A laminectomy is an operation to expose the spine over the nerves. As the name implies, laminectomy means removing the lamina, which is the bony covering of the nerves in the back of the spinal column. In so doing it is a treatment because un-roofing the nerves relieves the pressure upon them.
Laminectomy is usually used to treat spinal stenosis. Spinal stenosis is a condition in which there is nerve impingement due to bone spurs, thickened ligaments, or bulging discs. In the process of the laminectomy, these offending structures are removed, therefore freeing up the nerves.
Most patients with spinal stenosis present with buttock, hip, or leg pain and frequently difficulty standing for a period of time or walking. If your pain is mild or moderately tolerable we do not recommend you proceed with surgery.
After general anesthesia, patients are carefully placed on a frame and secured in a prone position. X-ray imaging is used to localize the proper level for surgery and an incision is made over the lamina. The muscles on both sides of the spine are pushed to the side and the lamina is then removed, taking care to preserve the facet joints which provide stability for the spine.
One of the most common complications of lumbar laminectomy is a spinal fluid leak. This occurs in about 1-2% of patients who have never had prior surgery and up to 10% of patients who have had prior surgery. Spinal fluid leaks are repaired but may add 1–2 days to the hospital stay.
Nerve injury-producing leg weakness or numbness occurs in less than 1% of cases. Infection occurs in about 1% of cases. Wrong-level surgery can occur but chances of this are minimized by Dr. Button’s use of live x-ray during the surgery to locate the proper disc.
Sometimes laminectomy alone cannot adequately relieve pressure on the spinal nerves and patients see less than complete relief and may require a fusion in the future to produce more relief.
In general, a lumbar laminectomy is about 85% successful in relieving pain in the buttocks and legs. Pain relief is typically quite rapid, although it may take six to eight weeks for the nerves to calm down in specific instances. If a nerve has been pinched for a long time, the success rate is rarely 100% as there is usually some residual mild tingling, weakness, or pain, all of which are fairly tolerable.
Our overall advice for this type of surgery is the same for any other spine surgery, which is to live with the pain you are experiencing if you can. The reason to undergo the operation is that the pain or weakness is making life so uncomfortable or difficult that you are willing to accept the chance of a result that is less than 100% successful.