Step 4: decompress the spinal cord
Once the lamina and ligamentum flavum are removed the protective covering of the spinal cord (dura mater) is visible. The surgeon can gently retract the protective sac of the spinal cord and nerve root to remove bone spurs and thickened ligament.
Step 5: decompress the spinal nerve
The facet joints, which are directly over the nerve roots, may be undercut (trimmed) to give the nerve roots more room. Called a foraminotomy, this maneuver enlarges the neural foramen (where the spinal nerves exit the spinal canal). If a herniated disc is causing compression the surgeon will perform a discectomy.
Step 6: fusion (if necessary)
If you have spinal instability or have laminectomies to multiple vertebrae, a fusion may be performed. Fusion is the joining of two vertebrae with a bone graft held together with hardware such as plates, rods, hooks, pedicle screws, or cages. The goal of the bone graft is to join the vertebrae above and below to form one solid piece of bone. There are several ways to create a fusion. The right one for you depends on your own choice and your doctor’s recommendation.
The most common type of fusion is called the posterolateral fusion. The topmost layer of bone on the transverse processes is removed with a drill to create a bed for the bone graft to grow. Bone graft, taken from the top of your hip, is placed along the posterolateral bed. The surgeon may reinforce the fusion with metal rods and screws inserted into the vertebrae. The back muscles are laid over the bone graft to hold it in place.
Step 7: closure
The muscle and skin incisions are sewn together with sutures or staples.
What happens after surgery?
You will wake up in the postoperative recovery area, called the PACU. Your blood pressure, heart rate, and respiration will be monitored, and your pain will be addressed. Once awake you will be moved to a regular room where you’ll increase your activity level (sitting in a chair, walking).If you’ve had a fusion, a brace may need to be worn. In 1 to 2 days you’ll be released from the hospital and given discharge instructions.
Discharge instructions:
Discomfort
After surgery, pain is managed with narcotic medication. Because narcotic pain pills are addictive, they are used for a limited period (4 to 8 weeks). Their regular use may also cause constipation, so drink lots of water and eat high fiber foods. Laxatives (e.g., Dulcolax, Senokot, Milk of Magnesia) can be bought without a prescription. Thereafter, pain is managed with acetaminophen (e.g., Tylenol).
Restrictions
If you have had a fusion, do not use non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., aspirin; ibuprofen, Advil, Motrin, Nuprin; naproxen sodium, Aleve) for six months after surgery. NSAIDs may cause bleeding and interfere with bone healing.
Do not drive for 2 to 4 weeks after surgery or until discussed with your surgeon.
Avoid sitting for long periods of time.
Do not lift anything heavier than 10 pounds (e.g., gallon of milk). Do not bend or twist at the waist.
Housework and yard-work are not permitted until the first follow-up office visit. This includes gardening, mowing, vacuuming, ironing, and loading/unloading the dishwasher, washer, or dryer. Postpone sexual activity until your follow-up appointment unless your surgeon specifies otherwise.
Do not smoke. Smoking delays healing by increasing the risk of complications (e.g., infection) and inhibits the bones' ability to fuse.
Activity
You may need help with daily activities (e.g., dressing, bathing) for the first few weeks. Fatigue is common. Let pain be your guide.
Gradually return to your normal activities. Walking is encouraged; start with a short distance and gradually increase to 1 to 2 miles daily. A physical therapy program may be recommended.
If applicable, know how to wear the brace before you leave the hospital. Wear for daily activities
(excluding sleep) unless instructed otherwise.
Bathing/Incision Care
You may shower 4 days after surgery unless instructed otherwise.
Staples or stitches, which remain in place when you go home, will need to be removed. Ask your surgeon or call the office to find out when.
When to Call Your Doctor
If your temperature exceeds 101° F or if the incision begins to separate or show signs of infection, such as redness, swelling, pain, or drainage.
What are the results?
Decompressive laminectomy is successful in relieving leg pain in 70% of patients allowing significant improvement in function (ability to perform normal daily activities) and markedly reduced level of pain and discomfort [1]. However, back pain may not be relieved and 17% of older adults need another operation [2]. Symptoms may return after a few years.
Decompressive laminotomy is successful in relieving back pain (72%) and leg pain (86%), and in improving walking ability (88%) [3]. Endoscopic laminotomy results in less blood loss, shorter hospital stay, and less postoperative pain medication than an open laminotomy.
The results of the surgery are largely up to you. It is important to keep a positive attitude and diligently perform your physical therapy exercises. Maintaining a weight that is appropriate for your height can significantly reduce pain. Do not expect your back to be as good as new. You need to be mindful that you’ll always have a bad back and will need to use correct posture and lifting techniques to avoid re-injury.
What are the risks?
No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. If spinal fusion is done at the same time as a laminectomy, there is greater risk of complications. The following are risks that should be considered:
Vertebrae failing to fuse.
Among many reasons why vertebrae fail to fuse, common ones include smoking, osteoporosis, obesity, and malnutrition. Smoking is by far the greatest factor that can prevent fusion. Nicotine is a toxin that inhibits bone-growing cells. If you continue to smoke after your spinal surgery, you could undermine the fusion process.
Deep vein thrombosis (DVT) is a potentially serious condition caused when blood clots form inside the veins of your legs. If the clots break free and travel to your lungs, lung collapse or even death is a risk. However, there are several ways to treat or prevent DVT. If your blood is moving it is less likely to clot, so an effective treatment is getting you out of bed as soon as possible. Support hose and pulsatile stockings keep the blood from pooling in the veins. Drugs such as aspirin, Heparin, Lovenox, or Coumadin are also commonly used.
Hardware fracture. The metal screws, rods and plates used to stabilize your spine are called "hardware." The hardware may move or break before your vertebrae are completely fused. If this occurs, a second surgery may be needed to fix or replace the hardware.
Bone graft migration. In rare cases (1 to 2%), the bone graft can move from the correct position between the vertebrae soon after surgery. This is more likely to occur if hardware (plates and screws) are not used to secure the bone graft. It’s also more likely to occur if multiple vertebral levels are fused. If this occurs, a second surgery may be necessary.
Transitional syndrome (adjacent-segment disease).
This syndrome occurs when the vertebrae above or below a fusion take on extra stress. The added stress can eventually degenerate the adjacent vertebrae and cause pain.
Nerve damage or persistent pain. Any operation on the spine comes with the risk of damaging the nerves or spinal cord. Damage can cause numbness or even paralysis. However, the most common cause of persistent pain is nerve damage from the disc herniation itself. Some disc herniations may permanently damage a nerve making it unresponsive to decompressive surgery. In these cases, spinal cord stimulation or other treatments may provide relief. Be sure to go into surgery with realistic expectations about your pain. Discuss your expectations with your doctor.
If you have any questions please don’t hesitate to contact us: 209-349-8429.