Decompressive Laminectomy

Decompressive laminectomy is the most common type of surgery done to treat lumbar (low back) spinal stenosis. This surgery is done to relieve pressure on the spinal nerve roots caused by age-related changes in the spine. The surgery creates space by removing the lamina — the back part of the vertebra that covers your spinal canal.

Laminectomy is generally used only when more-conservative treatments — such as medication, physical therapy or injections — have failed to relieve symptoms. It may also be recommended if symptoms are severe or worsening dramatically.

This procedure is also used to treat other conditions, such as injuries to the spine, herniated discs, or tumors. In many cases, reducing pressure on the nerve roots can relieve pain and allow patients to resume normal daily activities.
Why is it done?
Your doctor may recommend surgery for spinal stenosis when:

• Severe symptoms restrict normal daily activities and become more severe than you can manage.
• Conservative treatment such as medication or physical therapy does not relieve pain and symptoms are getting worse.
• You experience loss of bladder or bowel control.
• You notice sudden changes in your ability to walk in a steady way, or your movement becomes clumsy.

Bony overgrowths within the spinal canal can narrow the space available in your spinal cord and nerves. This pressure can cause pain, weakness or numbness that can radiate down your arms or legs. Laminectomy is usually better at relieving these types of radiating symptoms than it is at relieving actual back pain.

The decision to have surgery is not based on imaging test results alone. Even if the results of imaging tests show increased pressure on the spinal cord and spinal nerve roots, the decision to have surgery also depends on the severity of symptoms and your ability to do normal daily activities.

Risks

Laminectomy is generally a safe procedure. But as with any surgery, laminectomy carries a risk of complications.

Possible complications include:

• Problems from anesthesia.
• Blood clots.
• An unstable spine.
• Nerve injury.
• Tears in the fibrous tissue that covers the spinal cord and the nerve near the spinal cord, sometimes requiring a second surgery.
• Trouble passing urine, or loss of bladder or bowel control.
• Long-term (chronic) pain, which develops after surgery in some cases.

What to Expect After Surgery

Depending on your health and the extent of the surgery, it may take several months or more before you are able to return to your normal daily activities.

Most people report measurable improvement in their symptoms after laminectomy, but the benefit may lessen over time as the spine continues to age or if there is a recurrence of arthritis. Laminectomy is more likely to improve leg pain caused by a compressed nerve than back pain. Because laminectomy can’t stop the buildup from osteoarthritis that caused the nerve compression in the first place from happening again, symptoms may come back over time. After a laminectomy and fusion, spinal stenosis may develop directly above or below the surgery site. Repeated surgeries for spinal stenosis increase your risk of complications and instability in the spine.

Age should not be a factor in deciding whether to have decompressive laminectomy. But if you have other medical conditions that will make this procedure and follow-up rehabilitation less successful, surgery may not be recommended.