Laminectomy - Laminotomy - Discectomy

Your surgeon has decided that a laminectomy (entire lamina removal) or laminotomy (partial lamina removal) is the best treatment for your back problem. These procedures involve removal of bone to relieve pressure on nerve roots. It allows the surgeon access to parts of the spine where other problems are located. This could be an injured disc (the cartilage-like structures located between the bones of the back). In this surgery your surgeon removes a part of the boney arch that surrounds your spinal canal. This may be compressing nerve roots. In some cases, the surgeon will remove the disc and fuse (stick together) vertebral bodies (the bones of your back) to make the spine more stable. The type of procedure you will need is usually decided prior to surgery, however modifications may be necessary. The time in surgery depends on the findings in surgery and the procedure necessary to correct the problems.

DISCECTOMY

For people with disc problems, the surgeon removes the portion of the disc that is causing the pressure on the nerve root. Some surgeons perform a micro (small) discectomy, which may require removal of only a small portion of the lamina. A disc nucleus (center) may also be removed either through a needle (percutaneous discectomy) or by injecting an enzyme called chymopapain into the disc. Chymopapain is an enzyme that dissolves the disc. For people with back instability, the surgeon fuses vertebrae that are next to each other with tiny pieces of bone. These are used as bone grafts on the facets, or between the vertebrae. When this heals, the bones will no longer be able to move. These bone chips are often taken from the pelvic bones. Bones and bone grafts grow into one unit, stabilizing the segments of the spinal column.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies.

  • Medicines taken including herbs, eyedrops, over-the-counter medicines, and creams.

  • Use of steroids (by mouth or creams).

  • Previous problems with anesthetics or numbing medicine.

  • Possibility of pregnancy, if this applies.

  • History of blood clots (thrombophlebitis).

  • History of bleeding or blood problems.

  • Previous surgery.

  • Other health problems.

RISKS AND COMPLICATIONS

Your caregiver will discuss possible risks and complications with you before surgery. In addition to the usual risks of anesthesia, other common risks and complications include:

  • Blood loss and replacement.

  • Temporary increase in pain due to surgery.

  • Uncorrected back pain.

  • Infection.

  • New nerve damage (tingling, numbness, and pain).

BEFORE THE PROCEDURE

  • Stop smoking at least 1 week prior to surgery. This lowers risk during surgery.

  • Your caregiver may advise that you stop taking certain medicines that may affect the outcome of the surgery and your ability to heal. For example, you may need to stop taking anti-inflammatories, such as aspirin, because of possible bleeding problems. Other medicines may have interactions with anesthesia.

  • Tell your caregiver if you have been on steroids for long periods of time. Often, additional steroids are administered intravenously before and during the procedure to prevent complications.

  • You should be present 60 minutes prior to your procedure or as directed.

AFTER THE PROCEDURE

After surgery, you will be taken to the recovery area where a nurse will watch and check your progress. Generally, you will be allowed to go home within 1 week barring other problems.

HOME CARE INSTRUCTIONS

  • Check the surgical cut (incision) twice a day for signs of infection. Some signs may include a bad smelling, greenish or yellowish discharge from the wound; increased pain or increased redness over the incision site; an opening of the incision; flu-like symptoms; or a temperature above 101.5° F (38.6° C).

  • Change your bandages in about 24 to 36 hours following surgery or as directed.

  • You may shower once the bandage is removed or as directed. Avoid bathtubs, swimming pools, and hot tubs for 3 weeks or until your incision has healed completely. If you have stitches (sutures) or staples they may be removed 2 to 3 weeks after surgery, or as directed by your caregiver.

  • Follow your caregiver's instructions for activities, exercises, and physical therapy.

  • Weight reduction may be beneficial if you are overweight.

  • Walking is permitted. You may use a treadmill without an incline. Cut down on activities if you have discomfort. You may also go up and down stairs as tolerated.

  • Do not lift anything heavier than 10 to 15 pounds. Avoid bending or twisting at the waist. Always bend your knees.

  • Maintain strength and range of motion as instructed.

  • No driving is permitted for 2 to 3 weeks, or as directed by your caregiver. You may be a passenger for 20 to 30 minute trips. Lying back in the passenger seat may be more comfortable for you.

  • Limit your sitting to 20 to 30 minute intervals. You should lie down or walk in between sitting periods. There are no limitations for sitting in a recliner chair.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

SEEK MEDICAL CARE IF:

  • There is increased bleeding (more than a small spot) from the wound.

  • You notice redness, swelling, or increasing pain in the wound.

  • Pus is coming from the wound.

  • An unexplained oral temperature above 102° F (38.9° C) develops.

  • You notice a bad smell coming from the wound or dressing.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop a rash.

  • You have difficulty breathing.

  • You have any allergic problems.