What is a Laminectomy? (Indications, Reasons, and Benefits)

If your spinal issues are caused by overcrowding of the nerves or spinal cord, and if more conservative, non-surgical treatments haven’t helped, then yes—you may be a good candidate for laminectomy.

What Is a Lamina?

The laminectomy procedure involves surgical removal of a part of the vertebra called the lamina. If you held a single vertebra bone in your hand, the lamina would be the sides of the spiny part, which resemble two sides of a triangle or arch. The lamina curves to a point and forms a bony protrusion called the spinous process. The space between the flat part of the vertebra (called the body) and the lamina is called the vertebral foramen. This is the spinal canal: the hole through which the spinal cord passes (much the way a string would pass through beads or pearls in a necklace).

Together, all the sequential laminae of the spine provide a “roof” over the spinal canal, shielding the spinal cord and nerve roots from damage.

Sometimes conditions like spinal stenosis, a tumor, or arthritis can lead to a crowding or narrowing of the spinal canal. Compression may put pressure on spinal cord or nerve roots of the spine, which can lead to pain, numbness, and other symptoms. (For example, sciatica or cauda equina syndrome.)

In certain cases, your orthopedic surgeon may determine that a laminectomy is advisable or necessary. Removing the lamina accomplishes two goals: it makes more room for the nerves by relieving pressure; and it takes away part of the “roof,” allowing your surgeon access to the spinal canal, should other repairs or procedures be necessary.

The Laminectomy Procedure

Laminectomy is named for the region of the spine where it’s performed. There are three types:

• Cervical laminectomy (in the neck region)

• Thoracic laminectomy (in the middle back)

• Lumbar laminectomy (in the lower back)

The procedure is common and safe, and is performed in a hospital or surgery center under general anesthesia. Your surgeon will make an incision over your spine to remove the lamina, relieving pressure on the spinal cord and nerve roots. Any tumors will be removed at this time.

If the pressure on the spine calls for it, the surgeon may determine that the patient will gain additional benefit from enlarging the foramina (the holes through which the spinal cord passes). In that case, he or she may perform a foraminotomy to remove extra bone. The surgeon may also remove part of the facet joint, which is the surface of the vertebra that contributes to the mobility of the spine—its ability to bend and twist.

In the case of laminectomy, the removed lamina does not need to be replaced; the spinal cord is protected enough by bone on the sides and by surrounding muscle and fascia. However, if you have vertebral degeneration, spinal fusion (the joining together of two or more vertebrae) may be recommended to give a weakened spine more stability. Your surgeon will discuss this possibility with you prior to the procedure.

Laminectomy concludes with suturing the wound. Most patients can go home after two to three days and can walk immediately. Some may benefit from physical therapy afterward. After surgery, you can walk and exercise, but activities should stay at a calm level for several weeks while you heal.

Laminectomy vs Laminotomy

Many people ask the question, “What’s the difference between laminectomy and laminotomy?” Both are spinal decompression surgeries.The answer is, the difference is small (and in fact, some doctors use the terms interchangeably, though they should not).

Laminectomy is the complete removal of a lamina. The suffix “ectomy” means “removal.” You’ve probably seen this word formation before in appendectomy (removal of the appendix), tonsillectomy (removal of the tonsils), and hysterectomy (removal of the uterus).

The suffix “otomy” means “to cut into or separate.” Common “otomy” procedures you may have heard of include episiotomy (a procedure common during childbirth), lobotomy (a brain procedure), and tracheotomy (an incision made to access the windpipe). In orthopedics, osteotomy—a procedure in which a bone is cut for the purpose of lengthening, shortening, or realigning—is also fairly common.

Laminotomy, thus, is a partial removal of the lamina to create a larger opening for the spinal cord (for example, a doctor might remove just one side of the lamina, or a small piece).

Your surgeon will advise as to whether a complete or partial removal of the lamina is necessary to alleviate your symptoms. Often, the full laminectomy is simply a matter of allowing the surgeon a clearer view and better access to discs, which may be damaged and could be pressing on nerve roots.

Reasons/Indications for a laminectomy

If you’re having neck or back symptoms like back or leg pain, muscle weakness, numbness, or bladder or bowel impairment, see a doctor to be examined and diagnosed.

Laminectomy may be recommended if you have one of the following conditions, and if conservative, non-surgical treatments like physical therapy, heat and cold therapy, and corticosteroid injections have been ineffective in providing relief.

• Ankylosing spondylitis. This inflammatory disease can lead to vertebrae of the spine fusing together, creating spine stiffness and a hunched posture. This is a progressive condition with no cure, but surgery like laminectomy can often help to alleviate symptoms.
  
  
• Degenerative disc disease. As we age, the discs that serve as cushioning between the vertebrae break down. This naturally-occurring degeneration can contribute to other problems, including herniated discs, osteoarthritis of the spine, and spinal stenosis. Sometimes a laminectomy is required to help surgeons gain access to, and repair, the injured discs.
  
  
• Herniated disc. If a vertebral disc becomes damaged from pressure (for example, as the result of sudden movement or injury), its insides may bulge outward. The disc may even rupture under the force or pressure. Laminectomy may be required to alleviate pressure on the spinal cord created by the disc. Removing the lamina can also grant the surgeon access to the disc itself, in order to repair it.

• Sciatica symptoms are caused by pressure on the nerve roots at the base of the spine, in the lumbar region. In some situations, a laminectomy may relieve this pressure by creating more space for the nerve.

• Spinal stenosis. This condition is a narrowing of the spinal canal. It’s often caused by age-related wear-and-tear, though in some people it may have a genetic component. If the stenosis involves narrowing or compression at the back of the spinal canal, a laminectomy may help relieve that pressure on the spinal cord and nerves.

• Spondylosis (spinal osteoarthritis). This degenerative condition, caused by aging and wear and tear, can happen anywhere along the spine. It can affect the discs or the facet joints. When bone rubs against bone, bony spurs can form. These put pressure on the spinal cord. Decompression surgery like a laminectomy or laminotomy may be helpful in relieving symptoms. Removal of the bone spurs may also be helpful. However, in most cases, spondylosis can be treated using non-surgical methods.
  

• If a benign spinal tumor is the cause of your symptoms, removal of the lamina may be needed for the surgeon to access and remove the growth.

Benefits of Laminectomy

Laminectomy is generally considered a very safe surgery. Doctors recommend it to patients who’ve tried other medical solutions but still experience back pain and related symptoms. If signs of nerve damage develop in addition to the pain (for example, leg weakness or numbness, or bladder or bowel control), this may be an indication that something’s pressing on the spinal cord.

The main benefit of laminectomy is that it removes this pressure, and therefore the symptoms caused by it. Most people in good health recover quickly and can walk within two days of surgery.

If you or a loved one wants to learn more about the laminectomy procedure, contact Coastal Orthopedics in Corpus Christi today at (361) 994-1166.

Article written by: Rob Williams, MD