OS17 Lumbar laminectomy - Bankmed · 2019-01-03 · lumbar laminectomy. A dural tear can cause spinal fluid to leak out and you may get a bad headache for a few days. Your surgeon

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Lumbar laminectomy

Copyright © 2016 Page 1 of 4Expires end of May 2014

What is lumbar spinal stenosis?Lumbar spinal stenosis is where the spinal canal narrows in your lower back. This may cause pain or weakness in your legs.

About this documentYour surgeon has recommended a lumbar laminectomy. However, it is your decision to go ahead with the operation or not.We understand this can be a stressful time as you deal with different emotions and sometimes have questions after seeing your surgeon. This document will give you a basic understanding about your operation. We tell you about the things you can do to help make the operation a success. It is also important to remember to tell your surgeon about any medicine you are on so he or she can manage this, if necessary. It will also tell you about what to expect after the operation � while in hospital and in the long term. Your surgeon remains the best person to speak to about any questions or concerns you may have about the operation.

How does spinal stenosis happen?Your spine is made up of a column of bones called vertebrae. The vertebrae are arched at the back and are joined together by small facet joints and spongy discs between the vertebrae. The arches (laminae) form a protective tunnel called the spinal canal. The spinal cord passes down the spinal canal from your brain. Nerves from your spinal cord and blood vessels that supply the nerves pass into the spinal canal within the vertebrae. The nerves carry messages from your brain so you can move your muscles. They also carry messages from your skin so you have the sense of touch and feel pain.The spinal canal tends to narrow as we get older caused by wear and tear in the facet joints, thickening of surrounding ligaments and bulging of the discs (see figure 1). The spinal canal can also narrow because of arthritis in your spine and other conditions that cause problems with your bones. Some people are born with a narrow spinal canal.A narrowed spinal canal means that there is not enough space for the nerves and blood vessels. So when you exercise or stand for a time, the nerves do not work properly. You may have difficulty walking and leg pain, often with a tingling sensation.You can usually get relief by bending forwards or sitting.

What are the benefits of surgery?The aim is to prevent your symptoms getting worse. You may get less pain and be able to walk further. Some people have a major improvement.

Are there any alternatives to surgery?If your symptoms are mild, you may not need any treatment. If your symptoms are severe or are getting worse, surgery is usually the only option.

What will happen if I decide not to have the operation?Your symptoms are unlikely to get worse quickly. A few people will even get better with time.If your symptoms get worse, you may decide to have surgery.

Disc bulge

Thickened ligament

Figure 1a A normal spinal canal and discb A disc bulge pressing the nerves within the spine

Spinal nerve Spinal

canal

a

b

Disc

Copyright © 2016 Page 1 of 4Expires end of December 2017


What does the operation involve?You will usually have an MRI scan to confirm the diagnosis and help your surgeon to plan the operation.The healthcare team will carry out a number of checks to make sure you have the operation you came in for. You can help by confirming to your surgeon and the healthcare team your name and the operation you are having.Various anaesthetic techniques are possible. Your anaesthetist will discuss the options with you and recommend the best form of anaesthesia for you.You may be given antibiotics during the operation to reduce the risk of infection. The operation usually takes one to two hours.Your surgeon will make a vertical cut on the centre of your lower back. They will part the muscles to get to your spine. Your surgeon will remove enough bone and ligament tissue to open up the narrowed part of the canal, giving the nerves and blood vessels more room (see figure 2).

Your surgeon will close your skin with stitches or clips. They may insert a drain (tube) under your skin to help your wound to heal. This is usually removed after one to two days.

What should I do about my medicine?Let your doctor know about all the medicine you take and follow their advice. This includes all blood-thinning medicine as well as herbal and complementary remedies, dietary supplements, and medicine you can buy over the counter.

What can I do to help make the operation a success?If you smoke, stopping smoking several weeks or more before the operation may reduce your risk of developing complications and will improve your long-term health. Nicotine is known to prevent wounds from healing properly following lower-back surgery, and increases the risk of unsightly scarring and chronic pain.Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.You can reduce your risk of infection in a surgical wound.� In the week before the operation, do not shave or wax the area where a cut is likely to be made.� Try to have a bath or shower either the day before or on the day of the operation.� Keep warm around the time of the operation. Let the healthcare team know if you feel cold.

What complications can happen?The healthcare team will try to make the operation as safe as possible but complications can happen. Some of these can be serious and can even cause death (risk: 1 in 300). You should ask your doctor if there is anything you do not understand. Your doctor may be able to tell you what the risk of a complication for you is.

1 Complications of anaesthesiaYour anaesthetist will be able to discuss with you the possible complications of having an anaesthetic.

2 General complications of any operation� Pain. The healthcare team will give you medicine to control the pain and it is important that you take it as you are told so you can move about as advised.� Bleeding during or after the operation. This can cause pressure on the nerves (extradural haematoma) (risk: 1 in 125). You may need another operation.� Unsightly scarring of your skin, although the cut usually heals to a neat scar.

Spine

Figure 2Top view showing bone and ligament removed

Lamina



� Infection of the surgical site (wound) (risk: 1 in 100). It is usually safe to shower after two days but you should check with the healthcare team. Let the healthcare team know if you get a high temperature, notice pus in your wound, or if your wound becomes red, sore or painful. An infection usually settles with antibiotics but you may need another operation.� Difficulty passing urine (risk: 1 in 25). You may need a catheter (tube) in your bladder for one to two days.� Blood clot in your leg (deep-vein thrombosis � DVT) (risk: 1 in 125). This can cause pain, swelling or redness in your leg, or the veins near the surface of your leg to appear larger than normal. The healthcare team will assess your risk. They will encourage you to get out of bed soon after the operation and may give you injections, medicine, or special stockings to wear. Let the healthcare team know straightaway if you think you might have a DVT.� Blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs. Let the healthcare team know straightaway if you become short of breath, feel pain in your chest or upper back, or if you cough up blood. If you are at home, call an ambulance or go immediately to your nearest casualty unit.� Chest infection. You may need antibiotics and physiotherapy.� Heart attack or stroke (loss of brain function resulting from an interruption of the blood supply to your brain). Sometimes a heart attack or stroke can cause death.

3 Specific complications of this operation� Worse pain or numbness down your leg caused by damage to nerves in your spine (risk: 1 in 250).� Numbness between your legs, loss of normal bowel and bladder control and, for men, problems having an erection. These problems can happen because nerves in your spine can get damaged during surgery. Although the nerves should get better over time, 3 in 5 people with nerve damage do not get completely back to normal.� Neuropathic pain. This is a burning pain that may happen once the pressure on the nerves has been released. You may need a special form of pain relief.

� Tear of the thin membrane that covers the nerves in your spine (dural tear) (risk: less than 3 in 100). The risk is higher if this is your second lumbar laminectomy. A dural tear can cause spinal fluid to leak out and you may get a bad headache for a few days. Your surgeon may need to repair the tear, either during the operation or with another operation later.� Infection in your spine (risk: 1 in 100). You will usually need another operation to clean out the infection. You will also need a long course of antibiotics.� Spinal instability, where there is too much movement between the vertebrae. The risk depends on how much bone and ligament tissue your surgeon needs to remove. You may need another operation to stabilise your spine.

How soon will I recover?

� In hospitalAfter the operation you will be transferred to the recovery area and then to the ward. Sometimes you may go to the intensive care unit or high care unit for up to 24 hours so the healthcare team can monitor you more closely. You will be able to drink after you have recovered from the anaesthetic.You will usually be able to start walking on the day of the operation or the next day.Keep your wound dry for 4 to 5 days. The healthcare team will tell you if you need to have any stitches or clips removed, or dressings changed.You should be able to go home after two to three days. However, your doctor may recommend that you stay a little longer.If you are worried about anything, in hospital or at home, contact the healthcare team. They should be able to reassure you or identify and treat any complications.

� Returning to normal activitiesTo reduce the risk of a blood clot, make sure you follow carefully the instructions of the healthcare team if you have been given medicine or need to wear special stockings.The physiotherapist may give you an exercise programme to help you to strengthen your back. It is important to do your exercises as you are told to reduce the risk of getting back problems again.



The healthcare team will tell you when you can return to normal activities. Do not lift anything heavy or twist your body. Make sure you keep a good posture when sitting and walking.Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.Do not drive until your doctor tells you that you can.

� The futureMost people make a good recovery from surgery, with 17 in 20 people able to return to their normal activities.Surgery should relieve any leg pain but you may still get backache from time to time because of wear and tear in your spine. If you have severe back pain caused by instability, you may need a spinal fusion operation.Spinal stenosis can sometimes come back at the same place or at a different place in your spine. Up to 4 in 100 people will need another operation in the first four years.

SummaryLumbar spinal stenosis is where the spinal canal narrows in your lower back. This may cause pain or weakness in your legs. The aim of surgery is to prevent your symptoms getting worse.Surgery is usually safe and effective but complications can happen. You need to know about them to help you to make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early.

Keep this information leaflet. Use it to help you if you need to talk to the healthcare team.

AcknowledgementsAuthor: Mr Stephen Milner DM FRCS (Tr. & Orth.) and Mr Richard Ashpole FRCS (Neuro. Surg.)Illustrations: Copyright © . All rights reserved. www.neurosurgeon.co.uk and Medical Illustration Copyright © Medical-Artist.com

This document is intended for information purposes only and should not replace advice that your relevant healthcare professional would give you.

You can access references online at www.aboutmyhealth.org. Use reference OS17.


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OS17 Lumbar laminectomy - Bankmed · 2019-01-03 · lumbar laminectomy. A dural tear can cause spinal fluid to leak out and you may get a bad headache for a few days. Your surgeon