Minimally Invasive Laminectomy

Back pain sends thousands of Americans to the doctor to seek care. It can cause a disability that can persist from childhood into adulthood, ranging from a dull, constant ache to a sudden, sharp or shooting pain. Back pain may result from an accident, lifting heavy objects or develop over time as we age.

If the pain becomes persistent, incapacitating or continues for 12 weeks or longer despite conservative treatments, like over-the-counter medications and physical therapy, surgical treatment may be the next option.

What Is a Minimally Invasive Laminectomy Surgery?

To better understand the laminectomy procedure, it would help to learn about minimally invasive spine surgery.

Unlike traditional surgery, minimally invasive spine surgery uses ports and/or small incisions to operate on the bones of the spine. The procedure uses laparoscopes and instruments equipped with video capabilities for spine doctors to view real-time X-ray images of the spine. This advanced surgical procedure can lead to reduced pain and faster laminectomy recovery.

The adoption of minimally invasive surgery in the surgical community is due to the understanding that minimal interruption of the patient's physiology may offer the best chance at a faster recovery after surgery and decrease the risk of complications such as failure of proper wound healing or wound reopening, incisional hernia and bowel adhesions. Spine doctors can use minimally invasive surgery for some types of spine surgery, such as laminectomy.

Laminectomy is a common procedure to remove the lamina to decompress a narrowed spinal canal so the spinal nerves have more room. The lamina is part of the bone that makes up a vertebra in the spine. Spine doctors also perform laminectomy surgery to remove bone spurs or herniated (slipped) disks in the spine and other surgical procedures, such as diskectomy, foraminotomy or spinal fusion.

Spinal stenosis is a degenerative condition characterized by the narrowing of the spinal column that causes pressure on the spinal cord or the narrowing of the openings where spinal nerves leave the spinal column. It usually occurs as a person ages and often worsens, but this may happen slowly.

Some causes of spinal stenosis include spinal disks that become drier and start to bulge and rupture and bones and ligaments of the spine that thickens or grow more prominent. Other causes may include:

• Arthritis of the spine, usually in middle-aged or older people.
• Bone diseases, such as Paget disease.
• Defect or growth in the spine that was present from birth.
• A narrow spinal canal that the person was born with.
• Herniated or slipped disk, which often may have happened in the past.
• An injury that causes pressure on the nerve roots or the spinal cord.
• Tumors in the spine.
• Fracture or injury of a spinal bone.

Who Needs a Minimally Invasive Laminectomy?

Aside from spinal stenosis, spine doctors perform laminectomy surgeries on patients with the following conditions and chronic symptoms:

Conditions:

• Fracture.
• Primary and secondary spinal tumors.
• Abscess.
• Deformity.

Symptoms:

• Pain or numbness in one or both legs.
• Pain around your shoulder blade area.
• Weakness or heaviness in your buttocks or legs.
• Problems emptying or controlling your bladder and bowel.

These symptoms may likely worsen while you are standing or walking. Discuss your symptoms with your doctor to help you decide when you need surgery to treat your condition.

How To Prepare for Minimally Invasive Spine Surgery?

If you and your spine doctor have decided that your back pain requires surgery, here are some things you can do to prepare for your procedure:

• Your doctor may ask you to have a preoperative checkup with your family doctor and any other doctor you see regularly, such as a cardiologist.
• If you smoke, try to quit months before your surgery. People who smoke may have difficulty recovering after surgery, likely due to wound infections and a delay in bone healing for successful fusion surgeries.
• Inform your spine doctor about all the medications you are taking, including aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, as well as dietary supplements and herbal medicines. Certain over-the-counter medications can cause bleeding or interfere with anesthesia.
• Talk with your spine doctor about donating your blood in case blood loss occurs during surgery. However, donating blood for low back surgery is not usually necessary.
• Make arrangements to get help with activities at home, such as washing, dressing, cleaning, laundry and shopping. Your doctor may recommend that you do not drive for some time. Make sure to arrange transportation to and from your hospital appointments and other places you may need to go during your laminectomy recovery period.

How Is a Minimally Invasive Laminectomy Performed?

During the laminectomy procedure, your doctor will ask you to lie on your stomach on the operating table. You will be given general or spinal anesthesia, during which you may be asleep or have no feeling from the waist down for the entire operation.

The spine doctor will make a small incision in the middle of your back or neck to see inside your back. Some or all the lamina bones may be removed on both sides of your spine, along with the spinous process, the sharp part of your spine.

Aside from your lamina bones, your spine doctor may remove small disk fragments, bone spurs or other soft tissue. Your spine doctor may also perform a foraminotomy surgery to help widen the opening where nerve roots travel out of the spine and a spinal fusion to stabilize your spinal column after surgery.

After the procedure, your spine doctor will put your muscles, ligaments and other tissues back in place and sew the skin together. The laminectomy surgery takes one to three hours.

What To Expect After a Minimally Invasive Laminectomy?

The goal after spine surgery is to reduce pain and make it more manageable. Your doctor may use a combination of medications to help manage pain, including opioids, NSAIDs and local anesthetics. Icing the incision area can also limit inflammation and help with pain control. Limit the icing to no more than 30 minutes per hour, and do not place ice directly on the surgery site.

The incidences of complications are low after spine surgery. If you experience any of the symptoms below, notify your doctor immediately. Have someone drive you to the nearest emergency room or call 911 if any of the following symptoms present themselves:

• Swelling in the calf, ankle or foot.
• Tenderness or redness, which may extend above or below the knee.
• Pain in the calf.

Most patients go home the same day or one to two days after surgery. There will be movement limitations. Follow instructions on moving properly, repositioning, sitting, standing and walking to keep your spine correctly aligned. Make sure to schedule regular checkups to prevent problems from developing post-surgery.