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A laminectomy is a surgical procedure that removes a portion of a
vertebra The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristi ...
called the
lamina Lamina may refer to: Science and technology * Planar lamina, a two-dimensional planar closed surface with mass and density, in mathematics * Laminar flow, (or streamline flow) occurs when a fluid flows in parallel layers, with no disruption betwee ...
, which is the roof of the
spinal canal The spinal canal (or vertebral canal or spinal cavity) is the canal that contains the spinal cord within the vertebral column. The spinal canal is formed by the vertebrae through which the spinal cord passes. It is a process of the dorsal body ca ...
. It is a major spine operation with residual scar tissue and may result in postlaminectomy syndrome. Depending on the problem, more conservative treatments (e.g., small endoscopic procedures, without bone removal) may be viable.


Method

The lamina is a posterior arch of the vertebral bone lying between the spinous process (which juts out in the middle) and the more lateral pedicles and the transverse processes of each
vertebra The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristi ...
. The pair of laminae, along with the
spinous process The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic ...
, make up the posterior wall of the bony spinal canal. Although the literal meaning of laminectomy is 'excision of the lamina', a conventional laminectomy in neurosurgery and orthopedics involves excision of the supraspinous ligament and some or all of the spinous process. Removal of these structures with an open technique requires disconnecting the many muscles of the back attached to them. A laminectomy performed as a minimal spinal surgery procedure is a tissue-preserving surgery that leaves more of the muscle intact and spares the spinal process. Another procedure, called the laminotomy, is the removal of a mid-portion of one lamina and may be done either with a conventional open technique or in a minimalistic fashion with the use of tubular retractors and endoscopes. The reason for lamina removal is rarely, if ever, because the lamina itself is diseased; rather, it is done to break the continuity of the rigid ring of the spinal canal to allow the soft tissues within the canal to: 1) expand (decompress); 2) change the contour of the vertebral column; or 3) permit access to deeper tissue inside the spinal canal. A laminectomy is also the name of a spinal operation that conventionally includes the removal of one or both lamina, as well as other posterior supporting structures of the vertebral column, including ligaments and additional bone. The actual bone removal may be carried out with a variety of surgical tools, including drills, rongeurs and lasers. The success rate of a laminectomy depends on the specific reason for the operation, as well as proper patient selection and the surgeon's technical ability. The first laminectomy was performed in 1887 by Victor Alexander Haden Horsley, a professor of surgery at
University College London , mottoeng = Let all come who by merit deserve the most reward , established = , type = Public research university , endowment = £143 million (2020) , budget = ...
. A laminectomy can treat severe
spinal stenosis Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual i ...
by relieving pressure on the
spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the sp ...
or nerve roots, provide access to a tumor or other mass lying in or around the spinal cord, or help in tailoring the contour of the vertebral column to correct a spinal deformity such as
kyphosis Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. Abnormal inward concave ''lordotic'' curving of the cervical and lumbar regions of the spine is called lordosis. It can result ...
. A common type of laminectomy is performed to permit the removal or reshaping of a spinal disc as part of a lumbar
discectomy A discectomy (also called open discectomy, if done through a 1/2 inch or larger skin opening) is the surgical removal of abnormal disc material that presses on a nerve root or the spinal cord. The procedure involves removing a portion of an int ...
. This is a treatment for a herniated, bulging, or degenerated disc. The recovery period after a laminectomy depends on the specific operative technique, with minimally invasive procedures having significantly shorter recovery periods than open surgery. Removal of substantial amounts of bone and tissue may require additional procedures such as
spinal fusion Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine (cervical, thoracic, or lumbar) and pre ...
to stabilize the spine and generally require a much longer recovery period than a simple laminectomy. With spinal fusion, the recovery time may be longer. In some cases after laminectomy and spinal fusion, it may take several months to return to normal activities. Potential complications include bleeding, infection, blood clots, nerve injury, and spinal fluid leak.


For spinal stenosis

Most commonly, a laminectomy is performed to treat spinal stenosis.
Spinal stenosis Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual i ...
is the single most common diagnosis that leads to spinal surgery, of which a laminectomy represents one component. The
lamina Lamina may refer to: Science and technology * Planar lamina, a two-dimensional planar closed surface with mass and density, in mathematics * Laminar flow, (or streamline flow) occurs when a fluid flows in parallel layers, with no disruption betwee ...
of the
vertebra The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristi ...
is removed or trimmed to widen the
spinal canal The spinal canal (or vertebral canal or spinal cavity) is the canal that contains the spinal cord within the vertebral column. The spinal canal is formed by the vertebrae through which the spinal cord passes. It is a process of the dorsal body ca ...
and create more space for the
spinal nerve A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one on each side of the vertebral column. These are grouped into the ...
s and thecal sac. Surgical treatment that includes a laminectomy is the most effective remedy for severe spinal stenosis; however, most cases of spinal stenosis are not severe enough to require surgery. When the disabling symptoms of spinal stenosis are primarily
neurogenic claudication Neurogenic claudication (NC), also known as pseudoclaudication, is the most common symptom of lumbar spinal stenosis (LSS) and describes intermittent leg pain from impingement of the nerves emanating from the spinal cord. ''Neurogenic'' means that ...
and the laminectomy is done without spinal fusion, there is generally a more rapid recovery with less blood loss. However, if the spinal column is unstable and fusion is required, the recovery period can last from several months to more than a year, and the likelihood of symptom relief is far less probable.


Results

In most known cases of lumbar and thoracic laminectomies, patients tend to recover slowly, with recurring pain or spinal stenosis persisting for up to 18 months after the procedure. According to a
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
census in 2001, most patients who had undergone a lumbar laminectomy recovered normal function within one year of their operation. Back surgery can relieve pressure on the spine, but it is not a cure-all for spinal stenosis. There may be considerable pain immediately after the operation, and pain may persist on a longer-term basis. For some people, recovery can take weeks or months and may require long-term occupational and physical therapy. Surgery does not stop the degenerative process and symptoms may reappear within several years.


Additional images

File:SAG.-T2-FRFSE-L-SPINE.jpg, MRI lumbar spine with degeneration, post-hemilaminectomy L4-5 (sagittal T2 FRFSE) File:SAG.-T1-FSE-L-SPINE.jpg, MRI lumbar spine with degeneration, post-hemilaminectomy L4-5 (sagittal T1 FSE) File:SAGITTAL-FAST-STIR MRI.jpg, MRI lumbar spine with degeneration, post-hemilaminectomy L4-5 (sagittal FAST STIR) File:SAG.-T2-FRFSE-L-SPINE.ogg, MRI lumbar spine post-hemilaminectomy (sagittal T2 FRFSE) File:SAG.-T1-FSE-L-SPINE.ogg, MRI lumbar spine post-hemilaminectomy (sagittal T1 FSE) File:SAG.-T1-FSE-FS-L-SPINE-C+.ogg, Contrast MRI lumbar spine post-hemilaminectomy (sagittal T1 FSE FS) File:SAGITTAL-FRFSE-T2 MRI.ogg, MRI lumbar spine pre-hemilaminectomy (sagittal T2 FRFSE) File:SAGITTAL-FSE T1 MRI.ogg, MRI lumbar spine pre-hemilaminectomy (sagittal T1 FSE) File:SAGITTAL-FAST-STIR MRI.ogg, MRI lumbar spine pre-hemilaminectomy (sagittal FAST STIR)


See also

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Artificial facet replacement An artificial facet replacement is a joint prosthesis intended to replace the natural facets and other posterior elements of the spine, restoring normal (or near-normal) motion while providing stabilization of spinal segments. It is typically used ...
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Failed back syndrome Failed back syndrome or post-laminectomy syndrome is a condition characterized by chronic pain following back surgeries. Many factors can contribute to the onset or development of FBS, including residual or recurrent spinal disc herniation, persi ...
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Spinal stenosis Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual i ...


References


External links


Back Surgery: When Is It A Good Idea


{{Bone, cartilage, and joint procedures Neurosurgery Orthopedic surgical procedures Surgical removal procedures