Generality
Laminectomy is the surgical procedure by which the vertebral lamina is removed, in order to reduce the disorders generated by excessive compression of the marrow and / or spinal nerves.
Surgeons resort to laminectomy only when conservative treatments for spinal stenosis, disc hernia or an abnormal curvature of the spine have yielded poor results.
As with any operation performed under general anesthesia, even in the case of laminectomy the patient must undergo a series of clinical examinations and tests and, on the day of the operation, present themselves to complete fasting.
The procedure is delicate and can take several hours; recovery times, as well as results, vary depending on the causes triggering spinal cord compression.
What is laminectomy?
Laminectomy is a surgical operation aimed at decompressing the spinal cord and / or spinal nerves, obtained by removing one or more vertebral laminae. For this reason, it is also called decompressive laminectomy or spinal cord decompression .
WHAT IS THE VERTEBRAL LAMINA? BRIEF REVIEW OF THE ANATOMY OF THE VERTEBRAL COLUMN
The spine, or spine, is the backbone of the human body and consists of 33 irregular bones superimposed on each other, called vertebrae .
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The spine is composed of:
- 7 cervical vertebrae
- 12 thoracic vertebrae
- 5 lumbar vertebrae
- 5 sacral vertebrae
- 4 coccygeal vertebrae
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In general, the vertebrae possess a fairly similar basic structure: they are, in fact, all composed of a body (anteriorly) and an arch (posteriorly), similar to a horseshoe.
The vertebral arch, which delimits the hole within which the spinal cord passes ( vertebral hole ), includes various parts:
- Two peduncles, which actually form the basis of the arch. The peduncles of the same side of two adjacent vertebrae delimit a space, called the intervertebral hole, in which a spinal nerve passes
- Two transverse processes
- Two upper joint processes and two lower joint processes
- A thorny process
- Two plates
The laminae (often also referred to as singular, therefore lamina ) are the vertebral bone regions that go from the peduncles to the spinous process and that house the yellow ligaments of the vertebral column. The yellow ligaments, in addition to connecting the adjacent vertebrae to each other, also serve to guarantee elasticity and flexural capacity to the entire spine.
Between one vertebra and the other, there is a disk of fibrocartilaginous tissue, called intervertebral disk, whose function is to absorb shocks and loads to the detriment of the column. In other words the intervertebral discs act as small bearings.
The entire space along which the spinal cord passes is called the spinal canal .
When you run
The specialist surgeon uses laminectomy in the presence of a spinal stenosis . For spinal stenosis, we mean any narrowing of the spinal canal that causes a compression of the spinal cord or nerves that depart from it.
SYMPTOMS AND CAUSES OF SPINAL STENOSIS
A spinal stenosis causes different neurological deficits, depending on the region of marrow involved and the extent of compression. For example, if the affected area is the cervical area (cervical stenosis ), the disorders will be borne by the anatomical districts controlled by the nerves and spinal cord of the cervical area.
The classic symptoms of a spinal stenosis are:
- Ache
- Sense of numbness in the anatomical areas innervated by the affected marrow section.
- Muscle weakness
- Loss of control of anal and bladder sphincters
- Paresthesia
- Failure to control some voluntary muscles
Possible causes of spinal stenosis:
- Osteoarthritis
- Rheumatoid arthritis
- Chiari malformation and other congenital alterations of the central nervous system
- Syringomyelia
- Spine trauma. Following a trauma, a vertebra can shatter and a part of it ends up inside the spinal canal
- Effects of aging (osteoporosis; bone growths within the spinal canal, cysts against the spinal nerves, etc.)
- Spinal cord tumors
- Tumors near the spinal cord or spinal nerves
LAMINECTOMIA AS A LAST REMEDY
Typically, laminectomy is performed only after conservative treatments for spinal stenosis (drug therapy and physiotherapy) have failed.
This is because laminectomy is a delicate operation, whose complications can also be very serious.
OTHER USES
Doctors can also resort to laminectomy even in cases of severe herniated discs or abnormal curvatures of the spine . As in the case of spinal stenosis, before operating, one must try every other type of conservative therapy known.
risks
Laminectomy is a fairly safe procedure, but like any surgical operation, it can involve the following complications:
- hemorrhage
- Infections
- Formation of blood clots in the veins ( deep vein thrombosis )
- Stroke or heart attack during the operation
- Allergic reaction to anesthetic drugs or sedatives used during surgery
Furthermore, since it affects very delicate structures such as the spine and spinal cord, there is a risk (albeit minimal) of:
- Permanent damage to the spinal nerves or spinal cord
- Relapses, or reappearance, after a period of temporary healing, of pain, numbness, etc.
- Reduced improvement in symptoms
- Infections at the level of the operated vertebra
Preparation
Laminectomy is performed under general anesthesia and therefore requires special preparation.
First of all, the patient undergoes a series of clinical tests ( physical examination, blood test, electrocardiogram, etc.) and an evaluation of his clinical history .
After that, the operating surgeon (or a qualified member of his staff) will explain the methods of intervention, the possible risks, the pre- and post-operative recommendations and, finally, the recovery times.
Main pre- and post-operative recommendations:
- Before laminectomy, suspend any treatment based on antiplatelet agents (aspirin), anticoagulants (warfarin) and anti-inflammatory drugs (NSAIDs), because these drugs, by reducing the coagulation capacity of the blood, predispose to serious bleeding.
- On the day of the procedure, appear at full fast since at least the previous evening.
- After the surgery, be assisted by a trusted person .
- If you are a smoker, stop smoking at least until the wound is completely healed.
WHY IS CLINICAL HISTORY IMPORTANT?
Evaluating a patient's clinical history means interrogating them to know, for example, if they know they are allergic to some anesthetic drug, if they suffer or have suffered from cardiovascular problems in the past, if they take certain drugs and if, in the case of a woman, it is pregnant.
This information is valuable, because it allows you to better plan the procedure.
Attention: those suffering from diabetes or other pathologies that require a constant pharmacological intake are required to inform the surgeon of their condition, so that the latter can make the most appropriate changes to the standard procedure.
Procedure
Once in the operating room and lying on the surgical bed on his stomach, the patient is connected by the medical staff to a series of instruments for monitoring heart rate, blood pressure and blood oxygen levels.
Once this is done, it is anesthetized and rendered completely unconscious and insensitive to pain. Anesthesiologist is a doctor in charge of anesthesia.
At this point the surgeon intervenes, who begins the actual procedure:
- First, it affects the cutaneous region of the back where the vertebra (or vertebrae) to be operated resides, and moves the muscles and ligaments that cover the latter.
- Then, using a highly precise surgical microscope, it dissects the vertebral lamina with extreme delicacy and removes the desired part (NB: very often the removal also includes the spinous process).
- Finally, it repositions the muscles and ligaments as they were in the beginning and closes the incision with stitches.
Warning: if the laminectomy is aimed at treating a disc hernia or an abnormal curvature of the column, the surgeon also performs a discectomy (ie the elimination of the herniated portion of the disc) or a spinal fusion operation, respectively.
DURATION OF THE PROCEDURE
A laminectomy can last from 1 to 3 hours (including anesthesia).
Post-operative phase
Immediately after the laminectomy, the patient is taken to a hospitalization room, where the surgery was held, and then kept under close observation for several hours.
Based on the assessments of the operating surgeon, the discharge can take place the same day as the operation or one or two days later.
Once the patient has been discharged, it is advisable for the patient to begin physiotherapy as soon as possible, so as to recover more quickly and in the best possible way.
WHAT TO DO IN CASE OF PAIN?
After a laminectomy, it is normal to feel pain, so do not be alarmed (unless it is very intense).
To alleviate this feeling, doctors recommend taking pain-relieving medicines, such as paracetamol.
RECOVERY TIMES
The complete recovery of flexibility and mobility of the spine occurs after several months of careful and scrupulous physiotherapy.
During this time, it is possible to resume some of the normal daily activities, unless they lead to an excessive load on the column. The return to work depends on the type of work performed.
In the case of laminectomy combined with spinal fusion, complete recovery occurs only after 6-12 months.
Results
In most cases, laminectomy improves the patient's symptomatology and quality of life.
However, if the triggers are degenerative diseases (such as, for example, in the case of spinal stenosis due to osteoarthritis), the original symptoms that forced the operation can recur.
Therefore, the results of laminectomy depend largely on the reasons that made it necessary.
