PROCEDURE DETAILS OF LAMINECTOMY

What do I need to do before surgery?

The patient will have nothing to eat or drink for 6 to 10 hours prior to surgery and an enema will be given to empty the bowel. A pre-medication injection is usually given to promote drowsiness and to dry up some internal secretions. If you take a daily medication, ask if you should still take it the morning of surgery.

A number of tests are performed before the operation, which include blood tests, urine analysis and sometimes an electrical recording of the heart (electrocardiogram, ECG) and a chest X-ray.

Your surgeon should explain to you the nature of your operation, the reasons for it, the outcome and the possible risks involved. They should be able to tell you the approximate length of stay in hospital that will be required and the number of weeks you will need to recuperate before returning to work. Your anaesthetist will visit you to see how suitable you are for surgery.

What happens on the day of the procedure?

On the day of the surgery, your temperature, pulse, breathing, and blood pressure will be checked. An IV (intravenous) line may be started to provide fluids and medications needed during surgery.

What type of anesthesia will be used?

Laminectomy is usually performed under general anesthesia so you are fully asleep during the operation.

What happens during the surgery and how is it performed?

The patient is placed face-down on the operating table. The exact procedure depends on the location of the herniated disc; example, if the disc is located in the neck, the head is clamped to prevent movement. The skin is marked for incision.

During a laminectomy, the lamina (bone that forms the back of the spinal canal) is removed from the affected vertebra. If the operation is performed on the neck (a cervical laminectomy), it is usually performed through a vertical cut, three or four inches long, along the middle of the neck at the back. The surgeon exposes the bones of the neck beneath the skin and a small amount of bone is clipped away, which relieves the pressure on the nerves. Once the nerve is free of pressure, the incision is closed with stitches or surgical staples. An adhesive dressing is applied over the wound. Sometimes, a plastic drain is left in the wound for a few days after the operation to drain any blood that may have collected under the wound.

What happens after the surgery?

After surgery, you’ll be sent to the PACU (post-anesthesia care unit). When you are fully awake, you’ll be moved to your room. The nurses will give you medications to ease the pain and stiffness in your neck or back. You may have a catheter (small tube) in your bladder. You’ll also be shown how to keep your lungs clear.

Usually, after cervical laminectomy you are nursed up-right in bed for the first day and not allowed to lie flat to prevent excessive build-up of fluid under the wound. If a drain has been inserted into the wound, this is usually removed after two days. You may be allowed out of bed one or two days after a cervical laminectomy. The period of bed rest may be a few days longer for a lumbar laminectomy.

How long will I be in the hospital?

The average length of stay in hospital is two to three days, but this can vary somewhat, according to whether your operation was on the neck or back and on the size and exact nature of the operation performed.

While in the hospital, the patient is taught the proper method of rolling the body in order to maintain proper body alignment. This is most important for the first 48 hours or so. A physiotherapist gives specific instructions on how to get out of bed properly in order to avoid stress and strain on the wound site.

The patient is encouraged to walk, stand and sit for short periods. The patient is taught how to prevent twisting, flexing or hyperextending the back while moving around. Patient is later treated with ultrasound therapy to rehabilitate from this surgery.

What are the risks/complications associated with laminectomy?

Some of the possible complications of laminectomy include:

• Infection of the wound
• Blood clots in the legs
• Splitting open of the wound (wound dehiscence)
• Injury to the spinal cord
• Paraplegia or quadriplegia (depending on the site and severity of the spinal cord injury)
• Post-laminectomy syndrome, consisting of chronic back pain and spinal instability

What should I watch out for?

Once at home, call your doctor if you have any of the symptoms below:

• Unusual redness, heat, or drainage at the incision site
• Increasing pain, numbness, or weakness in your leg
• Fever over 101.0°F

When can I expect to return to work and/or resume normal activities?

Most people need to be off work for between one and three weeks after leaving hospital, depending on the nature of their work. Work that is physically demanding or that involves lifting heavy objects may require a longer time off.

What are the post-operative recovery measures that I should take?

Although guided by a doctor, general suggestions include:

• Continue taking your medications as advised, especially the full course of antibiotics.
• If the operation was performed on your neck, you will need to wear a cervical collar for about six weeks.
• Try to rest as much as possible for at least two weeks.
• Avoid activities that strain the spine – such as sitting or standing for too long, flexing your spine, bending at the waist, climbing too many stairs or going for long trips in the car.
• Avoid wearing high-heeled shoes.
• Sleep on a firm mattress.
• Continue with any exercises you were shown in the hospital.
• Beware of heavy lifting for a long period.
• After two weeks at home, try to have a 10 minute walk each day, unless advised otherwise by your doctor.
• Report to your doctor any signs of infection, such as wound redness or drainage, elevated body temperature or persistent headaches.

Overview of Laminectomy

Cost and Availability of Laminectomy