Patient education: Laminectomy (The Basics)

What is laminectomy? — To understand what a laminectomy is, it's helpful to first learn a little about the back and spine.

The back is made up of:

●Vertebrae (figure 1) – These are your "back bones." They sit on top of one another to form a column. Each bone has a hole in the center. When stacked, the holes in the bones form a hollow "tube" called the spinal canal. This protects the spinal cord and nerve roots.

●Spinal cord and nerves – The spinal cord is like a highway of nerves that connects the brain to the rest of the body. Spinal nerves branch off of the spinal cord and pass in between the vertebrae. From there, they connect to the arms, legs, and organs. This is why a pinched nerve in the neck can cause arm pain, and a pinched nerve in the back can cause leg pain or bladder problems.

●Muscles – Long muscles run along the spine and help hold the spine upright. Along with the muscles in the belly and hips, these spinal muscles form the "core" and help support the vertebrae.

●Discs – Rubbery spacers sit in between each of the vertebrae to add cushioning and allow movement. They can break down as a normal part of the aging process.

Each of your vertebrae has a part called the "lamina." The lamina is the part that forms the roof of the spinal canal (figure 1). It helps protect your spinal cord and nerves. Sometimes, the spinal canal can become too narrow. This is called "spinal stenosis," and can be caused by different things, including disc problems, bone spurs, or tumors. It can cause the spinal cord or nerves to get pinched, which can lead to symptoms like pain, tingling, numbness, and weakness.

Laminectomy is surgery to remove the lamina. This creates more space and helps relieve pressure. This surgery can be done in 2 ways:

●Open surgery – The doctor makes a cut, or "incision," in the skin. This allows them to see directly inside the body when they do the surgery.

●Minimally invasive surgery – The doctor makes smaller cuts in the skin and works through a tube. They insert a camera and small tools through the tube to do the surgery. Minimally invasive surgery is only an option in certain situations.

Usually, surgery for spinal stenosis is done after a person has tried other treatments first. Talk to your doctor about whether laminectomy is the right choice for you, or if there are other treatments you can try.

How do I prepare for laminectomy? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might also send you to get tests, such as:

●Imaging tests – These create pictures of the inside of your body. They can help your doctor diagnose the problem that is causing your symptoms. Standing X-rays show how aligned and stable your spine is. An MRI shows problems with the nerves.

●Lab tests – In some cases, your doctor might order lab tests (such as blood or urine tests) to make sure that you are ready for surgery.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

●Whether you or anyone you are related to have had problems with anesthesia

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) some of your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you will need to have someone else bring you home from the surgery. If you live alone, you might want to have someone stay with you for at least a few days while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during laminectomy? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Spinal surgery is most often done under "general" anesthesia." This makes you unconscious so you won't feel, see, hear, or remember anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The surgeon will remove part or all of your lamina.

●The surgeon will close your cuts (incisions) and cover them with clean bandages.

What happens after laminectomy? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine to help with pain, if needed. You might need other medicines, too.

●You will be allowed to eat after surgery, but you might feel better if you start with bland foods.

What are the risks of laminectomy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Bleeding

●Infection

●Blood clots developing in the lungs or legs

●Damage to the nerves in the spinal cord

●Leaking of the fluid surrounding the spinal cord

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Laminectomy – Discharge instructions (The Basics)
Patient education: Low back pain in adults (The Basics)
Patient education: Herniated disc (The Basics)
Patient education: Spinal stenosis (The Basics)
Patient education: Cauda equina syndrome (The Basics)
Patient education: Do I need an X-ray (or other test) for low back pain? (The Basics)

Patient education: Low back pain in adults (Beyond the Basics)