Decompressive Lumbar Laminectomy
An actual surgery done by Jeff Fischgrund, M.D.
A decompressive lumbar laminectomy is the removal of the back of the spinal bones to relieve the pressure on the nerves. This is most frequently done for patients who have pressure on the nerves (spinal stenosis) with resulting leg pain, weakness or numbness. Frequently, patients with this condition are only able to walk a short distance when they feel a tightness, cramping or drawing sensation in the buttocks and thighs, which significantly limits their ability to walk. Patients who have had these symptoms for a prolonged period of time and have failed non-operative treatment may be a candidate for this procedure. Prior to surgical intervention, either a magnetic resonance imaging (MRI) or computerized tomography (CT scan) is done to visualize the amount and location of compression on the nerves.
This procedure is done through a skin incision along the middle of the low back. After the incision through the skin, the lumbar muscles are visualized and these are pushed to the sides to visualize the back of the spinal bones. The most prominent bone initially seen is the spinous process which flows down towards the spinal lamina. After completion of the exposure, a sharp cutting instrument called a Leksell rongeur is used to remove the spinous processes and a portion of the spinal lamina. By thinning down the lamina, small angled instruments called curets can be used to find the space in between the undersurface of the lamina and the covering of the spinal nerves (dura). Once this space is found, an instrument called a Kerrison rongeur is used to remove the spinal lamina in small pieces. Care is taken at all times not to damage the dura or the spinal nerves themselves. The lamina are usually quite thick due to arthritic changes and this thick bone can compress the nerves. Another source of compression on the nerves is a yellow ligament called the ligamentum flavum which is normally found between the lamina and the spinal nerves. Thickenings of this ligament leads to pressure on the nerves and this ligament is usually also removed with a Kerrison rongeur. After removal of the central portion of the lamina, as well as the thickened ligamentum flavum, the dura is easily seen and the spinal nerves are free of compression.
In the example shown in this video, the patient required lumbar pedicle screws to be placed to stabilize the spine, however, screws are not always necessary following a decompressive lumbar laminectomy. The typical rehabilitation course following a decompressive lumbar laminectomy involves activity modification for 6-weeks following the procedure. Patients should avoid heavy lifting, bending, twisting and turning for several weeks, until advised by their doctor. Occasionally, physical therapy is needed to strengthen the back muscles.
Patients who have a decompressive lumbar laminectomy procedure usually have a good result. Most patients notice a significant reduction in buttock and leg pain, and usually have a markedly increased ability to walk for prolonged distances.