A patient who has undergone a laminotomy or laminoplasty is likely to have had minimally invasive surgery using a local anaesthetic and sedative. This means that they are often quickly mobile after surgery and can move between their hospital bed and their chair, or walk a little ways with assistance to visit the bathroom. Patients are usually encouraged to start moving as soon as possible after surgery in order to reduce the risk of thrombophlebitis (dangerous blood clot formation). Making sure to stay hydrated is also important in this regard.
The length of hospital stay for a patient having a laminotomy is usually fairly short, with some patients able to leave later in the day, and some kept overnight for monitoring. Patients should not drive themselves, and will usually need some form of assistance for a few days after their surgery in order to reduce the risk of complication and help the healing process. If an open procedure has been performed then the patient is likely to be quite sore and have some pain in the back musculature due to tissue trauma. Minimally invasive back surgery shortens the recovery time and allows patients to get back to a fairly normal routine within a few days of surgery.
Immediate Results from Laminotomy
Some patients feel the effects of the surgery quite quickly, in a handful of cases the decompression can be felt immediately if having the procedure under local anaesthetic. Pain from the surgery itself may mask the relief of pre-surgical symptoms, so patience is required for many to determine the full effects of the laminotomy of laminoplasty. If a discectomy was also performed then healing will take a little longer due to the invasiveness of this procedure. Laser laminotomy is very quick to recover from in most cases, as trauma to surrounding tissues is very minimal. In cases where an open procedure using a large incision has been necessary then patients will usually be advised to avoid any lifting or twisting for six weeks or so in order to allow adequate healing time and reduce the risks of scarring of the nerves or other complication.
As with any surgery, there is a risk of infection and patients need to be aware of the warning signs. Any feeling of heat in the incision area, or spread of redness beyond a centimeter or so past the incision line should be investigated. If a fever develops, or persistent headache with stiffness of the back or neck, seek emergency medical attention as this could indicate an infection that has spread to the spinal fluid. Weeping from the incision may also indicate an infection that may be treated with antibiotics before it spreads, an infection of the meninges may require further surgery to drain the infection. Keeping the incision site clean and dry is very important. Do not immerse the incision in water until it is fully closed. Using soaps or creams on the incision site is usually inadvisable and patients should discuss this with their surgeon if they are concerned about scarring.
In the majority of cases a patient undergoing a laminotomy need not wear a cervical collar or back brace for any extended period following a laminotomy or laminoplasty. Wearing these devices may cause the muscles of the spine to become weak through misuse, leading to further problems of hyper-flexibility of the spine. It may be recommended to wear a neck collar when travelling as a passenger in a car in order to prevent jarring of the neck immediately after neck surgery. Most patients should avoid driving after a neck laminotomy, or for any extended period after back surgery, for at least two weeks. The surgeon will give guidance on the use of supportive devices.
Returning to daily activities
Returning to physical activity after a laminotomy is important in order to optimize recovery. Starting with gentle walking is recommended, with a gradual progression to normal activities. Physical therapy sessions are often part of patient after-care with gentle stretching and strengthening exercises given to enhance recovery and healing. Some activities are usually restricting until the follow-up appointment (two weeks after surgery in most cases), such as driving, heavy lifting or other manual work, sexual activity, and high-impact exercise, such as running. An X-Ray may be taken at the follow-up consultation to assess the level of spinal decompression achieved and ensure that no complications have arisen, such as retaining or bridging device failure. If traditional stitches were used to close the incision, rather than dissolving sutures, these will be removed at the follow-up appointment or earlier if appropriate.
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