Spine surgery

Lumbar laminectomy (lumbar decompression)

This article provides general information about lumbar laminectomy surgery and is not a substitute for advice from Dr Reddy. It may not cover all the details relevant to your individual health, diagnosis or treatment plan.

 

A lumbar laminectomy or lumbar decompression is a surgical procedure that removes part of the lamina, an arch of bone over the back of the vertebra, to make more space in the lower spine and relieve pressure on the spinal nerves, spinal cord or cauda equina (the bundle of nerves at the end of your spinal cord).

Why might someone need a lumbar decompression?

Sometimes, the spinal canal (the tunnel down your spine through which your spinal cord passes) or intervertebral foramina (openings that allow your spinal nerves to reach parts of your body) can become too narrow because of things like bone overgrowth (bone spurs), thickened ligaments and joint capsules, herniated discs, spinal tumours, injury or other health conditions. This narrowing, known as spinal stenosis, can put pressure on the spinal nerves, spinal cord or the cauda equina.

While nonsurgical treatment such as physical therapy and medication often resolves spinal stenosis, a lumbar laminectomy may be recommended if someone has persistent, severe pain in the back, buttocks and legs, and numbness, tingling (pins and needles), cramping or weakness in the legs.

If you have any of the following serious symptoms, seek medical attention immediately:

  • loss of bowel or bladder control
  • severe or worsening numbness in your saddle region (inner thighs, legs and back of legs)
  • severe pain and weakness that spreads to one or both legs, making it hard to stand or walk

How is a lumbar decompression done?

First, the anaesthetist will give you medicine to put you to sleep. Then the neurosurgeon will make a small incision (a surgical cut) to your skin and carefully move muscles aside to reach the relevant vertebra.

The surgeon will use special instruments to remove part of the lamina to reach the affected nerves. Sometimes, only a very small part of the lamina needs removing, which is called a laminotomy.

The surgeon may then remove any bone spurs, facet joints (bones that sit over the spinal nerves) and tissue to help the spinal nerves pass freely through the spinal canal or out of the intervertebral foramen (small opening in the vertebra). Rarely, a tumour or cyst causes pressure on the spinal nerves or cord, which the surgeon can also remove as part of this surgery.

A person may have a lumbar laminectomy with a spinal fusion, discectomy or disc replacement, depending on their circumstance.

Speak with your surgeon to understand what is most appropriate for your condition.

What are the benefits of a lumbar decompression?

The chance of benefiting from a lumbar decompression depends on several factors, though symptoms improve in most people.

People tend to feel less pain in their legs after this surgery, depending on the severity and duration of their symptoms beforehand. Physiotherapy after surgery may help further ease their pain.

Sensory symptoms (numbness, tingling, and pins and needles) may take longer to improve, and this may persist in some people, despite surgery.

It is difficult to predict if back pain will resolve since this is often caused by arthritis for which there is no cure.

Because each person’s condition is different, it’s important to speak with your surgeon to understand if a lumbar laminectomy is suitable for you.

What are the risks of a lumbar decompression?

While generally safe, all surgery carries risks. Complications are possible but uncommon.

Some potential risks include bleeding, infection, blood clots, or reactions to anaesthesia. Spinal stenosis may recur, new pain may emerge, or cerebrospinal fluid leaks or instability may occur.

Very rare risks include damage to spinal nerve roots, leg paralysis, incontinence or impotence.

This is not a complete list, and your surgeon will discuss the risks with you in more detail.

How should I decide to have a laminectomy?

Deciding on a laminectomy involves discussing your medical condition and weighing the benefits, risks, and limitations of surgery with your doctor. If left untreated, pressure on spinal nerves can lead to more severe damage and symptoms.

If you decide to have surgery, you will need to sign a consent form. Please read this carefully before signing it. If you have any questions, ask Dr Reddy.

What happens after surgery?

After surgery, you’ll be monitored in the recovery area until fully awake. Pain at the surgery site is normal, but medication helps to manage it.

Most people will be up and walking within hours, which helps to reduce the risk of blood clots.

You can leave hospital in 1 to 3 days, depending on your health.

Older patients may benefit from a short period of recovery in a rehabilitation hospital to improve their mobility and confidence.

 

Remember to consult with Dr Reddy for personalised information and advice.

Sources
  • Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, et al. Surgical versus non-operative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine 2010;35(14):1329.
  • Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine 2006;31(22):2541-9.
  • Levin K. Lumbar spinal stenosis: Treatment and prognosis. UpToDate® Updated Aug1 2012.
  • Djurasovic M, Glassman SD, Carreon LY, Dimar JR. Contemporary management of symptomatic lumbar spinal stenosis. Orthopedic Clinics 2010;41(2):183-91.
  • Neurosurgical Society of Australasia (Lumbar laminectomy)