Laminectomy is procedure which aims to relieve pressure on the nerves due to abnormalities structure bone. If left untreated, the pressurecouldcause nerve damage. Laminectomy is performed with lifting the lamina, i.e. the back of the curvature of the spine.
Spinal cord compression is often caused by narrowing of the spinal cord (spinal stenosis). This pressure on the spinal cord can cause pain, stiffness, and weakness in the arms, legs, or both.
Laminectomy is done by removing the lamina, so that the spinal canal where the spinal nerves are located becomes wider. That way, the pressure on the nerves will be reduced.
Generally, laminectomy is performed on patients who experience serious symptoms that interfere with daily activities, or if other treatments are not effective in relieving complaints.
Laminectomy Indications
Laminectomy is performed to treat spinal stenosis which is the main cause of pressure on the spinal nerves. Spinal stenosis itself can be caused by various conditions and diseases, including:
- Thinning of the bearing and calcification of bones due to aging
- Paget's disease
- Congenital abnormalities in the shape of the spine
- Tumors in the spine
- Injury to the spine
- Spinal bearing protrusion or herniation
- Inflammation of the joints of the spine (arthritis)
- Achondroplasia, which is one of the reasons dwarfism
The following are some of the symptoms that can occur due to spinal stenosis:
- Pain or stiffness in one leg or both
- Pain in the shoulder area
- Difficulty controlling urination or defecation
- Feeling weak or heavy in the legs or buttocks
- These symptoms are worse when standing or walking
However, because laminectomy is an invasive treatment or a procedure that requires an incision, the doctor will first recommend treatment or other non-invasive treatment methods, such as:
- Changes in patient activity
- Physiotherapy
- Quit smoking
- Use of support devices to maintain spinal posture, such as a corset
- spinal injection
- Medications, such as anti-inflammatories, pain relievers, and muscle relaxants
- Weight loss, for patients who are overweight
Laminectomy Warning
Laminectomy is not recommended to be performed in children or in people who have a history of kyphosis. Before deciding to undergo surgery, make sure that you have undergone all the other recommended therapies and that all of them have not succeeded in relieving the complaint.
There are several other things that also need to be done before undergoing a laminectomy, namely:
- Tell your doctor what medications you are taking, including vitamins and supplements. If you are taking blood-thinning drugs, such as aspirin, your doctor will usually ask you to stop taking the drug.
- Tell your doctor about your current health condition and medical history.
- Tell your doctor if you have any allergies, such as drug allergies, including anesthetics.
- Tell your doctor if you are pregnant or have missed your period.
Before Laminectomy
To confirm the condition experienced by the patient, the doctor will conduct an examination with X-rays. If necessary, the patient may also be advised to undergo an MRI or CT myelogram examination.
The patient will be asked to fast for a few hours before undergoing surgery. If the patient is a smoker, the doctor will also ask the patient to stop smoking before undergoing a laminectomy.
After surgery until the recovery period, patients need to be accompanied by family or friends.
Laminectomy Procedure
Before the laminectomy procedure begins, the anesthesiologist will give general anesthesia (general anesthesia) in the form of a mixed gas, so that the patient will fall asleep and feel no pain during the procedure. In addition to anesthesia, doctors can also inject a sedative.
After that, the doctor will install a breathing apparatus (intubation). If the patient is asleep and the intubation is in place, the laminectomy procedure can be started.
The patient will be positioned prone to sleep to facilitate the operation process. The doctor will clean the skin area in the area to be operated on using an antiseptic liquid, so that it is sterile from germs.
Once sterile, the doctor will make an incision (incision) in the skin on the back or neck, so that the underlying tissue is exposed. The soft tissues, ligaments, and muscles that cover the spine are shifted to the side, making it easier for doctors to observe and repair the spine.
Part or all of the laminae will be removed from the spine, and sometimes the bony prominences and spinal cushions are also removed.
Furthermore, the doctor can connect two or more parts of the spine, so that the patient's spine is more stable. If needed, the doctor will also perform a foraminotomy, which is an action to widen the spinal canal, so that the spinal cord tissue is more flexible.
When the laminectomy is complete, the doctor will return the tissues, ligaments, and muscles to their original position. After that, the incision made for surgery will be sutured and covered with a sterile bandage to prevent infection. Laminectomy surgery generally lasts about 1-3 hours.
After Laminectomy
After surgery, the patient will be taken to the recovery room to then be evaluated whether there are side effects either due to the procedure or the anesthetic procedure.
Some patients may be able to go home immediately after surgery and examinations are completed. However, generally the patient will be hospitalized first for a few days.
When the effects of the anesthetic have worn off completely, the patient will be asked to get out of bed and try to walk. The patient may still feel pain after surgery, but the doctor will prescribe pain relievers.
Usually after 1-3 days of monitoring and treatment, patients who need to stay in the hospital can go home. Some of the things that patients who are recovering after a laminectomy should pay attention to are:
- Increase physical activity gradually and avoid doing strenuous physical activities that can interfere with spinal recovery.
- Always be careful when walking and climbing or descending stairs.
- Don't forget to have regular check-ups with the doctor so that the recovery process can be monitored.
- Do not rub the surgical sutures, because it is feared that it will cause infection.
- Avoid exposing the stitches to water or applying lotion to the suture area.
- Do not drive a car or motorbike during the recovery period.
Call your doctor immediately if the following symptoms appear:
- Chest pain
- Fever
- Swelling in the surgical suture area
- Discharge or pus from the surgical suture site
- Swelling in the legs
- Loss of control of urination or bowel movements
- Difficult to urinate
- Difficult to breathe
If there is pain in the area of the suture wound, the patient can take pain relievers given by the doctor. It is important to remember that patients should not take any medicine outside of the doctor's recommendation, because it is feared that it may cause unwanted side effects, such as bleeding.
If the surgical wound has closed properly, the stitches will be removed by the doctor during routine check-ups.
Laminectomy Complications
In general, laminectomy is a safe procedure. However, in certain cases, this procedure can cause complications such as:
- Constant pain
- Surgical wound infection
- Bleeding
- stroke
- Pulmonary embolism due to blood clots
- Hard to breathe
- Heart attack
- Allergic reaction to the drugs given
- Spinal nerve damage
- Leakage of fluid in the spinal cord (cerebrospinal fluid), due to tears in the protective membranes of the spinal cord (meninges)
