Laminectomy, Here's What You Need to Know

Laminectomy is a type of surgery that aims to remove the lamina, which is the very back of the spinal arch, in order to relieve pressure on the nerves, due to abnormal bone structure. Abnormalities in the structure of the spine can cause pressure on the spinal cord tissue which can cause nerve disorders. Laminectomy is done by removing the lamina, so that the spinal canal (the place where there are spinal nerves) becomes wider. Spinal cord compression is often caused by narrowing of the spinal cord due to changes in the shape of the spine. This compression of the spinal cord can cause pain, stiffness, and weakness in the arms, legs, or both. In addition to changes in bone shape, pressure on the spinal nerves can also be caused by protrusion of the bone bearing (herniated disk). Laminectomy is performed on a person if the symptoms caused by suppressing the spinal nerves have disrupted daily activities, and if other treatments have not been effective in alleviating complaints in patients.

Laminectomy Indications

Laminectomy is performed to treat spinal stenosis or narrowing of the spinal canal. Spinal stenosis can be caused by various diseases, such as:

• Thinning of the bones and calcification due to aging.
• Spinal deformity is congenital.
• Tumors of the spine.
• Spinal cord injury.
• Spinal pads that are protruding or herniated.
• Inflammation of the spinal joints (arthritis).
• Paget's disease of the spine which causes the bones to grow abnormally.
• Achondroplasia, which is a type of disease caused by dwarfism.

Symptoms of spinal stenosis that commonly appear in sufferers include:

• Pain or stiffness in one leg or both.
• Pain in the shoulder area.
• Difficulty controlling urination or bowel movements.
• Feeling weak and heavy in the leg or buttocks area.
• These symptoms are more severe when standing or walking.

However, because laminectomy is an invasive treatment, the doctor will first recommend a non-invasive treatment or other recovery method before performing a laminectomy, such as:

• Changes in patient activity.
• Physiotherapy.
• Quit smoking.
• Use a brace to maintain the spine posture, such as a corset.
• Anti-inflammatory drugs, pain relievers, and relaxants
• Lose weight, for patients who are overweight.

Laminectomy Warning

Laminectomy is not recommended for children or for people who have had previous kyphosis. Before deciding to undergo surgery, make sure that you have undergone all the other therapies that were recommended, but were unsuccessful.

Risk of laminectomy

Just like surgery in general, laminectomy can also pose risks, including:

• Surgical wound infection.
• Bleeding.
• Stroke.
• Blood clots.
• Hard to breathe.
• Heart attack.
• Reactions to medicines given.

Other risks that can arise from laminectomy are:

• Spinal cord damage.
• Fluid leak in the spinal cord (cerebrospinal fluid), due to tears in the protective membrane of the spinal cord (meninges).
• Pain that persists after laminectomy.

Laminectomy Preparation

Before undergoing laminectomy, patients are encouraged to discuss with a neurosurgeon, related to the drugs being consumed and the allergies suffered. If you are pregnant or late for menstruation, tell your doctor. If the patient is a smoker, the doctor will ask him to stop smoking before undergoing a laminectomy. In addition, if the patient is taking blood-thinning drugs, such as aspirin, the doctor will ask that the consumption of these drugs be stopped. Patients will also be asked to fast several hours before undergoing surgery. Ensure that there is a family accompanying because the patient will need post-operative assistance until the recovery period.

Laminectomy Procedure

Laminectomy is done by giving general anesthesia (general anesthesia) by the anesthetist, so that the patient will be in a state of sleep during this procedure. The first general anesthesia is given in the form of a mixed gas. After that, the doctor will help the patient to calm down by giving medicine by injection, and installing a breathing apparatus (intubation). If the patient has fallen asleep and intubation has been installed, the laminectomy procedure can already be started. The patient will be positioned on his stomach to ease the operation process. The doctor will clean the skin area on the back using an antiseptic solution, making it sterile from germs. After being sterile, the doctor will make a skin incision in the back, so that the underlying tissue becomes exposed. The connective tissue, ligaments, and muscles that cover the spine will be shifted to the side, so that doctors more easily observe and repair the spine. Some or all of the lamina will be removed from the spine, and sometimes the protrusion of the bone and spinal cavity are also removed. The doctor can do the spinal fusion by connecting two or more segments of the spine, so that the patient's spine is more stable. If needed, the doctor will perform a foraminotomy, which is the act of widening the spinal canal, so that the spinal cord tissue is more flexible. If the laminectomy operation is complete, the doctor will return the tissues, ligaments, and muscles to their original position. After that, the incision made for surgery will be sewn and covered with a sterile dressing to prevent infection. Laminectomy surgery generally lasts about 3 hours.

After laminectomy

Postoperatively, the patient will be made aware and will be hospitalized for several days. If the operation is done in the morning, evening or evening the patient will be asked to get out of bed and try to walk. Patients may still feel pain after surgery, but the doctor will give pain relievers. After monitoring at the hospital is finished, the patient will be discharged, usually after 1-3 days of hospital treatment. Some things that should be considered by patients undergoing post-laminectomy recovery include:

• Avoid heavy physical activity that can interfere with spinal recovery.
• Always be careful when walking and going up or down stairs.
• Don't forget to carry out routine control to the doctor so that the recovery process can be monitored.
• Do not rub the surgical suture, because it is feared to cause infection.
• Avoid stitching the wound in water, or applying lotion to the stitching area.
• Patients should gradually increase their physical activity to get used to the backbone in undergoing physical activity.

Contact the relevant doctor immediately if any of the following symptoms occur during the postoperative recovery period:

• Chest pain.
• Fever.
• Swelling in the surgical suture area.
• Liquid or pus comes out, and redness is at the site of the surgical suture.
• Swelling in the limbs.
• Loss of control of urination or bowel movements.
• Difficulty urinating.
• Difficulty breathing.

If there is pain in the wound wound area, the patient can take pain medication given by the doctor. Keep in mind, patients should not take any medication outside the doctor's recommendation, because it is feared that it can cause unwanted side effects, such as bleeding. Do not drive a car during the recovery period. If the surgical wound closes properly, the suture will be removed by the doctor during postoperative control.