laminectomy

Laminectomy.
This procedure involves removing the bone, bone spurs, and ligaments that are compressing the nerves. This procedure may also be called a "decompression." Laminectomy can be performed as open surgery, where your doctor uses a single, larger incision to access your spine. The procedure can also be done using a minimally invasive method, where several smaller incisions are made. Your doctor will discuss with you the right option for you.


To access the spine, muscles are pulled back to expose the bone. After the laminectomy, bone graft material and screws are placed along the sides of the vertebrae to help with healing.Spinal fusion. If arthritis has progressed to spinal instability, a combination of decompression and stabilization or spinal fusion may be recommended.

In a spinal fusion, two or more vertebrae are permanently healed or fused together. A bone graft taken from the pelvis or hip bone is used to fuse the vertebrae.

Fusion eliminates motion between vertebrae and prevents the slippage from worsening after surgery. The surgeon may also use rods and screws to hold the spine in place while the bones fuse together. The use of rods and screws makes the fusion of the bones happen faster and speeds recovery.

Rehabilitation. After surgery, you may stay in the hospital for a short time, depending on your health and the procedure performed. Healthy patients who undergo just decompression may go home the same or next day, and may return to normal activities after only a few weeks. Fusion generally adds 2 to 3 days to the hospital stay.

Your surgeon may give you a brace or corset to wear for comfort. He or she will likely encourage you to begin walking as soon as possible. Most patients do not need physical therapy except to learn how to strengthen their backs.

Your physical therapist may show you exercises to help you build and maintain strength, endurance, and flexibility for spinal stability. Some of these exercises will help strengthen your abdominal muscles, which help support your back. Your physical therapist will create an individualized program, taking into consideration your health and history.

Most people can go back to a desk job within a few days to a few weeks after surgery. They may return to normal activities after 2 to 3 months. Older patients who need more care and assistance may be transferred from the hospital to a rehabilitation facility prior to going home.

Surgical risks. There are minor risks associated with every surgical procedure. These include bleeding, infection, blood clots, and reaction to anesthesia. These risks are usually very low.

Elderly patients have higher rates of complications from surgery. So do overweight patients, diabetics, smokers, and patients with multiple medical problems.

Specific complications from surgery for spinal stenosis include:

•Tear of the sac covering the nerves (dural tear)
•Failure of the bone fusion to heal
•Failure of screws or rods
•Nerve injury
•Need for further surgery
•Failure to relieve symptoms
•Return of symptoms
Surgical outcomes. Overall, the results of laminectomy with or without spinal fusion for lumbar stenosis are good to excellent in approximately 80% of patients. Patients tend to see more improvement of leg pain than back pain. Most patients are able to resume a normal lifestyle after a period of recovery from surgery