One of the most common surgeries for lower back (lumbar) spinal stenosis is Decompressive Laminectomy. The goal of this surgery is to make more space for the compressed nerve roots by removing a part of the vertebra posterior. This can be quite an extensive surgery, lasting a few hours. Hence it is important for a patient to know the basics of the methods used for decompressive laminectomy.
As people age, their spinal health slowly deteriorates in most cases. In lumbar spinal stenosis, the spinal cavity gradually narrows, which leads to pressure on the nerve roots in the area that connect the spinal cord and the muscles.
While spinal stenosis in the lower back is most common, there are other parts of the spine where stenosis can occur. To be more exact, lumbar spinal stenosis occurs in the five vertebrae that are connected to the pelvis.
Patients with lumbar spinal stenosis usually also show symptoms of osteoarthritis, which is the leading cause behind this disease. However, it can also be caused by certain other factors, like spinal injury, bone diseases, complications from previous surgeries, and more.
Now, let’s take a look at the main goals of this surgery and the methods used for decompressive laminectomy.
The main goals of this surgery are to provide the patient relief using the following techniques:
When lumbar stenosis occurs in a patient, their mobility is decreased because of the pain and general weakness in the leg muscles. The methods used for decompressive laminectomy are meant to decrease pressure on nerve roots and reduce pain and weakness to restore normal functionality.
When stenosis occurs in the lower back, the spinal cord, along with other parts of the spinal structure gets compressed. When this occurs, the patient may feel pain while walking forwards or moving their leg forward. Also, the same applies to the spine, and when the patient bends forward, they feel a sharp pain. The techniques used for decompressive laminectomy aim to widen the spinal canal to stop the compression on the nerve roots.
It is important to note that the focus of decompressive laminectomy is to recover leg function by reducing pain and weakness. But the lower back pain may still persist after the surgery as they are caused by more factors, which need further treatments.
The approach used by the surgeon depends on the amount of laminal to be removed, and the method used to decompress the nerves. The different types of lumbar decompressive laminectomy are as follows:
In this technique, the lamina is removed from both sides of the spine. This is accompanied by either widening the foramina inside the vertebrae or leaving it as, depending upon the patient’s condition. Also, the adjacent bone and tissue are removed in most cases to allow the nerves to relieve pressure.
With this technique, there is a lower recovery period after the surgery because of the less invasive methods used. Here, a part of the entire lamina is removed on one side to decompress the nerves. This is accompanied by either removing the adjacent tissues or not, depending upon the patient’s needs.
With unilateral laminectomy, minimally invasive surgery is also possible. This is generally done by using an endoscope and leads to much lower blood loss, recovery time, and preserver more tissue. Both types of laminectomy, whether open or minimal, have almost the same success rates.
In some cases, the vertebrae may have to be completely or partially removed from the lumbar region. Most surgeons consider a spinal fusion to be the best choice in these cases.
Arthrodesis or spinal fusion is needed after the process used for decompressive laminectomy to make those regions of the spine stable. Spinal fusion can be done in different ways and proves to be helpful for most patients.
In some cases, the bone is extracted from another part of the body or from a donor. Next, these are attached to two vertebrae in order to keep them connected. Over time, this graft is intended to make the new bones grow.
If this does not seem viable, the surgeons may opt for instrumented fusion. In this process metal brackets, screws, hooks, plates, wires, and other instruments are used to hold the adjacent vertebrae together. This leads to natural bone formation over time between the mechanically jointed parts.
Surgery for spinal stenosis can require many other different techniques, which depend on many factors like health conditions, additional bone problems, the intensity of pressure on the nerve roots, and the surgeon’s experience.
As with most spinal surgeries, there are a few factors to keep in mind before getting the operation. The main benefits and the potential risks of the methods used for decompressive laminectomy are listed below:
This surgery has been proven to be beneficial to most patients. They report much lower pain in the lower back region and are able to alleviate much of the weakness in the legs.
Surgery works better for people who don’t respond well to nonsurgical methods to alleviate the pain. Even after the duration of 8-10 years, patients report being much more active and satisfied with the process.
Spinal stenosis surgery can result in complications in case of other medical problems in the patient or problems during the surgery. It can lead to instability of the spine, or long-term pain because of other factors.
Also, the patient may require a second fusion in the case of unfused vertebrae. It is important to note that all types of surgeries, including the ones used for decompressive laminectomy, pose risks, but they can be controlled in most cases.
Before opting for a decompressive laminectomy for lumbar spinal stenosis, it is always recommended by surgeons and experts alike to try nonsurgical pain control techniques.
But, in case you do need the surgery, it is very effective and the reports show that patients can lead normal lives even after long periods of time. Surgery for lumbar spinal stenosis relieves pain and numbness from the lower back and legs and should help patients with very limited mobility as a result of the disease.