Lumbar Laminectomy

What is a lumbar laminectomy?

Lumbar = low back

Lamina = a bone in the back of the spinal cord vertebrae

-ectomy = remove

Lumbar laminectomy (also known as decompression surgery) is a procedure that involves removing the lamina or back part of the spinal cord vertebrae. This procedure is usually done to make more space and take pressure off of the spinal cord.

When is a lumbar laminectomy recommended?

Dr. Webb may recommend a lumbar laminectomy when there is pressure on the spinal cord and/or spinal nerves that causes pain, weakness, numbness, or tingling in your back or legs. Sometimes, this procedure is done for patients with loss of bowel or bladder function. A laminectomy is generally only recommended when conservative treatments such as physical therapy, pain medications, or injections fail to relieve your symptoms.

What you can expect during a Lumbar Laminectomy?

Anesthesia & Induction

• Your anesthesiologist will talk to you about the specifics of his/her plan for the procedure. You will find out what medications and what type of anesthesia will be used to keep you pain free and comfortable throughout the operation.
• In general, most patients will undergo general anesthesia during spine procedures meaning you will be asleep and wont remember or feel any pain during the procedure itself. Patients may have pain upon waking up from anesthesia, but this will be managed with intravenous and oral pain medications.
  • After a breathing tube is placed and you are fully asleep, you will be positioned on the operating room table.
  • Surgery will not begin until you are asleep and given pain medications so that you don’t feel any pain during the procedure.

The Approach

A skin incision is made on lower aspect of your back.

• After dissecting through the skin, Dr. Webb will carefully peel off the muscles overlying your spine using special instruments.
• These muscles will be held apart with the use of special tools, called retractors.

Performing the Decompression

• Before removing the diseased and herniated disc, Dr. Webb will confirm that he is operating at the correct level by taking an x-ray while you are asleep.
  • When the level is confirmed, Dr. Webb will then begin the decompression (removing the areas of compression from your spinal cord) portion of the procedure.
  • Webb will then carefully remove bone in order to get to the spine using special instruments.
  • The disc that is pressing on your spinal cord/nerves will be removed with the use of special instruments and tools. He will also remove any additional surrounding structures which may be pressing on your spinal cord, such as bone spurs and/or excess ligaments.
  • Webb will then ensure that your spinal cord and nerves are free from compression.

Closure

• The retractors that held the muscles apart will now be removed and will be allowed to fall back into their normal position.
• Webb uses absorbable sutures to close your wound. These sutures do not typically need to be removed and will absorb on their own.
• Sometimes, a special tube called a drain will be used. This is to collect any blood or fluids that can collect after surgery. This drain will be removed before you leave the hospital, usually the next day after surgery.

What to expect after surgery?

After surgery you will be transferred to the recovery room, also called the PACU (post anesthesia care unit). After you have awaken from the anesthesia, you will then be transferred to your hospital room. This is typically when your family members can visit you.

Either the same day or the following morning after surgery, a physical and/or occupational therapist will begin your therapy. During your hospital stay, you will be given medications to help with pain and IV antibiotics to minimize the risk of infection. Most patients go home the same day of surgery but some patients may spend 1-2 nights in the hospital and are discharged home after:

1. You are tolerating a diet
2. Your pain is controlled
3. After you have worked with and passed physical therapy.

Walking after surgery is highly encouraged, even the same day of surgery!

What kind of recovery can you expect after surgery?

Recovery from a lumbar laminectomy surgery generally takes 8-12 weeks, but patients continue to heal for up to a year after surgery.

When can you return to work and/or activities?

Walking is highly encouraged, immediately after surgery and throughout your postoperative period. Most patients can return to a light desk job or household activities by 2-3 weeks after surgery. Patients with jobs that require heavy lifting, strenuous labor, or high impact activities such as running, biking, skiing, sports will not be allowed to return until Dr. Webb clears you, usually around 6-8 weeks.

When can I expect my back and/or leg pain to go away?

Short answer: depends on how long your nerves have been compressed. If you can imagine putting your elbow on a hard surface for a long time, what happens? Your fingers start to go to sleep. Why? Because the nerves to these fingers is compressed, is asleep, and is irritable. Once you realize this, you pick up your elbow (to remove the pressure off of the nerve) and shake your fingers until they wake up. This is a similar concept in spine surgery where depending on how long your nerves and spinal cord have been compressed, will determine how long it takes for the nerve to wake up after the surgery.

-If you have had compression of your nerves and spinal cord for months to years, then it may take some time before the nerve recovers and wakes up (if it recovers at all). Most patients, however wake up from surgery with leg pain relief meaning that the debilitating leg pain they had before surgery went away, but may have some back pain and spasms from the surgical incision itself. This pain will be controlled with oral/IV pain medications and antispasm medications throughout your hospital stay.

What complications should I be aware of with surgery?

Inadequate relief of symptoms

• Webb is very particular about making sure we target the right level of your spine that may be causing your symptoms.
• Inadequate relief of symptoms after surgery could be due to a number of things including: multiple levels that are degenerated or worn out that will not be addressed in surgery, surgery done on the wrong level, or advanced and severe spinal cord compression that may be irreversible.
• Injections are confirmatory and are very predictive of how well you will do with surgery. These spinal injections, usually done before surgery in the conservative treatment period, are essential in determining which level of your spine is the cause of your symptoms.
• Just because you have multiple degenerated areas of your spine according to your imaging studies (MRI, X-ray, etc.), does not mean every level needs an operation.

Failure of bone graft to heal adequately (called a non-union or pseudarthrosis)

• This risk is elevated if you are a smoker, are older than 60 years old, on chronic steroids, have osteoporosis, or if you are diabetic.
• Smoking cessation, optimizing your bone and general health, and maintaining normal glucose levels are recommended before any spine procedure to give you the best outcome.
• Some patients whose bones do not fuse after this procedure may require additional surgery to reattempt a spinal fusion if their symptoms are bad enough to warrant it.

Post Laminectomy Syndrome

• A generic term that describes a condition where you still feel the pain that you had before surgery in your back and legs.
• Post laminectomy Syndrome is also called Failed Back Syndrome.
• This can be caused by a number of different things such as inadequate decompression of your nerves/spinal cord, history of smoking, previous surgeries to name a few.

Nerve damage, causing leg weakness or pain

• There are small nerves that control the muscles in your legs and foot that are close to where Dr. Webb will be working.
• Webb carefully works around these nerves and ensures they are not damaged during surgery.
• If these nerves become irritated during surgery (sometimes just by touching or moving them), these nerves may cause pain for weeks to months after surgery until the nerve recovers. During this time, Dr. Webb may prescribe you nerve medication or steroids to help calm the inflammation down.

Dural tear

• The dura is the outer layer of the spinal cord. Sometimes, this layer can be especially thin in certain patients and very friable. During surgery, if there is a small tear in this layer, Dr. Webb will attempt to repair it. This is a not a very common complication, but definitely one that needs to be known.
• Sometimes after a dural tear is repaired, Dr. Webb may ask that you lay flat for 24 hours after surgery. This is done to give the repair time to heal and to ensure his repair does not come apart.
• Fortunately, multiple studies have shown that having a dural tear repair does not affect your outcome from surgery.

Infection

• Very low risk (<1%) but this risk is increased if you are overweight, immunosuppressed, on chronic steroids, or diabetic.
• Antibiotics will be given before surgery starts and also given for 24 hours after surgery while you are in the hospital to decrease the risk of infection.

Bleeding

• Very low risk, but increased if you are taking blood thinners, fish oil, herbal medications or have a clotting disorder.
• These medications will need to be stopped before surgery.
• Sometimes, a special tube called a drain will be placed during surgery. This tube is to collect any blood or fluids that can collect after surgery. This drain will be removed before you leave the hospital, usually the next day after surgery.

Spinal cord or Nerve damage

• Low risk
• A neuromonitoring technician is a professional trained in the monitoring of your nerves and spinal cord.
• This person (along with a Neurologist) is part of the team that will be taking care of you during surgery and will help Dr. Webb monitor your nerves and spinal cord throughout the procedure.
• You will be able to meet this person the morning of surgery and ask any questions about their role in your care.
• Generally, after you are asleep from anesthesia, this technician will place small wires on your legs and arms so that the nerves and spinal cord and be monitored during surgery.

Frequently asked questions

How long will the surgery take?

The length of the surgery varies depending on each individual patient’s circumstances and spinal complexity. The more levels of the spine that need to be addressed or the more severe the spinal stenosis (narrowing), the longer the procedure will take. Dr. Webb will take however long it takes to complete the surgery in the safest and most efficient manner, but generally takes anywhere between 2-3 hours.

Will I be in a lot of pain after surgery?

Everyone responds to pain differently depending on their tolerance for pain, prior pain medication usage, and other factors to include how quickly or slowly your body metabolizes the medication in your liver or kidneys. Most patients tend to be sore at the incisional site from surgery, but their pain is manageable with IV and oral pain medications. Before surgery, you will be given a “cocktail” of medications which studies have shown to decrease the amount of pain medication that is needed after surgery. After surgery, you will be able to receive oral pain medications every 4-6 hours supplemented by IV medication for breakthrough pain. At discharge, you will be given a prescription for oral pain medication, a muscle relaxant, and a stool softener. Please make sure to include a laxative, as your oral pain medications can make you constipated at times.

Can I walk after surgery?

Yes, Dr. Webb encourages walking as soon as you wake up from anesthesia. The more you walk, the better. While in the hospital, a physical therapist will work with you and teach you how to walk, get in and out of bed, to and from the bathroom.

What restrictions will I need to abide by after surgery?

In general, we recommend you follow the “No BLT” (bending, lifting >10 pounds, or twisting) protocol for 6 weeks following surgery. If you do have to lift an object, following proper lifting mechanics is essential.

Can I remove my dressing after surgery?

Dr. Webb prefers that you keep any and all dressings on until he sees you back in the clinic, which is usually 2 weeks after surgery. Your wound will be closed typically with absorbable sutures that do not need to be removed and will absorb on their own.  At times, dressings can have some “strikethrough” meaning you can see speckles of either blood or fluid through the dressing which is considered normal after surgery (especially the more you get up and move around). Most wounds take about 10-14 days to heal and fully close. Keeping your dressing in place for during this time ensures that your wound is not introduced to the outside world and minimizes your chance of infection. If your dressing becomes saturated, please reinforce this dressing and/or call our office.

Can I get my dressing wet after surgery?

Activities such as bathing, swimming, and hot-tubs should be avoided after surgery until you are given the clearance by Dr. Webb. This is usually after your wound is healed. Showers are usually allowed right after surgery depending on which dressing is used to protect your incision after surgery.

Can I drive or fly after surgery?

Driving after surgery is allowed once you are off all narcotics. Dr. Webb recommends that you start back driving by starting in an empty parking lot to ensure your braking time has returned. You can be a passenger in a car or fly immediately after surgery. If you are driving or flying long distances, Dr. Webb recommends that you stop and get up every 30 mins to pump your calves and walk around. Having surgery places you at risk for blood clots. This is to ensure that you do not get a blood clot.

When can I return to work after surgery?

Most patients can return to sedentary/office based jobs in 1-2 weeks and heavy duty jobs (which require lifting, twisting, bending) by 6 weeks. A return to work as “light duty” is also an option for a lot of people.

My leg pain got better right after surgery but then started hurting again. Is this normal?

Yes, this is called “nerve stretch pain” which is common after laminectomies. During surgery, Dr. Webb has to move the spinal nerves around to decompress the spine. This can cause the nerves to become irritable. This takes time to get better. It usually takes weeks but can take months to improve. If this pain becomes unbearable, let our office know and nerve medication can be prescribed.

What is the recovery process after surgery?

Most patients will receive relief right after waking up from surgery and for others, this may take some time (depending on how long the nerve has been compressed). Most patients notice improvement up to 3 months but full recovery may take up to 12-18 months.

When can I resume my home medications after surgery?

Generally, any heart and blood pressure medications are continued throughout the surgical period. There are a certain number of immunosuppressive medications that must be stopped 1-2 weeks prior to surgery and restarted 1-2 weeks after. Blood thinners are usually held a few days before and restarted a few days after surgery. A discussion with your treating physician may help answer some of these questions.

How long will I stay in the hospital after surgery?

Very few patients may be candidates to go home the same day of surgery. Most patients undergo what is called “same day surgery” meaning they will be in the hospital for 23 hours or less. Some patients require an additional 1-2 days in the hospital for logistical, pain, or medical reasons.

Will I need physical therapy one discharged from the hospital?

Physical therapy is important to “rehab” you back to your presurgery state. Our physical therapists will begin working with you in the hospital either the same day of surgery or the following morning. You may be given a prescription for outpatient physical therapy or home physical therapy, usually started after your incisions have healed.

Lumbar Laminectomy