What to Expect in Laminectomy and Spinal Fusion

Decompressive laminectomy is done to release pressure exerted on the roots of the nerves found on the lower back. The condition is mostly brought by old age. There are, however, other reasons your surgeon may suggest surgery. These include herniated discs, traumas, and tumors. In case you are going through persistent pain in your spine that interferes with your day to day activities, your doctor may also suggest surgery for you.

During laminectomy, enlarged bones and tissues are removed to open up the spinal canal and relieve the pressure exerted on the nerve roots. Your surgeon has to make incisions on your back around the affected areas.

Spinal Fusion

During laminectomy, your surgeon may find it worthy to perform a spinal fusion to stabilize your spinal cord. Spinal fusion lasts up to around 4 hours. The following are different methods of performing a spinal fusion:

• Typically, a bone is either taken from a bone bank or any other part of your body. It is then used to connect the vertebrae on your spine. The bone graft helps your back grow another fresh bone.
• Another method involves artificial rods, wires, plates, screws or hooks. This method is known as instrumented fusion. The artificial instruments are placed to hold the vertebrae together until you grow another fresh bone between them.

In spinal fusion, there are various techniques used but typically, the procedure is the same. These techniques rely on:

• The type of bone used
• The type of metal used
• Whether the surgery is anterior
• Whether the surgery is posterior

There are a number of things that will influence the technique used on your surgery. These include:

• Your age
• Associated symptoms
• Your health condition
• The level of pain
• The number of affected vertebrae
• The experience of the surgeon

Remember, when you undergo spinal fusion, you may experience various complications. It also takes a longer time for you to fully recover.

What to Expect After Surgery

It may take you several months to recover. This entirely depends on your condition. If you experience post-surgery conditions, this may also delay your overall recovery time.

Why It Is Done

There are several reasons your doctor may diagnose spinal stenosis. These include:

• When your symptoms are persistent and interfere with your day-to-day routine.
• When alternative non-surgical treatments do not relieve your pain, weaknesses, numbness, and compression on the nerve roots or when other spinal stenosis symptoms are worsening.
• When you can’t feel your bowel or control your bladder.
• When your ‘walking’ is not stable or when you actually cannot walk.

Your doctor may have other reasons apart from the tests results. The pressure exerted on the roots of your nerve alone may not result into surgery. Your doctor will only suggest surgery if other alternatives have failed, or when other symptoms are persistent and affect your daily routine.

In most cases, you may undergo spinal fusion to stabilize your spine. This may help reduce your back pain significantly. It can also help you regain your ability to move by keeping the bones in place, not allowing them to move into positions where they may press the naval roots.

How Well It Works

Laminectomy is usually only recommended if other medications have not worked. Generally, doctors consider all your conditions before suggesting surgery. They also consider and expect that the surgery helps you relieve the pain and restores your ability to move without stress. Successful surgery depends on your condition and age. However, the following factors are true according to research:

• To improve movement and reduce pain, surgery is more recommended than other non-surgical alternatives. In case you have been using medication but the symptoms still persist, you are most likely to undergo surgery.
• In around 3 months, those who underwent surgery notice significant improvements compared to those who did not. Those who did not continue to deteriorate while those who had surgery continue to improve for at least 4 years before getting any other symptoms.
• For 8 to 10 years, those who underwent surgery continue to enjoy the benefits of the surgery. This includes:
                 - Successful patients record more satisfaction than those who never attempted surgery.
                 - Numbness and pain in the legs have reduced significantly for those who had surgery compared to those who only used medication.

• Surgery works more effectively in reducing pain in the legs, as well as relieve back pain.

In case the symptoms come back after several years, you may need a second surgery. This will depend on:

• Whether the spinal stenosis affect a different area of your spine.
• Whether the first surgery did not effectively relieve you from your symptoms.
• If you develop instability while walking or if the fusion was not successful.
• When the new growth of the lamina exerts another pressure on your spinal cord or naval roots.

You may have spinal fusion at the same time with the laminectomy. The spinal fusion is meant to stabilize the parts of the spine that have undergone laminectomy. Typically, the fusion is done in unstable sections of your spine. These unstable sections may result to too much or abnormal movement of the vertebrae. The extra or abnormal movements may wear and tear soft tissue or muscles around the spine. The objective of spinal fusion is to stabilize the deteriorated bone in the spine in order to protect the soft tissues and muscles.

How Is a Laminectomy Performed?

A laminectomy is performed on general anesthetic. It means that during the whole procedure you will be unconscious. You may also opt for spinal anesthetic. Anyhow you will not feel any pain during the surgery. You will be monitored by an anesthesiologist throughout the entire procedure. At this time, your surgeon will be doing the following:

1. Make incisions of the affected areas in your lower back or neck.
2. Use antiseptic solution to clean the incisions to help you from contacting infections.
3. Create access to your spine by pushing your muscles aside.
4. Remove sections of your lamina or the whole of it.
5. Remove fragments of bones that may be affecting you.
6. Stitch back the incision and use sterile bandages to cover it.

During this operation and if need be, the surgeon may perform a spinal fusion. To stabilize your spine, the surgeon may connect two or more bones. He or she will also make the part that the naval roots connect with the spine wider in a procedure known as foraminotomy. The whole surgery should last about 1-3 hours.

Risks

Just like any other surgeries, laminectomy may pose a number of complications. This may also be influenced by the existing condition of your health and your spinal cord. Older people have a higher risk of these complications. The conditions may include:

• Reaction to the anesthetics
• Persistent infections on the wounds
• Clotting of the blood
• Numbness, weakness, or paralysis caused by naval injury
• Instability of the spine
• Loss of control of the bladder or bowel
• Severe pain after the surgery
• Skin complications
• Tearing of the tissues that seal the spinal cord.

Death may occur during surgery, even though this is a very rare circumstances. You are at a greater risk of the above mentioned complications if you are a smoker or if you are diabetic.