Laminectomy (Lamina Removal, Removal of the Lamina)

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Definition

This is a surgical procedure to remove a portion of a vertebra, called the lamina. The lamina is removed to get to a ruptured disc that is pushing on nerves. The ruptured disc is then removed. In other cases, the lamina is removed because of pressure caused by bony spurs or other problems.

Ruptured Disc in Neck Pushing on Nerves

cervical disc herniation small

2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

  • Back
  • Spinal column
  • Intervertebral disc

Reasons for Procedure

This is done to treat severe pain and disability caused from a ruptured disc, bony spurs, or other problems. The surgery is recommended when other treatments, like physical therapy and medications, have not worked. It is most often done to treat progressive neurological problems, such as weakness, numbness, pain in an arm or leg, or loss of bowel or bladder control. These symptoms may be caused by:

Risk Factors for Complications During the Procedure

  • Another medical condition, particularly heart or lung problems
  • Obesity
  • Advanced age

What to Expect

Prior to Procedure

Your doctor will likely do the following:

Physical examX-raya test that uses radiation to take a picture of structures inside the body, especially bonesMRI scana test that uses magnetic waves to make pictures of the inside of the body, especially the spinal nerves and the intervertebral discMyelograma specialized type of x-ray that requires dye to be inserted near the spinal cord and shows if there is pressure on the cord or the nerves Possibly a CT scana type of x-ray that uses a computer to make pictures of the inside of the body, especially to see if there is room for the nerves and the spinal cord In the time leading up to your procedure: If you are overweight, try to lose weight. This will decrease the amount of stress on your back.Review your medications with your doctor. You may need to stop taking some medications before the procedure.Arrange for a ride home and for help at home.Eat a light meal the night before, then avoid eating or drinking anything after midnight. You may need to have an empty stomach before the procedure. AnesthesiaGeneral or spinal anesthesia Description of the ProcedureThis can be done using an open incision or several small incisions (called laparoscopic). During laparoscopic surgery, the doctor uses the incisions to insert small instruments, as well as a device with a tiny camera on one end. With either technique, lamina is removed. This allows the doctor to see what is compressing the nerve. Usually, this disc is also removed.
Laparoscopic Removal of Disc Tissue 2008 Nucleus Medical Art, Inc. If it is not a disc problem, the doctor can look for other causes and try to reduce the pressure on the nerves. In rare cases, the doctor may do a spinal fusion, joining two side-by-side vertebra (bones). The incision is then closed with stitches or staples. After ProcedureA lab will examine the removed tissue. How Long Will It Take?1-3 hours Will It Hurt?Anesthesia prevents pain during surgery. You may have pain during recovery, but pain medications will help. If you felt pain in your limbs before, you may now feel numbness and tingling. Possible ComplicationsInfection Blood clots in a vein (phlebitis) or traveling to the lungs (embolism) Return of ruptured disc Damage to nerves, resulting in pain, numbness, tingling, or paralysisPoor bladder functionProblems related to anesthesia Average Hospital Stay0-3 days (depending on anesthesia and pain) Postoperative CareThe evening after surgery or the next day, walk with help. You may need to wear a back brace.Keep the incision area clean and dry.Exercise your legs while in bed. This is to improve circulation and decrease the risk of blood clots.Do not lift anything heavy.Only take medications recommended by your doctor. Ask your doctor before taking any over-the-counter medication.Expect to have the stitches or stapes removed in two weeks. OutcomeFollowing your doctor's rehabilitation program will speed recovery. You'll probably start with walking, then progress to swimming or other low-impact exercises. You may still feel some achy pain in your back. Doing exercises and maintaining a healthy weight will help reduce this discomfort.
Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteCough, shortness of breath, chest pain, nausea, or vomitingWeakness or paralysis that you did not feel before surgeryLoss of bowel or bladder functionNumbness, tingling, or pain RESOURCES: Family Doctor.orghttp://familydoctor.org/online/famdocen/home.html NINDS Back Pain Information CenterNational Institute of Neurological Disorders and Strokehttp://www.ninds.nih.gov/disorders/backpain/backpain.htm CANADIAN RESOURCES: BC Health Guidehttp://www.bchealthguide.org/ Health Canadahttp://www.hc-sc.gc.ca/index_e.html References: American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org. Herniated disc. American Association of Neurological Surgeons website. Available at: http://www.neurosurgerytoday.org/what/patient_e/herniated.asp. Updated September 2005. Accessed June 13, 2008. Laminectomy or laminotomy. North American Spine Society website. Available at: http://www.spine.org/Pages/ConsumerHealth/SpineConditionsAndTreatments/CommonProblemsCorrectiveActions/CommonSurgicalProcedures/LaminectomyorLaminotomy.aspx. Accessed June 13, 2008.
Pain: hope through research. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#Treatment. Updated May 2008. Accessed June 13, 2008. Last reviewed November 2007 by Rosalyn Carson-DeWitt, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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