LAMINECTOMY

Laminectomy is surgery that creates space by removing the lamina — the back part of the vertebra that covers your spinal canal. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves.This pressure is most commonly caused by bony overgrowths within the spinal canal, which can occur in people who have arthritis in their spines.

TYPE:-

• Lumber laminectomy
• Cervical laminectomy

Lumber laminectomy Indication:-

Laminectomy is generally indicated only when

• Conservative treatment, such as medication or physical therapy, fails to improve symptoms.
• Muscle weakness or numbness that makes standing or walking difficult.
• Loss of bowel or bladder control.
• Laminectomy may also be recommended if symptoms are severe or worsening dramatically and significantly affecting dailly activity of living.

Indicated to treat the following disease:-

• Laminectomy is the most effective remedy for severe spinal stenosis.
• For the treatment of tumor or other masses lying in or around spinal cord by providing direct access
• Help in tailoring the contour of the vertebral column to correct a spinal deformity such as kyphosis
• Removal or reshaping of a spinal disc as part of a lumbar discectomy. This is a treatment for a herniated, bulging, or degenerated disc

Contraindication:-

• Patients not medically stable to undergo general anesthesia
• Back pain without leg symptoms
• No evidence of stenosis on imaging studies
• Active systemic infection or local skin disease
• Inadequately treated coagulopathies

Complication-very rare:-

• Hematoma
• Dural tear
• Infection
• Deep vein thrombosis
• Atelectasis
• Paralytic  Ileus
• Urinary retention
• Nerve root injury

Cervical laminectomy :-

 Cervical laminectomy is a surgical procedure designed to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This procedure involves removing the bony arch (lamina), any bone spurs, and ligaments that are compressing the spinal cord. Laminectomy relieves pressure on the spinal cord by providing extra space for it to drift backward.Laminectomy ensures complete decompression of the spinal cord, but makes the bones less stable. This may or may not be requires fusion with a bone graft and possibly screws and rods.

Indication

• Cervical Radiculopathy
• Cervical Spondylotic Myelopathy (3 or more than 3 level)
• Cervical Stenosis with Myelopathy( 3 or more than 3 level)

Ideal candidate for surgery

Posterior laminectomy is ideal for people with very small spinal canals, enlarged or swollen soft tissues at the back of the spine, and problems in more than four spine segments or levels

General Risks

The potential risks for cervical spine surgery include;

• Infection
• Bleeding
• Injury to the nerves
• Injury to the spinal cord
• Reactions to anesthesia
• Need for additional surgery in the future
• Failure to relieve symptoms
• Tear of the sac covering the nerves (dural tear)

Posterior Cervical Spine Surgery Risks

The potential risks for posterior cervical spine surgery include:

• Degeneration of disk levels above or below surgery level
• Injury to the vertebral artery
• Stretch on the nerves from the spinal cord drifting backwards

Contraindication

These approaches cannot be used in patients with kyphotic (bent forward) spines, since the cord will not shift backwards. . These approaches cannot be used in patients with kyphotic (bent forward) spines, since the cord will not shift backward.

After Posterior Cervical Laminectomy Surgery

The results of the laminectomy are variable, since some people have more extensive disease than others. In general, after the laminectomy most patients can expect to regain:

• Some spinal cord function
• Improvement in their hand function and walking capabilities
• Less or no numbness in their hands (if there was a lot of numbness prior to the surgery, it probably won't go away completely)

If the back surgery simply prevents progression of the spinal cord damage (myelopathy) and there is no loss of function due to the surgery, both the patient and spine surgeon should consider it successful.

Posterior laminectomy is ideal for people with very small spinal canals, enlarged or swollen soft tissues at the back of the spine, and problems in more than four spine segments or levels.