Advanced Laminectomy Surgery​ in Hyderabad, India

Before the procedure 

Before the surgery, the surgeon discusses the nature of the operation, the reasons for it, the outcome, and the possible risks involved.

• They may be able to tell the patient about the approximate length of the stay in the hospital that may be required and the number of weeks that the patient may need to recover before returning to work.
• Before performing a laminectomy, anaesthesiologists or surgeons review the patient's medical history to decide the best type of anaesthesia and decide whether the patient is suitable for surgery or not. 
• The surgeon may ask about any medications the patient has been taking, such as drugs, supplements, or herbs, and the surgeon may ask to stop taking any medicines that make it hard for the patient's blood to clot two weeks before the surgery.
• The patient will also ask about the asthma or allergic reaction to identify the symptoms such as itchiness, difficulty breathing, and hives.
• Laboratory tests may be performed before surgery, and the patient should avoid food for several hours before surgery.
• The patient may be connected to the monitoring equipment to monitor the patient's vitals during the procedure. 

During the procedure

This laminectomy procedure time may differ from person to person. Laminectomy surgery duration is not flexible for all patients. Usually, it may take one to three hours and may take longer for some patients. Surgeons perform the laminectomy using large incisions (open surgery) or small incisions with specialised tools (minimally invasive spine surgery).

• Open approach vs minimally invasive spine surgery: The only difference between the open and minimally invasive techniques while performing the surgery is the incision size. The rest of the scope of the procedure is the same. 
• Laminectomy position during surgery: Usually, the patient may be positioned in a prone position (lying on the stomach), lateral (lying on the side), or in the knee-to-chest posture (sitting up with knees bent and chest).
• Anaesthesia: General anaesthesia is used in this procedure, which can be done by neuraxial (spinal or epidural) anaesthesia. Muscle relaxants are also given to the patient to facilitate intubation and muscle dissection. 
• Incision: Surgeons perform the laminectomy using large incisions (open surgery) or small incisions with specialised tools (minimally invasive spine surgery). The surgeon makes an incision (3-5) cm along the midline of the back (posterior midline incision), over the targeted region, and carefully separated the layers of tissue, muscles, and spinous processes to expose the bones (subperiosteal dissection) underneath. This lifting creates a detailed view of the affected region, which is helpful to a surgeon in performing the surgery without harming the facet bones (joints connecting bones).
• Lamina removal: The spine surgeon carefully removes the portion of the lamina or complete lamina to create space within the spinal canal to relieve pressure on nerves or the spinal cord.
• Nerve decompression: However, in some conditions, spinous processes and dorsal laminae (parts of the bone covering the spinal canal) may be resected to expose the specific ligament (ligamentum flavum) to create more space. The neurosurgeon will gently move affected nerve roots to access the disc to remove the bulging or herniated part of the disc if herniated discs are present to reduce compression. If needed, a medial facetectomy will be performed, which involves the trimming on one side of the small portion of the facet joints to further create more space for nerves. Afterward, surgeons measure the space around the nerves by using specific tools and carefully protecting the essential parts during surgery without harming them to avoid further spinal instability issues.
• Closure (laminectomy wound care): The decompression procedure can be completed after creating sufficient space for the nerves and surrounding tissues. After completing the procedure, surgeons suture the incision and close it. 

Microendoscopic laminotomy

It is a safe and very effective minimally invasive surgical approach similar to laminotomy. However, the surgeon makes small incisions to send specific tools and a tiny camera to see and operate on the affected region. Most common cause of degenerative constrictions of the spinal canal are spinal canal stenosis (narrowing of one or more spaces within spinal canal) and disc herniation (slipped, ruptured or bulging disc.).

Minimally invasive surgical techniques offer different benefits than traditional open surgery, such as less muscle disruption (less muscle cutting), reduced bleeding, hospital stay, reduced surgery duration, complications, quicker recovery, and less post-operative pain; Minimally invasive surgical techniques include laminotomy and microendoscopic laminotomy.)

Post laminectomy: After the procedure

The patient will be under post-operative observation. The wound will be checked for swelling, redness, and signs of infection.

• The neurosurgical team monitors the patient after the surgery to recognise any early complications. This includes early neurological examination and frequent assessment to identify neurological abnormalities after the surgery.
• Pain and antispasmodic medications may be given to the patient regularly to relieve the post-operative pain or discomfort.
• The patient will be provided with intravenous fluids for a few days. Afterward, the medical team (physiotherapists) will show the patient how to roll over the bed and the proper method of body rolling to maintain proper body alignment and avoid stress and strain on the wound site. 
• The patient may be referred to inpatient or outpatient rehabilitation.
• Specific instructions are given to the patient by the surgeon about how to take care of the wound and to look out for any complications.

It is suggested to consult the healthcare professional if the patient experiences the following:

• Increased pain
• Erythema (redness)
• Swelling 
• Wound infection
  

Decompressive laminectomy recovery time depends on the patient's age, overall health, fitness, activity level before surgery, and the surgeon's approach. This is why a surgeon recommends a course of physiotherapy before the surgery.

The patient may go home a couple of days after surgery. The patient will be encouraged to walk and move around the day after the laminectomy, as inactivity may increase the risk of developing a blood clot in the leg. However, gentle movement may speed up the recovery process.

Patients may recover within four to six weeks after a minimally invasive technique. However, recovery time for an open approach may take more than six weeks. 

The surgeon might suggest avoiding bending or twisting motions and some exercises or rehabilitation and post-operative instructions.

Physical therapy may help the patient to move more efficiently with less pain. Most patients may feel well enough to drive within a week one to two weeks after surgery.

The patient may go back to work within one month. Recovery after laminectomy may take a few months to recover fully.

As per research, it has been shown that the quicker a patient returns to normal activity, the better the outcome of the operation. Research has demonstrated that the quicker a patient returns to their normal routine, the better the outcome of the operation is.

A physiotherapist may recommend some of the following exercises, (exercises after lumbar laminectomy) based on the patient condition: such as:

• Alternate knees to chest
• Crook lying, legs side to side
• Sitting pelvic tilt
• Transversus in standing
• Left and right-side bend

The success rate of this technique is approximately 90%, and the patient satisfaction rate is above 75%, where pain and weakness resolve early.



However, the reoperation rate is 18% within five years, and laminectomy can also be helpful for symptomatic improvement and early recovery with low complication rates.

Every surgical procedure has benefits and complications. As with any surgery, laminectomy also has some complications. However, they are rare and include the following: 

General complications of any surgery

The possible general complications of any surgery may include the following:

• Bleeding
• Infection of the surgical site
• Allergic reaction to medications, materials, or equipment
• Chest infection 
• Scarring

Possible complications of laminectomy surgery

The following are the other possible complications after laminectomy:

• Dural and nerve root injuries: Mechanical damage to the nerves and the covering of the spinal cord (dura)
• Arachnoiditis: Inflammation of the spinal cord membrane (arachnoid mater)
• Instability: Abnormal mobility or loss of spinal stability
• Bony re-growth: Abnormal bone growth in the spine
• Kyphosis: Forward curvature of the spine
• Spinal epidural hematoma: Accumulation of blood in the epidural space
• CSF (cerebrospinal fluid) leak from dural sac tear: Leakage of cerebrospinal fluid due to a tear
• Cerebellar haemorrhage (rare): Bleeding in the cerebellum
• Epidural abscesses: Accumulation of pus in the spinal epidural space.
  

Laminectomy allows sufficient and safe decompression (pressure relief) of the spinal canal in patients with spinal stenosis, which is a condition where the canal becomes narrow. This procedure is safe and effective in improving symptoms, disability, and enhancing the quality of life for patients. After undergoing laminectomy surgery, the majority of patients experienced few complications.

• What are the wound care instructions for my incision site?
• How soon should I contact the healthcare team if I notice any unusual symptoms or issues after the procedure?
• What signs of complications or infections should I watch for at the surgical site?
• When can I go back to my normal activities?
• Are there any specific activities I should avoid during my recovery period?
• What dietary restrictions should I follow during recovery?
• When should I schedule follow-up appointments?
• Will any tests or evaluations be required after the surgery?
  

Difference between laminectomy and discectomy

Laminectomy vs Discectomy

Laminectomy and discectomy are two spinal surgical procedures that may be performed to relieve pressure on the spinal cord and nerves. Although these are similar, they have some differences, and they address different issues, which include: 

Difference between Laminotomy and Laminectomy

Laminotomy vs Laminectomy

Laminectomy and laminotomy both are the spinal surgeries where the surgeon removes part or most of the spinal bone (lamina) to create enough space in the spinal column for reducing pressure on nerves. Although these are similar, they have some differences, and they may perform alone or combination with other procedures, the differences may include:

Difference between Fusion and Laminectomy

Spinal Fusion vs Laminectomy

Spinal fusion and laminectomy are both used to address the various issues in the spine, to provide pain relief, and to increase stability issues; the differences may include as follows:

Differences between Laminectomy and Laminoplasty

Laminectomy vs Laminoplasty

Laminectomy and laminoplasty are two spinal surgical procedures that may be performed to relieve pressure on the spinal cord and the nerves. Although these are similar, they have some differences, that includes

What is post-laminectomy pain syndrome? 

Post laminectomy syndrome (PLS) or failed back surgery syndrome (FBSS) is a condition where the patient continues to feel pain after undergoing laminectomy or other spinal surgeries. This syndrome is a significant cause of chronic back pain, which may lead to disability, decreased quality of life, and psychological disorders (such as anxiety & depression). Some patients may experience pain in the lumbar region due to re-herniation (herniated discs) after laminectomy. 

Is laminectomy surgery the same as a discectomy?

No, laminectomy is not the same as a discectomy, but both are decompression surgeries of the spine. In laminectomy, the surgeon removes the lamina (section of bone) to relieve pressure on the affected nerve. In diskectomy, a section of the damaged disc is removed to ease pressure. A surgeon may perform discectomy surgery during the laminectomy.

What is a laminectomy back surgery? 

Laminectomy back surgery is the surgical removal of all or part of the lamina (partial or complete) to create more space for the compressed spinal cord or nerve roots. It is mainly performed to treat the symptoms of spinal stenosis (narrowing of the spinal canal).

How soon after laminectomy can I exercise?

One may continue with gentle exercises after discharge. The physiotherapist will recommend the appropriate exercises after laminectomy; however, the exercise types and duration may depend on the patient's condition. One should avoid bending, twisting the back, heavy lifting, or moving objects. Avoiding swimming until three weeks after surgery is recommended to allow the wound to heal.

Why is laminectomy done? 

Laminectomy is performed when the spinal cord or the nerves of the spine compress and cause symptoms such as pain, numbness, tingling, and weakness that continue despite medical treatment (non-surgical treatments).

The surgeon first investigates the cause of the pressure on the spinal cord and also examines the muscle strength, spine, reflexes, and sense of feeling before deciding whether to perform the laminectomy.

What is a laminectomy foraminotomy? 

Laminectomy and foraminotomy are both spinal surgeries that are performed to relieve pressure on compressed nerves. In laminectomy, the surgeon removes the lamina to reduce pressure on the affected nerve.

Whereas in foraminotomy, the surgeon re-opens the intervertebral foramen (nerves of the spine enter and exit the spinal canal through the specialised gaps called foramina) to remove the blockages if present or to allow surgical treatment. A laminoforaminotomy is often performed at the same time as a laminotomy or laminectomy. The combination of these procedures is called a laminoforaminotomy.

Is there entire disk removal in laminectomy? 

No, the surgeon may not remove the entire disc in laminectomy. In the laminectomy, the surgeon removes a portion or complete lamina (bone) just over the nerve root. However, in some conditions, the surgeon may perform additional procedures (such as discectomy) to remove or trim disc material underneath the nerve root to create more space and also to address disc-related problems.

Can a laminectomy help numbness & tingling? 

Yes, a laminectomy can help to address numbness and tingling. Usually, this procedure is used to reduce the symptoms, such as back (lumbar) or neck (cervical) pain that continues after conservative treatments, or it is also performed when the symptoms of nerve damage, such as numbness, tingling, or weakness in the arms or legs.

Does the bone grow back after a laminectomy? 

Yes, the bone can grow back after a laminectomy or laminotomy, especially in the lower back (lumbar spine). However, this regrowth of the bone is less strong than the original one (bone before laminectomy).

Usually, this growth occurs in certain areas, such as the facets and vertebral laminae, but it doesn't completely cover the original bone area. The rate of bone regrowth may increase with the spinal fusion procedures and in cases of increased vertebral instability.

What should you avoid after a laminectomy? 

After laminectomy, avoiding activities that strain the spine is recommended, including sitting or standing for too long, bending or twisting at the waist, flexing the spine, climbing too many stairs, going for long trips in the car, lifting over 10 pounds, engaging in sports, aerobic, or cardio activities, strenuous and jarring activities.