Laminectomy is an open surgical procedure that removes the lamina, a thin layer of bone that covers the spinal canal. It is done to relieve pressure from the nerves that causes pain, numbness or weakness.
Laminectomy is performed in cases of narrowing of the spinal canal (stenosis) with pressure on the nerves when it causes pain or affects function. Laminectomy may be done in any part of the spine, cervical, thoracic or lumbar.
Figure 1 MRI of lumbar spine. Green arrow: normal spinal canal. Red arrow: narrow spinal canal
(spinal stenosis). Blue arros: lamina over the spinal stenosis.
How is laminectomy performed?
A skin incision is made above the affected level. Muscles are separated from the spine exposing the bones. Using a burr, bone cutters and graspers, the surgeon removes the lamina and overgrown soft tissues relieving pressure from the nerves.
Figure 2 Same patient after laminectomy at L4-5. Red arrow points at the site of spinal stenosis.
Green arrow indicates open spinal canal after renoval of the lamina (laminectomy L4-5.)
Does laminectomy require fusion?
In cases when there is abnormal movement of the bones or if structures that stabilize the spine need to be removed, laminectomy is combined with fusion. Laminectomy in the cervical spine is almost always accompanied by fusion. In the thoracic and lumbar spine, it may commonly be done without fusion.
Laminectomy is an outpatient procedure. Most patients will spend two-to-three hours in the hospital to make sure they are fully awake, pain is under control, and they can drink, walk unassisted and can empty the bladder. Stitches or staples on the incision are removed in two weeks.
What are the benefits of laminectomy over other procedures?
Laminectomy is one of the less invasive options to remove pressure from the nerves. If fusion is not required, there is no need to limit your activity once the incision is healed.
Limitations of laminectomy
In some situations, simple decompression with laminectomy may not work and requires additional fusion. In cases of preexisting instability (abnormal motion), laminectomy may make the spine even less stable. In these cases, your surgeon would add fusion to the procedure.
What are the risks?
As with any surgical procedure, there are risks. They are relatively small, but before you decide to have surgery, you need to understand them.
Some risks are similar to other surgical procedures, like the infection and complications from anesthesia.
Other risks are unique to laminectomy itself. Nerves may be injured because they are exposed during the procedure. A CSF (cerebrospinal fluid) leak may occur and would need to be repaired. There is a risk of hematoma formation (collection of blood) that may cause pressure on the nerves and may need to be removed with additional surgery.
What are the alternatives to laminectomy?
Laminectomy is one of the most common spine surgeries to relieve pressure from the nerves, but it is not the only option. Depending on which nerves are pinched and which structures compress the nerves, there are even less invasive procedures, that remove only part of the lamina:
- Hemilaminectomy – when only one half of the lamina is removed;
- Foraminotomy – when foramina, through which the nerve exits the spine, is open.
Sometimes simple removal of the lamina is not enough to “unpinch” the nerves. To prevent recurrence of nerve compression, bones may need to be realigned and fused together. This is called indirect decompression. Examples of indirect decompression include:
How do I know if laminectomy is right for me?
If you have pain in the legs because of the compressed nerves, laminectomy may be the right procedure. In general, you want to have the least invasive procedure and if possible, avoid fusion. Ask your surgeon if fusion is necessary or a simple laminectomy may help.
How do I prepare for surgery?
We have a standard preoperative protocol that we follow with all patients. You can find it by following this link.
- Lumbar spinal stenosis and neurogenic claudication
- Cervical spinal stenosis and myelopathy