Laminectomy is removal of posterior arch of vertebral ring. Laminectomy is done to achieve a more thorough decompression of the spinal cord. It is a traditional form of lumbar decompression, which is useful in certain type of spinal canal stenosis.
Indication of Laminectomy:
Lumbar laminectomy is done in cases with severe lumbar spinal canal stenosis. An MRI diagnosis of lumbar spinal stenosis and significant symptoms of spinal stenosis are must to decide about this procedure. Following are absolute indication for a laminectomy surgery:
- Severe lumbar spine stenosis on MRI,
- Severe symptoms of spinal stenosis,
- No relief with medical treatment and epidural injection,
- Multi-level spinal stenosis,
- Congenital/ Developmental spine stenosis.
Advantages of Laminectomy:
- Laminectomy provides thorough decompression of the spinal canal,
- Better chances of symptom relief,
- Less chances of recurrence of stenosis,
- Better decompression in multilevel and Congenital Spine Stenosis.
- Laminectomy is a more familiar procedure
Disadvantages of Laminectomy:
- Laminectomy is a more invasive procedure,
- Laminectomy can create destabilize spine, especially with preexisting spine instability and in multilevel decompressions.
Complications of Laminectomy:
- Dural tear: Dural tear happens in about 5% cases of lumbar decompression. Dura is usually repaired during the surgery and there are no major complications. An extra 1-2 days of bed rest is required. Dural tears mostly happens mostly in old patients with long standing spine stenosis as dura gets thinned out in these patients.
- Infection: It’s very uncommon (less than 1%) to have infection with the current surgery protocols and use of advanced antibiotics. Patients with uncontrolled diabetes, poor nutritional status and major medical illnesses are more prone to develop infection. Infection is controlled with the help of antibiotics. In some cases, surgical wound opening and cleaning is required to get rid of infection .
- Other complications: Pain is minimal after surgery due to combinations of pain medicines used during the surgery. Chance of developing paralysis is extremely rare due to advanced spine surgery techniques.
Alternatives to Laminectomy:
- Microlumbar Decompression: Lumbar decompression is achieved with the help of microscope and specialized retractors (e.g. tubes), similar to microdiscectomy. Microlumbar decompression can take care of majority of the cases of lumbar spine stenosis. It offers all advantages of minimally invasive spine surgery. For majority of spine decompression procedures, Microlumbar decompression is procedure of choice now a days. It is not suitable for severe and congenital stenosis.
- Endoscopic Lumbar Decompression: An endoscope, wider than the one used for microdiscectomy, is used to decompress spinal canal. Some of these procedures can be done under local anesthesia also as day care procedures.