Lumbar Laminectomy

Lumbar Laminectomy, Microdiscectomy, Endoscopic Discectomy

The Lumbar Spine has 5 vertebrae stacked on top of the sacrum.

Indications for a Lumbar Laminectomy:

This surgery is most often recommended when a herniated disc pinches nerves, creating symptoms of leg or hip pain, weakness in legs or feet, numbness in legs or feet, and problems with bowel or bladder functions.

The Surgery

On some occasions, the lumbar laminectomy will be the best approach:

Under general anesthesia, an incision is made in the back, cutting the muscles, and pulling them to either side and thereby exposing the posterior elements and lamina. The lamina may be removed on one or both sides, allowing access to the foramen, nerve roots and disc.

From this position, the foramen may be "cleaned out" to provide more space for the nerve roots to exit, and the part of the disc that is pressing on the nerve can be removed. Usually, only 10-15% of the disc will be removed. Muscles will be sutured back together and the incision closed.

A lumbar laminectomy usually takes 1 to 1 ½ hours, with additional levels taking as long as 2 to 2 ½ hours.

Recent surgical technology allows a minimally invasive procedure, the endoscopic discectomy, which reduces recovery time. A small incision is made, and an endoscope is inserted, providing exposure to the posterior elements. Only the part of the disc that is pressing against the nerve, or nerves, is removed. Muscles are not cut in this process, therefore there is much less discomfort after the procedure.

An Endoscopic discectomy usually takes 1 to 1 ½ hours, with additional levels taking as long as 2 to 2 ½ hours total time.

Your physician will recommend the best procedure to address your condition.

Hospital stay for endoscopic surgery, and lumbar laminectomies is usually overnight.

Risks and Possible Complications for the Lumbar
Laminectomy/Discectomy

There is a 90% chance for a good outcome from lumbar laminectomies and discectomies. Complications are rare, but you do need to be advised that they can occur.

Before surgery, you will sign a "consent and disclosure" form stating that the risks have been explained and that you understand what surgery will be performed, and that you wish to proceed with the surgery. Listed will be 7 potential complications:

1. Pain numbness, and clumsiness could occur even if the surgery is correctly done.
2. There could be impaired muscle function or paralysis which is temporary or permanent.
3. Incontinence or impotence could occur. This refers to loss of bowel, bladder or sexual function.
4. Unstable spine is a possibility. Sometimes, in order to resolve the problem, so much bone is removed that the spine is left with weakness or instability. If there is not enough bone left to provide the appropriate amount of stability, it might be necessary in the future to contemplate having a spinal fusion which is a more extensive surgical procedure to reconstruct he weakness in the bones.
5. Recurrence or continuation of the condition that required the operation. There is a possibility that the disc that has been removed might rupture again. This occurs 10% to 15% of the time, although it can be many years later.
6. Injury to major blood vessels. The area in front of the vertebral column is immediately adjacent to the major large arteries and veins that come from the heart to supply the organs in the lower part of the body. It is extremely rare, but it is possible for a surgical instrument to go beyond the annulus in the front part of the spine and injure one of these vessels. If that were to occur, we would be dealing with an internal hemorrhage situation and we would need to do an immediate operation from the front side to correct it.
7. Leakage of spinal fluid requiring re-operation. The dura is the hard covering of the nerves and spinal cord. Underneath the dura is the spinal fluid surrounding the nerves. If a hole is accidentally placed into the dura, then the spinal fluid could be allowed to exit this area. If that occurs while we are in surgery, then it is a fairly simple matter to place a stitch through the small tear and close the opening so that fluid can no longer exit. However, occasionally either the stitches will not hold, or there could be a small tear and leakage could occur. If that should happen, we would have to take you back to surgery and do another operation to sew up the hole in the dura. Usually this is not a major complication, but you need to be aware of this so that if it does occur it will not be a major shock or surprise to you.

Additional risks include: