A patient who is suffering from spinal stenosis may undergo a laminectomy if conservative spinal treatment has not been (or has ceased to be) effective at controlling symptoms of back pain, paraesthesia, numbness, and weakness. In some cases a patient will require an immediate operation to remove acute pressure on the spinal cord. Patients who require a discectomy to remove a herniated disc may need a partial laminectomy to provide access to the troublesome disc, although more minimal spinal surgeries are usually preferred to improve recovery times and reduce risk of complication. A laminotomy is a less extensive procedure and can maintain the stability of the spine more effectively than a laminectomy, as can a laminoplasty. As a general rule, cervical spinal procedures are conducted from the anterior (front) of the neck, whilst lumbar procedures commonly approached from the posterior spine.
Prior to the procedure the patient will undergo a thorough physical assessment to determine their continued eligibility for surgery. Any sign of infection will mean that surgery is delayed. The use of x-rays, MRI scans, and CT scans may assist the surgeon in determining how much of the lamina to excise, and whether fusion is necessary at this time. Additionally, x-rays may be used during the back surgery, via fluoroscope, in order to track the progress of the procedure. Patients will be admitted to the hospital on the day of surgery having been advised not to consume any food or liquids overnight. They will be prepared for surgery, with an IV line introduced, and a general anaesthetic administered.
Somatosensory evoked potentials (SSEPs) may be used by the surgeon during the operation to monitor nerve impulse transmission. Although this technique can provide an early alert for possible spinal cord or nerve damage it is not necessarily used by all surgeons as this complication is rare. A laminectomy is often performed prior to spinal fusion in order to prevent instability, pain, and deformity at a later date. If fusion is indicated then the patient may have a bone graft using donor bone or an autologous bone graft sourcing material from their own hip bone thus creating a second operation site and possible source of post-operative pain.
Patients need to be aware that a laminectomy can take a substantial amount of time to recover from. Post-operative care should be organized prior to the operation with a relative or friend available to drive them home from the hospital and take care of daily activities such as bathing, cooking, and food-shopping for the initial period of healing.
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