Lumbar Laminectomy / Intersegmental Decompression

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Procedure

Removal of part of the back parts (lamina) of the vertebra. This is done through an incision in the midline of the lower back. Often it is not necessary to remove all the bone but just the ligaments and a little bit of the bone (intersegmental decompression). The latter can be done through a small incision.


Indication

Decompression of a nerve root and the lumbar canal, which contains the nerves in lumbar canal stenosis. It may also be done in cases of compression from infection (epidural abscess), tumours or trauma. It is part of the access in operations on the spinal cord or cauda equina. The operation is not aimed at improving back pain.


Risks

Acute: Bleeding, Infection, cerebrospinal fluid leak, neurological deficit including paralysis, incontinence (no bowel or bladder control), no improvement of symptoms, late instability if bone and ligaments are excessively removed. Overall, the risks, in particular the very serious risks are very small (<5%).


Hospital stay

24-48 hours after operation in majority of cases


Anaesthesia

Usually general anaesthesia. In some patients, who are unfit for a general anaesthetic, the operation can be done under sedation and spinal block.


Outcome

The vast majority of patients (70-80%) will have a substantial improvement of leg symptoms and walking distance in cases of lumbar canal stenosis and nerve compression.


Recovery

The back will feel sore for a short while but unless there are complications, recovery is quick. Patients should refrain from sportive activities or strenuous physical work for about 2 months.


Commonly asked questions

Does removing the bone destabilise the spine?

There is a small risk that the removal of the lamina can destabilise the spine, in particular if several levels are involved. In cases with possible pre-existing excessive movement/ instability, x-rays taken when bending forward and backward (flexion and extension views) are helpful to determine whether a fusion should be done at the same time.