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Lumbar Laminectomy Introduction

Back pain can grow progressively worse and more disabling, depending on the cause. At some point, your
doctor may suggest surgery. The lumbar laminectomy may be one procedure. Despite medical
breakthroughs, back pain has been a common problem through the centuries with no simple solutions.

• Facts about back pain

o Back pain results in more lost work productivity than any other medical condition. It is the
second leading cause of missed workdays (behind the common cold).

o In their lifetime, 70% of people in the United States will have some kind of back pain. Each
year 1 person in 5 will have it.

o Back pain is more common in men than women.

o Back pain is more common among whites than among other racial groups.

o Most back pain occurs among people aged 45-64 years.

o Each year 13 million people go to the doctor for chronic back pain. It is estimated that the
condition leaves 2.4 million Americans chronically disabled and another 2.4 million
temporarily disabled.

o Discussion of back pain has been found on Egyptian papyrus dating 3500 years ago. As
the centuries went by, thousands of physicians have discussed it and recommended
treatments for it.

• Back pain that can lead to surgery

o The most common site of back pain is in the lower back. The National Center for Health
Statistics states 14% of all new visits to doctors are for low back pain.

o About 25% of people who have back pain have a herniated disk, called sciatica, because
the problem once was believed to stem from pressure on the sciatic nerve. Sciatica
causes pain to radiate through your buttocks into 1 or both legs.

o A disk acts as a shock absorber for your spine. It is made up of a tough outer ring of
cartilage with an inner sac filled with a jellylike substance. When a disk herniates, the
jellylike nucleus pushes through the harder outer ring (annulus), putting pressure on the
nerve root.

o A herniated disk can cause varying degrees of pain. The most serious problem is cauda
equina syndrome, compression at the point where roots of all the spinal nerves are
located.

 People may lose all nerve function below the area of compression, including loss
of bowel and bladder control.
 This condition is a true surgical emergency requiring immediate decompression if
you are to preserve bowel and bladder function. The longer the delay, the less
recovery can be expected.

• Surgery for back pain

o As with other back pain, doctors first attempt conservative medical treatment for a
herniated disc. But surgery often produces gratifying relief.

o Surgery may be considered for anyone with frequently recurring sciatica, usually if the
pain interferes with your ability to work or do daily activities.

o Doctors decide to perform surgery, however, only after they have tried a variety of
treatments. Doctors usually reserve surgery for chronic sciatica. In general, most medical
sources do not recommend considering surgery in acute sciatica. The decision to have
surgery should be a joint decision you make with your doctor.

o Another indication for surgery is a progressive loss of nerve function. For example, you
may lose a certain reflex and later begin to lose strength gradually.
 Far more commonly, people go to a doctor with an acute lack of nerve function.

 Usually these function losses are minor and may come and go. They respond
well to medical treatment.

 If the deficit is severe—you cannot bend a knee or move a foot—surgery is an


option.

 Many people may not regain full nerve function, however.

• In the US, some 450 cases of herniated disk per 100,000 require surgery.

o The average age for surgery is 40-45 years.

o Men are twice as likely to need surgery as women.

o More than 95% of disk operations are performed on the fourth and fifth lumbar vertebrae.

• Types of surgery: Doctors perform 3 common surgeries on your back to relieve nerve root
compression. They often are done in combination with each other.

o Laminotomy - Removal of part of the lamina above and below an affected nerve

o Laminectomy - Removal of most of the bony arch, or lamina, of a vertebra (Laminectomy


is most often done when back pain fails to improve with more conservative medical
treatment.)
o Discectomy - Removal or partial removal of a spinal disk

Risks

All operations have risks. Complications occur rarely, but include the following:

• Nerve damage

• Blood clots

• Spinal fluid leak

• Bleeding

• Infection

• Worsening of the back pain

During the Procedure

• Usually you will be placed in a kneeling position to reduce the weight of your abdomen on your
spine.

o The surgeon will make a straight incision over the desired vertebrae and down to the
lamina, the bony arches of your vertebrae.

o The doctor removes the ligament joining the vertebrae along with all or part of the lamina.
The goal is to see the involved nerve root.

o The doctor pulls the nerve root back toward the center of your spinal column and removes
the disk or part of the disk.

o The doctor closes the incision. Your large back muscle now protects your spine or nerve
roots.

• The surgery takes 1-3 hours. You lose very little blood.

After the Procedure

• Recovery: You will be moved to a recovery area until you are fully awake, and then you will return
to your hospital room.

o Normally you will lie on your side or back.

o You may have a catheter in your bladder.

o You should expect to have some pain at first. Nurses will provide pain medicine as
needed.

o You likely will wear compression stockings or compression boots to reduce the chance of
blood clots.

• Hospital room: Once you return to your hospital room, nurses will check your vital signs and help
with pain control.

o Depending on the surgeon’s preferences and your needs, you may be given pain
medicine orally or by IV injection.

o The medication will not make you pain free, but it should make the pain tolerable.

o Sometimes the surgeon will give you a machine that allows you to provide pain medicine
as needed, within certain limits. Patient controlled analgesia (PCA) pumps allow you a
little more control over managing your pain.

• Walking: Normally you will begin to walk within hours of the surgery. To avoid loss of air in a lung or
pneumonia, you may be asked to do a variety of breathing exercises.

• Protection while moving: A few simple techniques will help reduce post-surgical pain and injury. The
goal is to protect your back.

o Tighten your abdominal muscles to help support your spine. Stand up straight, keeping
your ears, shoulders, and hips in a straight line.

o Always bend at the hip and not at the waist. Move your body as a unit and do not twist at
the hips or shoulders.

• Sleeping and getting in and out of bed: You may have difficulty sleeping for the first few nights,
especially if the recommended positions are different from your normal sleeping positions. Some
options include the following:

o Sleep on your back with pillows under your neck and your knees.

o Lie on your side with your knees slightly bent and a pillow between your knees.

o Getting out of bed also can be tricky initially, but with some simple techniques you can
minimize possible injury or pain.

o Tighten your abdominal muscles and roll on to your side, making sure to move your body
as a unit.

o Scoot to the edge of the bed and press down with your arms to raise your body. As you
raise your body, gently swing your legs to the floor.

o Place one foot behind the other, tighten your abdominal muscles, and raise your body with
your legs.

o To get into bed, back up to the edge of the bed, tighten your abdominal muscles, and
lower yourself into bed with your legs.

o Once sitting on the bed, use your arms to lower your body onto the bed while you lift your
feet into bed.

o Roll your body as one unit onto your back.