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Pressure on the spinal nerves can be caused by degeneration of the spine that causes the spinal canal to narrow. Lumbar laminectomy can be used to remove a portion of the bony covering over the spinal canal, giving the spinal cord more room and creating less pressure on the spinal nerves. An incision is made in the lower back and the surgeon works with the pedicle and lamina bones to create more room in the spinal canal.
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During the procedure, most patients are put to sleep with general anesthesia. If your doctor chooses general anesthesia for your procedure, you may be put on a ventilator so that your airflow is monitored and controlled. If your doctor chooses to use spinal anesthesia, the anesthesia will be injected into the lower back in order to numb the spine and lower limbs. Sedation is given to patients receiving spinal anesthesia to keep them from having to be awake during the procedure.
Patients undergoing this procedure are often placed in a special frame that lessens blood loss during surgery. This frame allows patients to kneel facedown, which supports the abdomen and gives surgeons more room to work on the spine. Once the patient is properly prepared, a small incision is made in the middle of the low back. The bones are exposed by separating the skin and soft tissues. Some surgeons may use a surgical microscope to magnify the work area and reduce the chances of making an error.
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If a complete laminectomy is being performed, the spinous process and lamina are removed over the area where nerve pressure is occurring. Once the bony ring covering the spine is open, the ligamentum flavum is exposed. This runs between the lamina bones and spinal cord, so the surgeon must remove a small portion of it in order to expose the nerves inside the spinal canal. Disc fragments and bone spurs are removed, making more room for the spinal cord.
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Like any surgery, lumbar laminectomy has the potential for complications to develop. Patients can have problems with anesthesia or the anesthesia can react with other medications that have been taken. Blood clots can also develop as a surgical complication and can result in pulmonary embolism should they break free from the legs and travel to the lungs. Doctors try to prevent blood clots by having patients wear pressure stockings to help circulation and by giving patients medications that can prevent clotting. Infection of the surgical site is also a potential complication, but is rare for patients undergoing spinal surgery.
Complications specific to this procedure include nerve damage, segmental instability, and ongoing pain. Nerve damage can result from swelling around the nerves, formation of adhesions, or surgical error that causes the bumping or cutting of nerve tissue. Laminectomy can cause instability of the spinal segment, which can cause the need for additional surgery to fix the problem. Some pain can be expected after the surgery, but ongoing pain may indicate a need for you to contact your doctor and talk about treatment options.