Posterior Lumbar Decompression/ Laminectomy sos Stabilization
Overview:Posterior Lumbar Decompression surgery (laminectomy) is a surgery done through an incision through back. This procedure opens the bony canals through which the spinal cord and nerves pass, creating more space for them to move freely, thus relieving the compression.
Posterior Lumbar Decompression or Laminectomy generally comprises a large portion of a spine surgeon’s practice. It is one of the most common procedure required for the older population. Though the most common indication is unrelenting Lumbar Canal Stenosis, it is a part of the surgery to relieve neurological compression caused due to infections, tumours, fractures, etc. When the primary pathology affects spinal stability,Fusion and Stabilization is done in the same setting.
Surgery is usually suggested as the last resort. Failure of medical management, severe neurological compression causing weakness are usual circumstances when surgery is advised. In very few cases causing weakness of legs or urine and motion incontinence (Cauda Equina Syndrome) is an emergency procedure recommended. After a thorough discussion (understanding risks and benefits) with the surgeon, the decision for surgery is taken.
The procedure is done under general anaesthesia. A tube is inserted in the throat to help breathing during anaesthesia. Patient is placed prone (face down) on the operating table. A small incision 2-3 inches is taken over the lower back. The spinal canal is exposed after dissection of muscles and soft tissues. Magnification using microscope/ loupes is recommended. The bone overlying the spinal cord is removed using high speed burr and Kerrison surgical instruments. The spinal cord and nerve roots are decompressed. Any tissue causing compression is removed and wound is stitched up. If stabilization and fusion is planned it is carried out in same siting- see Lumbar Fusion and Stabilization. A drain may be inserted to prevent haematoma for 1-2 days. After the surgery, patient may be shifted to ICU for observation or to the room depending upon the medical condition. Patient is usually made to walk on the same/ next day. Normally, 1-3 days of hospital stay is required. Once medical condition is stabilized, patient has adequate pain relief and mobilized, discharge is planned.
Patient is asked to follow up for stitch removal between 2-3 weeks from surgery. A waterproof dressing may be applied in some patients so that bath can be taken. Patient is required to follow up at 6 weeks, 3 months, 6 months, 1 years and then annually after surgery for examination. Based on recovery – gradual increase in activities is advised.
Specific complications:
Dural Tears: There is a small risk of dural tear during surgery. It is a tear in the outer lining/ covering of spinal sac land contains fluid known as CSF. This fluid may leak from the tear. These are usually repaired during surgery or closed with tissue sealents. Even then, it may leak through the wound and cause headaches. Sometimes it may get infected and further surgery and longer hospitalization stay may be required.
The same surgery when done through Minimally Invasive Techniques is known as Tubular Endoscopic Decompression.
Disclaimer: The description of procedure is how usually a surgery is done. During the procedure, based on intra operative encounters which varies from patient to patient different steps may be performed.