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What is a Laminectomy ?
Laminectomy is a term used to describe operations on the spine where the bone surrounding the spine (the lamina) is removed. There are 7 laminae in the neck, laminectomy here being called a cervical laminectomy, 12 in the chest (thoracic laminectomy), and 5 in the lumbar region (lumbar laminectomy). All the laminae at the base of the spine are fused into one bone called the sacrum (sacral laminectomy). The laminae are named by the letter of their area and the number of the vertebrae from the top downwards. Hence the 3rd cervical lamina is noted as C3. A laminectomy may be at a single level, or cover multiple levels.
Why is a Laminectomy performed ?
There tend to be two broad reasons for a laminectomy: to relieve pressure on the spinal cord or the nerves emerging from it, or to allow access to the spinal cord in order to operate on it. An example of the first type is the common operation for a slipped disc. Here, the lamina (or part of it) has to be removed to allow the nerves coming from the spinal cord to be seen. The part of the disc pressing on the nerve can then be removed. An example of the second type of operation is where there is a tumour growing within the spinal cord itself.
Preparations needed for a Laminectomy
Some laminectomies are carried out as emergencies, perhaps for a problem causing rapid paralysis of the legs or arms. Others are carried out as planned procedures for slow deterioration in the limbs, or for pain. In emergencies, less time can be spent carrying out tests. X-rays of the spine are taken to see if there are any abnormalities of the bones. The usual next investigation is a myelogram. Here, dye is injected into the space around the spinal cord to see if anything is pressing on it. In the past, the dyes used were unpleasant and caused back pain and headaches. More modern dyes have reduced this problem so that nowadays it is uncommon to have difficulties. Computerized x-ray (CT) scanning of the spine is often combined with myelograms, and magnetic resonance (MRI) scanning can also give good information on the spinal cord and its surrounding bones. MRI scanning is rapidly becoming the main test for spinal problems. You should prepare for a hospital stay of about 2 weeks, depending on the type of problem being dealt with.
What Happens during a Laminectomy
Laminectomies are always performed under general anaesthetic. You will be admitted at least the night before surgery and starved for at least 6 hours before the operation. The anaesthetist will visit before surgery and prescribe a light sedative (the pre-med). In the operating theatre you will be anaesthetized and put on the operating table, usually face down, although occasionally on your side. A cut will be made in the middle of the back over the area being operated on. The cut is deepened to the muscles which are spread outwards to reveal the laminae. The correct level is confirmed either by counting from a fixed point, or taking an x-ray. Having exposed the laminae, the bone is nibbled away using a variety of bone cutters. Little is removed for a simple slipped disc operation, while a great deal of bone will be taken to decompress the spine for arthritis or tumour. Occasionally so much bone has to be removed that there are concerns about the strength of the remaining spine. In these situations metal rods or bone grafts from the hip may have to be used. Having completed the planned operation and stopped the bleeding, the muscles are sewn up and the skin closed. Stitches or staples can be used to close the skin, according to the surgeon's choice.
Possible Complications during a Laminectomy
All operations carry the risks of heart problems, stroke, chest and wound infections and leg thrombosis. Risks are higher, the older and sicker you are. The specific risks of laminectomy depend on the particular operation being carried out and will be discussed by the surgeon beforehand. When the spine is being operated on, there is a small risk that the spinal cord may be damaged and the patient ends up paralysed. The risks in the lumbar region for a slipped disc are very small. In the cervical or thoracic regions (especially for a tumour) they are higher. Normally high risk operations are not advised unless they are considered to be essential by the surgeon: the result of not having the operation may be paralysis.
After a Laminectomy
On recovery from the anaesthetic, observations of blood pressure, pulse and limb movement will take place at regular intervals for the first few hours. The back will be sore and regular painkilling injections or a painkilling drip will be given. Next day you will probably be able to eat or drink and the drip will be removed. Sometimes there is difficulty passing urine after the operation and a catheter is passed into the bladder, usually being left there until the you are up and about. The decision about when you can get up is made by the surgeon and usually depends on the type of operation. Most surgeons like to get people mobile as soon as possible, sometimes even the next day after a simple procedure. Once up, you will have physiotherapy to stop the back stiffening up. Most patients go home within 2 weeks of surgery, their stitches coming out after 10 days. Most patients also require some physiotherapy. In some, a spinal (corset) support will be advised. It may be wise to avoid car driving until it is comfortable to do so.
If a Laminectomy is not performed
Where weakness or paralysis was the initial problem, not having an operation can lead to serious disability which may not recover. Where pain alone was the initial problem (usually with slipped disc), pain may worsen without treatment. Occasionally, pain may subside completely without operation.
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