Minimally Invasive Lumbar Laminectomy
A lumbar laminectomy is a surgical procedure that removes part of the bone in the back of the spine along with overgrown ligaments and bone spurs in order to reduce pressure on the spinal nerves.
Who is a candidate for a laminectomy?
Patients with back and/or leg pain or weakness, particularly those who have a difficult time walking for long distances, who have failed conservative measures (physical therapy, medications, injections, etc.) and who have evidence of spinal stenosis (tightness around the nerves) on CT or MRI are candidates for a laminectomy.
What is a minimally invasive surgical approach?
Minimally invasive spine surgery is performed through small incisions in the back and uses intraoperative X-ray, microscope, tubular retractors, and special instruments to avoid damage to the back muscles.
Minimally invasive surgery has many advantages over traditional (or open) spine surgery that include smaller incisions, less surgical blood loss, smaller scars, a shorter hospital stay, less pain during recovery, and a faster return to work and daily activities.
What happens during surgery?
The patient is brought to the operating room and placed under general anesthesia with a breathing tube for the duration of surgery. A small incision (about 1 inch long) is made over the level of spinal stenosis. Without cutting through the muscles, a series of dilators are used to separate muscle fibers and provide access to the spine. A retractor is placed over the dilators and provides a working channel to perform the surgery. A microscope is brought in to provide a close-up view during the procedure.
Overgrown bone, ligament and bone spurs are then removed with special instruments in order to open up more room for the spinal nerves. If more than one level needs to be treated, the incision is slightly extended and the procedure is repeated in the same manner. The incision is then closed with sutures that stay under the skin and dissolve over time, so no suture removal is necessary. A sterile dressing is placed that stays in place for two days.
What is the recovery like?
The procedure takes about 1 hour per level and the patient is able to go home the same day if there are no complications. The only restrictions after surgery are no heavy lifting (no more than 10 lbs. for 4 weeks) and no repetitive bending or twisting at the waist. Most patients return to light duty or office-type work in 2-3 weeks and more strenuous activity in 4-6 weeks. Physical therapy is started at 6 weeks if necessary.
What follow up care is necessary?
The patient is seen in one week after surgery, and then at 6 weeks, and 3 months if needed.
What are the risks?
Serious or permanent complications are rare (risk for most is less than 1%) and include bleeding, infection, and nerve damage. There is a 5-10% risk of spinal fluid leak that is typically repaired during the surgery and may require you to stay on bedrest in the hospital overnight.
What are the benefits?
Most patients do very well after a laminectomy with significant improvement in pain and ability to walk. Numbness/tingling and weakness may take longer to improve and in rare cases may be permanent despite surgery.