Laminectomy is a form of spinal decompression used to treat spinal stenosis, a condition involving a narrowing of the spinal canal.

Spinal stenosis can cause pressure and pinching of the spinal nerves, which can result in chronic pain, numbness, and muscle weakness in the arms or legs. A laminectomy can be performed anywhere along the spine, from the neck (cervical spine) to the lower back (lumbar spine).

During a laminectomy a surgical removal of bone is performed to obtain access to the spinal canal so that nerves and/or spinal cord can have existing pressure areas removed. Things such as bone spurs, tumors or herniated intervertebral discs can cause pressure on a nerve or the spinal cord. Sometimes, the operation is not expected to relieve symptoms, but is performed to prevent the area from deteriorating any further. In this case, your original symptoms can remain, but not get any worse.

You will need a complete physical exam to be sure you are in good health. A blood test, electrocardiogram (EKG), and chest X-ray need to be performed. Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery.

Medications that thin the blood should be stopped prior to surgery. Your Internist or primary doctor should be consulted prior to changing or discontinuing any medications. Also, stop drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. An important thing you can do to ensure the success of your spinal surgery is to quit smoking. This includes cigarettes, cigars, pipes, chewing tobacco, and smokeless tobacco. Nicotine prevents bone growth and puts you at higher risk for a failed fusion.

Morning of surgery

  • Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
  • Wear flat-heeled shoes with closed backs.
  • If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
  • Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
  • Leave all valuables and jewelry at home (including wedding bands).
  • Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
  • If you have a cold, fever or some other illness the day before surgery, please call your surgeons office.
  • Bring a list of allergies to medication or foods.

You will lie on your back on the operative table and be given anesthesia. Once asleep you will be rolled over onto your stomach with your chest and sides supported by pillows. The area where the surgery is to be performed will be cleansed and prepped. 
A skin incision is made down the middle of your back over the appropriate vertebrae. An Xray image is taken to help verify the appropriate incision site. The length of the incision depends on how many laminectomies are to be performed. The strong back muscles are split down the middle and moved to either side exposing the lamina of each vertebra. Once the bone is exposed, an X-ray is taken to verify the correct vertebra. The surgeon will typically attempt to preserve the bony spinous process and the posterior spinal ligaments. Next, the bony lamina is partially removed with a drill or bone-biting tools. The thickened ligamentum flavum that connects the laminae of the vertebra below with the vertebra above is thinned and moved to the side to allow access to the spinal canal. Once the lamina and ligamentum flavum are removed, the neural structures become visible. The surgeon can gently retract the protective sac of the spinal cord and nerve roots to remove bone spurs and thickened ligament. The facet joints, which are directly over the nerve roots, may be trimmed to give the nerve roots more room. Called a foraminotomy, this maneuver enlarges the area where the spinal nerves exit the spinal canal. If a herniated disc is causing compression the surgeon will perform a partial discectomy. If you have spinal instability or have laminectomies to multiple vertebrae, a fusion may be added to the laminectomy. The muscle and skin incisions are sewn together with sutures or staples.

Surgery typically takes one to two hours. After the operation, it is normal to have pain after the operation, especially in the lower back. This does not mean that the procedure was unsuccessful or that your recovery will be slow. Leg/arm aching is also common, caused by inflammation of the previously compressed nerve. It will go away slowly as the nerve heals. Usually, you may take a shower the day after surgery. Your surgical dressing may be removed the day after surgery. Additional dressings can be applied if there is continued drainage. You are encouraged to walk, stand and sit for short periods. You are encouraged to avoid twisting, flexing, or hyperextending your back while moving around. You will be released from the hospital on the day of surgery. Typically, physical therapy will begin 2 weeks after the procedure to allow healing process to begin. It is common to return to some degree of work 2-6 weeks after surgery. You will have some restrictions for 12-16 weeks to allow the muscles to heal and strengthen with rehab to help prevent future injury.

The results of a laminectomy surgery are generally favorable. The surgical results are typically much better for relief of leg pain caused by spinal stenosis, and not nearly as reliable for relief of lower back pain.

The results of the surgery also depend upon you. It is important to keep a positive attitude and diligently perform your physical therapy exercises. Maintaining a weight that is appropriate for your height can significantly reduce pain. Do not expect your back to be as good as new. You need to be mindful that you’ll always have a bad back and will need to use correct posture and lifting techniques to avoid re-injury.