Laminotomy and laminoplasty present the same risks as any surgery, such as infection, scarring, blood loss, and bruising. Minimally invasive spine surgery reduces the risk of surgical complication over traditional open procedures but may not always be appropriate. Other risks include the potential for the treatment to have little, or no effect, or for further surgery to be necessary. Rates of complication are very low, with infection remaining the main issue; many patients are given antibiotics prior to, and after, surgery to limit the risk of infection.
Surgeries such as laminotomy and laminoplasty do present a slight chance that the surgeon will accidentally nick the dura surrounding the spinal cord. In most cases this will be noticeable during the surgery and steps can be taken to repair it with no subsequent problems. If, however, the dura is impaired and this goes unnoticed then spinal fluid may leak from the cut and an infection of the spinal fluid can occur. Sometimes the dura heals itself, but on rare occasions the infection can cause spinal meningitis and lead to serious complications such as paralysis, loss of limbs, and death. Antibiotic treatment can be given prophylactically, in cases where dural tear or leak is observed, but more aggressive intervention (such as surgery) may be required where the infection persists or spreads to the meninges.
Complications due to anesthesia
Complications surrounding the use of anaesthetic are also possible, with a small number of patients experiencing an allergic reaction to the anaesthetic given prior to surgery. Problems with the respiratory system or cardiovascular function can also occur with any surgery and all patients are carefully monitored to ensure quick intervention should any issue arise. Smokers are at particular risk of post-operative complications, particularly in terms of cardiology. Patients who are in good general health will fare better after any back surgery, and those who have a minimal access procedure under local anaesthetic are more likely to return to normal activities sooner than those undergoing a more invasive laminotomy or laminoplasty.
Spinal Nerve Damage
Nerve damage is a risk with any spinal surgery, particularly where a high degree of compression is present and where the surgeon is operating on the cervical spine. This region of the spine is very narrow in places, providing little room for manoeuvre. A spinal nerve may, therefore, be accidentally knocked, or in very rare circumstances severed, leading to pain, inflammation, scarring, paraesthesia, and, in extreme cases, paralysis. Where discectomy is also being carried out, the risk of nerve damage increases slightly. Hirabayashi (1999) found a relative incidence of radicular pain after laminoplasty in 5-10% of patients that was resolved within two years as the nerve trauma at C5-C6 healed itself.
A further risk of laminotomy and laminoplasty is the failure of the surgery to relieve pain and other symptoms. In some cases this can be due to the presence of other compression in the spine at a different level to that which was operated on. Surgical complications can also lead to failed back surgery syndrome, as can irreparable nerve damage having occurred prior to the surgery itself. Where decompression is inadequate after a laminoplasty, the spinal nerves and cord may remain under some degree or pressure. Symptoms such as back pain, radiculopathy, numbness, weakness, and paraesthesia may continue to a greater or lesser degree and the patient may require further, more invasive, back surgery to achieve full decompression. Less invasive procedures such as laminotomy and laminoplasty do present certain benefits to patients but can result in the surgeon being unable to assess the level of decompression actually achieved during the surgery.
Laminectomy is more appropriate where large amounts of material are to be removed from the spine to achieve decompression, but this is often followed by fusion to avoid spinal curvature. This curvature can also occur with laminotomy and laminoplasty but is less likely (Ratliff, 2003). In most cases, the curvature that occurs after these procedures is due to the general degeneration of the spine rather than as a direct result of the surgery itself (Chiba, 2006).
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