A laminectomy is a more invasive back surgery procedure performed to address spinal stenosis and reduce compression of the spinal cord and spinal nerves. The necessity of the surgery is not, usually, a diseased lamina but rather the need to increase the space available for spinal tissues and nerves through decompression. Laminectomy may also be performed in order to provide access to the tissues and structures deeper into the spinal column such as a herniated disc or problematic osteophytes. The lamina is a bony, cartilaginous structure which covers the back of the spinal cord. Removing a section of this can allow space for the spinal cord, nerves, and blood vessels to relax in cases where back pain symptoms are not manageable by conservative treatments. Disc herniation, and spinal curvature (such as in ankylosing spondylitis) may be better addressed through alternative procedures such as discectomy or foraminotomy.
Multiple Level Laminectomy
Laminectomy can be performed over several vertebral levels and may result in spinal instability if a large amount of structural tissue is removed. Many patients undergo a laminectomy with fusion to maintain the intervertebral height and the lordosis of the spine. Without such fusion the spine may suffer from kyphosis or slippage. The extra pressure placed on the surrounding vertebra can cause fracture and lead to the need for further surgery in some cases. A laminotomy or laminoplasty may be favored for this reason in order to maintain stability without the need for fusion.
As with any surgical procedure there are risks involving anaesthetic, bleeding, thrombophlebitis, and infection. Laminectomy is a more extensive back surgery than a foraminotomy, for example, and the recovery is almost always more protracted and difficult. Performing this surgery requires an open back operation rather than endoscopic surgery (in the majority of cases), leading to more tissue and nerve trauma and causing a higher degree of post-surgical pain, bruising, and possible complication. Usually, more than just the lamina is removed, with osteophytes, calcified tissue, and disc fragments also excised. Some of the back musculature is cut and scraped back from the bone to allow access during the procedure and nerves are retracted or nudged aside. Laminectomy can be very effective for relieving compression of the spinal cord, nerves, and blood vessels, and Chen (2009) observed an average 62.4% improvement in patients’ neurological symptoms after this back surgery.
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