If a nerve is damaged, it does not mean paralysis. Each spinal nerve supplies only a small group of muscles.
6. Dural Leak: This is the most common complication (5 – 10%). Because the spinal canal is so tightly bound to the spinal nerves (which are covered by a thin membrane called dura) the dura may be perforated or torn in the bone removal process. These dural tears are repaired at the time of surgery if possible. Occasionally the leakage of spinal fluid from the dural tear can prolong the patient’s hospital stay and may even require a second operation if the repair is not successful. This second operation is seldom necessary.
7. Expectations: The final risk is that the surgery may not give you the results you hoped it would. We hope to give you significant relief from your spinal stenosis symptoms, but it is unrealistic to expect 100% relief. It would be wise to get a clear understanding of what you can expect from your surgery.
How successful is the operation?
No operation is guaranteed to be successful and there is the possibility the operation may not work. For the majority of patients, a successful operation results in the relief of about 90% of preoperative pain. Your recovery period can range from three weeks to three months, depending on your age, level of previous conditioning, and your ability to follow the postoperative regimen give to you by your physician.
Is a blood donation necessary?
Normally blood is not needed for a laminectomy unless there is some rare complication. In most cases, your surgeon will not consider preparing a blood donation for you.
How long will I be in the hospital?
This varies from patient to patient. Depending on the amount of surgical decompression necessary, you may be sent home the day or surgery or require hospital admission. The hospital stay can be as brief as 24 hours or as long as one week, with an average of two days. While you are in the hospital, you will be taught how to roll over in bed, get up and begin your recover as far as walking.
What should I do when I leave the hospital?
Upon discharge from the hospital, you should plan to ride home in a reclining position in a car or other vehicle. Pillows behind your back will serve to keep you in this position. If you are traveling a long distance, you should plan on spending at least part of the time lying down in the back seat.
You may shower on the fifth day after surgery, sooner if your incision has waterproof dressing. The third week after your surgery, if your back condition and pain permit, you should begin gentle exercises as directed by your physician.
Sexual activity is of concern to most patients. You may begin within a few days of leaving the hospital, but you should be the passive partner, on your back at the beginning of relations.
Housework and yard work are generally difficult to do right after surgery and should be avoided until your physician gives you permission. Driving, returning to work and other activities vary depending on the individual’s condition and recovery rate. Your physician can guide you in these matters.
You should walk on a daily basis (preferably outside if the weather permits). You should gradually work up to a goal of at least one mile twice a day. Avoid lifting, bending or stooping until allowed to do so by your surgeon. In addition, sitting should gradually be increased as your tolerance allows.
If there are any problems such as fever, drainage, increased weakness or return of your back symptoms prior to your appointment, do not wait – call your surgeon right away.