The term laminectomy
is derived from lumber (lower spine), lamina (part of the spinal canal's
bony structure) and -ectomy (removal). The operation is performed
to relieve pressure on one or more spinal nerve roots. This pressure,
often called nerve root compression or a "pinched nerve",
is what often causes back and leg pain.
Nerve root compression is caused by:
- Ruptured disc - Also called a protruded, slipped or herniated
- Spondylosis - Deterioration or "wear and tear"
of multiple discs with bony spur formation and degenerative disc.
- Scar tissue
- Combination of the above factors
laminectomy surgery is performed with the patient lying on the abdomen
or side after being put "to sleep" with general anesthesia.
The surgeon reaches the lumbar spine through an incision in the
lower back. After the muscles of the back are spread apart using
a retractor to expose the lamina, a portion of one or more vertebra
are removed in order to reach the compressed nerve root(s). Once
the point where the nerve is being compressed is located, the source
of the pressure is removed. That may involve either:
- Removing the ruptured portion of the disc
- Removing the bony spurs and bony overgrowth
- Removing the scar tissue.
The operation normally takes approximately 2 hours. The skin layer
is closed with either steri-strips, sutures or skin clips that will
be removed at a later date. A large dressing will be placed over
the incision for protection.
What To Expect After Surgery
A plastic drain will be seen through the surgical dressing to remove
any blood that accumulates in the surgical area. The drain will
probably be removed on the second day after surgery. The dressing
will also be changed and a smaller one applied.
An IV may remain in your arm for two to three days to administer
antibiotics or other medications you may need. This helps prevent
infection and gives you proper nourishment until you are eating
and drinking comfortably. You will begin regular fluid and food
intake under the direction and advice of your surgeon. You may be
given a "pain pump" or PCA-patient controlled anesthesia
pump for the first 1 to 2 days after surgery.
After the acute pain has diminished, usually the day after surgery,
a physical therapist will help you begin standing and walking again.
They will also show you the proper way to get in and out of bed,
sit and stand, and sleep position.
It is normal to have pain after your operation. It will be most
severe in the lower back area where the surgery was done. Residual
leg pain is not unusual, this is caused by swelling of the previously
compressed nerve as well as from surgery itself. There may be muscle
spasms across the back and down the legs. Medication will be perscribed
to help relieve the pain and /or spasms.
Constipation is a significant side effect of the pain medication.
Your doctor will order a laxative to relieve constipation. We also
recommend a diet of whole grain cereals, fruit and fruit juices.
Initially, you are permitted to get out of bed following surgery
with assistance from a nurse. Thereafter, you should be up walking
as much as tolerated. The goal is to do more walking each day. Start
with short trips and set a graduated pace so that each day more
activity is accomplished. The easiest way for you to get out of
bed is to raise the head of the bed as far as it will go, balance
yourself in a sitting position, then stand with weight distributed
on the skeletal frame, to avoid straining of back muscles. Avoid
prolonged sitting. Initially, you should only sit for meals.
It is normal to feel physically and emotionally let down and tired
the second and third day after surgery. This may be a natural reaction
to the stress of surgery and the lingering effects of anesthesia.
While this feeling is not uncommon, it must not be allowed to get
in the way of your positive attitude that is essential for recovery
to normal activity.
Discharge from the hospital
The hospital stay for a lumbar laminectomy is approximately 2-3
days. Your progress and comfort will determine this.
At home you may climb stairs from the start; but slowly, one step
at a time. You should be active, walking as much as possible, but
avoid being tired. Lie down to rest as needed. Avoid prolonged sitting.
You may sit in a hardback wood chair for meals and short periods.
(10-15 minutes three times a day).
Walking each day is excellent exercise. You should begin with short
trips and increase your distance up to 4-5 miles daily. This will
take no more than one hour per day. Avoid pulling, pushing or lifting.
In the future, always protect your back when lifting or bending.
Proper body mechanics involve using your knees and not your back
during these activities.
Have a family member check the incision line daily at home. If
increased redness, swelling or drainage occurs and/or you develop
a fever, visit your doctor. Sexual relations are permissible within
reason, but be sure not to strain your back. You may take short
trips in the car after two weeks, but should avoid driving the car
yourself for approximately three weeks.
Questions regarding your return to work are best discussed with
your surgeon at the first postoperative checkup. The return date
will depend on a number of factors, including the type of work you
do, your particular problem and your postoperative condition.
You will have "good" days and "bad" days just
as you did at the hospital.
Nights may be uncomfortable; use of a heating pad may be of benefit.
Follow-up to remove staples will be scheduled for ten to fourteen
days following surgery. Another follow-up to see progress will be
scheduled four to six weeks following surgery. Other follow-ups
which may continue for as long as a year after surgery, will be
scheduled depending on progress.