Patients who are suffering with radicular pain, numbness, weakness, and paraesthesia in the neck, back, or down the arms and legs are potential candidates for laminotomy or laminoplasty. Physicians will take a detailed history of symptoms in the first case, conduct a thorough physical examination to determine the root cause of the condition, and use X-Rays, MRI, or CT scans to confirm the location of the pinched nerve or spinal cord pressure. In some cases, selective nerve root blocks may be used to verify the location of the pinched nerve and this can also provide a degree of symptom relief prior to surgery being scheduled. If a scan reveals the presence of disc herniation or osteophyte growth then a laminectomy may be more appropriate in order to allow the back surgeon to remove more of the material impinging upon the spinal nerves. Access to the intervertebral discs and spinal canal is more limited with either a laminotomy or laminoplasty. If a patient suffers from herniated disc in the neck then an anterior approach to perform a cervical discectomy is often preferable.
Patients with existing spinal curvature and the above symptoms will be considered for a laminotomy in preference to a full laminectomy in order to reduce the risk of further spinal instability. Some bone spurs can be accessed during a laminotomy, and the reduced invasiveness of the procedure can make recovery times shorter for the majority of patients. Discussing surgical options with a physician can help to ensure that the benefits and risks of laminotomy and laminoplasty are understood.
In order to reduce risks from surgery, patients should make sure that their physician knows of all the medications, prescribed or otherwise, that they may be taking. Some of these may interfere with the procedure itself, or can hinder recovery. NSAIDs for example, are contraindicated if spinal fusion may need to be performed as they can inhibit a successful union of graft material. Other medications such as aspirin, and alternative remedies for pain and inflammation, like fish oil, can have an anticoagulant effect which may lead to complications such as excessive blood-loss during surgery. Smokers should quit prior to surgery as smoking significantly reduces the likelihood of successful back surgery, particularly where fusion is concerned. Risk of complication is also higher, and smokers are advised to quit a few months in advance of any surgery.
In the Pre-Op
Immediately before surgery, a final physical assessment will be conducted to check for general health and any sign of infection that could delay surgery. Patients usually undergo the procedure under general anaesthetic and so are advised to not eat or drink anything from midnight before the day of their surgery. In some cases of minimally invasive procedures, the patient will have a local anaesthetic and sedative instead, which can help them to be up and moving faster after surgery and reduces the risks of thrombophlebitis. Patients may be advised to wear surgical stockings to further reduce their risk of blood clots forming in the deep leg veins.
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