Specialties

Axial images (cross-sections) of lumbar MRI showing stenosis (narrowing) at L2-3, L3-4, and L4-5 (red arrows). L5-S1 with no significant stenosis (green arrow) shown for reference. Blue arrows point to the lamina to be removed as part of laminectomy procedure.

What is a laminectomy?

Laminectomy refers to removal of the lamina of the vertebral bones to provide space for the nerves or spinal cord. The lamina is the bony covering of the spinal canal in the back of the spine.  The term “ectomy” simply means removal.  Thus, a laminectomy is removal of the lamina.  This procedure is often performed to relieve the symptoms resulting from a narrowed spinal canal known as spinal stenosis.

What is spinal stenosis and how can a laminectomy help?

Degeneration of the facet joints and intervertebral discs and thickening of the ligaments (ligament hypertrophy) can result in narrowing of the spinal canal, known as spinal stenosis. The arthritic facets (joints between the vertebrae) become bulkier and consume the space available for nerve roots. Bony outgrowths called bone spurs can also narrow the spinal canal. Spinal stenosis can cause symptoms such as pain, tingling, numbness or weakness that extends to the extremities, and bowel or bladder impairment.

The spinal canal is a bony ring, and the goal of laminectomy is to relieve the pressure on the spinal nerves or spinal cord by removing the back portion (lamina) of this ring and opening (decompressing) the spinal canal.  Depending on the location(s) of narrowing, this procedure may be an option in the cervical spine (neck), thoracic spine (chest area), or lumbar spine (lower back area).  Depending on your condition, surgery may be an option if non-surgical treatments fail to relieve the symptoms after a reasonable amount of time.

How is a laminectomy performed?

You’ll be resting on your stomach and put under general anesthesia. One you’re asleep, your surgeon will make an incision near the center of the back and approach the vertebrae by carefully moving the soft tissues and muscles away. Then, the total lamina or part of it is removed to relieve the compression. If other compression sources such as bone spurs and/or disc fragments are present, those can be removed as well. The surgeon then brings the soft tissues and muscles back in to position and closes the incision.

In some cases, spinal fusion may also be done along with the laminectomy by placing bone graft or appropriate substitute between two affected vertebrae to allow bone growth between them. The bone graft acts as a medium for binding the two vertebral bones to help provide stability to the spine if needed. If you want to learn more about the spinal fusion procedure then please refer to the section on spinal fusion.

What does post-op recovery look like?

After the surgery, you may notice early improvement of symptoms.  Sometimes, symptoms improve more gradually.   Often these procedures involve a hospital stay.  Physical therapy may be prescribed once you have had a sufficient chance to recover.  Your return to work and daily activities depends on how fast your body heals and the type of activities you aim to resume.

What are the risks or complications of Laminectomy?

All surgeries carry risk and the laminectomy is no exception. In addition to the anesthetic complications, spinal surgery is associated risks such as:

• Infection
• Blood loss
• Blood clots
• Nerve/spinal cord damage
• Durotomy (opening of the spinal fluid sac)
• Spinal instability that may require an additional surgery
• And bowel and bladder problems

Failure to fuse the vertebral bones with the bone graft may also occur if a fusion is performed and could require an additional surgery.

Before going through with any surgical procedure, educate yourself and make an informed decision! Talk to your physician for a complete list of indications, clinical results, adverse effects, warnings and precautions, and other relevant information about the cervical laminectomy procedure.

If you have any questions, comments, or concerns, please talk to your surgeon or contact us for more information.

Patient referred with scoliosis above previous instrumentation and failure to heal (fuse) at the prior TLIF at the L5-S1 level (red arrow)

As part of revision surgery, patient had ALIF at L5-S1 with personalized cage to fit the space (green arrow)

What is Anterior Lumbar Interbody Fusion?

Anterior lumbar interbody fusion, or ALIF, is just like any spinal fusion procedure used to correct those painful, life-inhibiting problems in the lumbar (lower back) region of the spine, except this it is performed from the front instead of the back of the patient.

Who is ALIF for?

Patients who undergo ALIF typically have one of the following problems:

• Severe lower back or leg pain that non-surgical treatment cannot sufficiently address
• Pain caused by degenerative disc disorder in the lumbar region
• Spondylolisthesis (vertebra slips forward onto the bone below it)
• Scoliosis (sideways curvature of the spine)
• Spinal fractures
• Spinal instability

ALIF may be recommended as a treatment option only after the surgeon completes a number of assessments including the patient’s spinal condition, age, activity levels, medical history, etc. Talk to your surgeon or contact us to set up an appointment to see if ALIF is right for you.

How is the ALIF procedure performed?

First, the patient lies on their back and undergoes general anesthesia. Once the patient is asleep the surgeon will make an incision in the abdomen and retract the muscles and various structures to gain vision and accessibility to the front of the vertebral body in the lower back region. The disc between the bones is removed, followed by fusion of the two adjacent vertebrae often with the use of a spacer/cage. A plate may be placed spanning the bones above and below the disc space for better support and stability during the healing process. Once that is completed, the structures and muscles are safely put back in their former place and the incision is stitched closed.

The success of this surgery is dependent on various factors including age, spinal condition, the patient’s overall health, and their activity level.

How long is recovery for those who undergo ALIF?

The recovery period can vary and depends on the body’s healing capacity. Your surgeon may also prescribe pain medications, a brace, and follow-up physical therapy upon discharge from the hospital.

Your rest period or inactivity depends on a few factors such as the type and extent of surgical procedure and the approach used to access your spine.  Your return to work or normal activity depends on what work or activity you plan to perform. But generally, the initial healing time takes 3-6 weeks but the bony healing inside often continues for several months afterward.

We recommend that you strictly follow the post-operative instructions given to you by your surgeon to promote healing, reduce the possibility of post-op complications, and quickly get you back to doing the things you love in life.

What are the risks and complications of ALIF surgery?

Despite the advanced techniques and technologies available to surgeons, complications can still happen.  Some of these include:

• Infection
• Nerve damage
• Blood clots or blood loss
• Bowel and bladder problems
• Adverse reactions to anesthesia
• Failure for the bones to heal together