Laminectomy is a surgical term for removal of lamina of a vertebra. Laminectomy done for lumbar spine is called Lumbar laminectomy.
Lumbar laminectomy surgery is also called decompressive laminectomy surgery. or open lumbar decompression. The surgery is done to remove the lamina(posterior part of a vertebra), which is the bone covering the spinal canal. The nerves in the spine are contained within the spinal canal. Laminectomy is done to relieve the pressure on the spinal canal contents, namely the nerves or the lower part of spinal cord called conus.
When is Lumbar laminectomy done?
Laminectomy is done for various indications. It can be a complete procedure in itself or part of a combination of procedures like that for tumour removal.
- Decompression of nerves- If the procedure is done to remove pressure from nerves in lumbar spine called Lumbar canal stenosis, a lumbar laminectomy is sufficient. This is done traditionally in an open fashion. However, in modern times this problem can be dealt with in a minimally invasive fashion, called MIS decompression. MIS decompression is Minimally Invasive Spinal decompression and is done using small incision.
- Disc surgery or Lumbar discectomy- Traditional methods involved a wide laminectomy to remove herniated disc fragments. But in modern times, this procedure can also be done using small incisions and is called Lumbar microdiscectomy.
- Infections- Laminectomy may be done in case of spinal infections like Tuberculosis or abscesses.
- Spine Tumour surgery– Laminectomy is also done to provide an access to the spinal canal, where tumours can form and cause pressure on nerves.
Also read- Keyhole spine surgery for Lumbar canal stenosis- MIS Lumbar decompression
How is a laminectomy done?
Laminectomy procedure is done mostly under General anaesthesia. In an open laminectomy, the cut is made in the midline over the back. The incision is deepened till the lamina starts appearing. The lamina is then removed using a drill or other cutting instruments by the surgeon. The procedure time for can vary depending up on the number of lamina to be removed. Removal of single lamina can be completed in approximately 45 minutes to one hour.
If laminectomy is done as a part of other procedures like disc surgery or tumour surgery, then the surgeon proceeds to those steps. Once the surgeon is satisfied with the decompression of nerves, the wound is closed using stitches.
What are the possible complications of laminectomy?
Laminectomy as a standalone procedure is quite a safe procedure. However, it may be associated with some complications.
- Bleeding or Haemorrhage – Blood loss can be one of the problems in certain patients. But it is rare for patients to require blood transfusion.
- Infection- Infection is another problem especially in patients with medical problems like diabetes. If an infection develops then it may require another surgery to wash out the wound and remove any dead tissues if present.
- Nerve injury- The nerves lie in the spinal canal and exit the spine under the lamina. While removing the lamina to decompress the nerve, the nerve may get damaged. The chances of this is less than 1%.
- Spinal fluid or CSF leak- Spinal fluid is the fluid in the spinal canal in which the nerves float. Spinal fluid is contained within the spinal canal by a layer called Duramater. If duramater is injured during the surgery, it is usually repaired. But in some cases, the repair may not hold and CSF may start to come through the wound.
What is the success and recovery after this surgery?
The success of this procedure depends on the primary indication of surgery. When done for lumbar canal stenosis, the recovery is very good. In most cases patients can expect to move out of bed for short walks on post-op day 1. The most important problem that patients encounter after laminectomy is pain. The patients are usually kept on some injectable analgesics. Most patients require 1-3 days of hospital stay. The doctor may call the patient after 7-10 days for a follow-up and removal of stitches.
Physical therapy is started within the hospital stay and continued even after the discharge. Physiotherapy aims at improving the muscle strength and mobility lost from the disease.
Depending upon work profile, patients can return back to work in 3-4 weeks or as per their level of comfort. In case laminectomy was done as a part of other procedure like for removal of tumour, recovery may take longer.
What is the cost Lumbar laminectomy in India?
If done as a procedure for Lumbar canal stenosis, the cost of lumbar laminectomy can vary from 75,000 to 2.5 lakhs(USD 1000-3500). The cost depends on the type of hospital one chooses for the procedure.