One of the methods of treating surgical spinal stenosis is laminectomy or hemilaminectomy. This procedure consists in widening the narrowed spinal canal by completely or partially removing the vertebral arches. The trapped nerve roots and / or spinal cord are released, removing the root cause of the condition.
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What is spinal stenosis?
The spinal canal runs the entire length of the spine. Its space is limited from the front by the vertebral bodies and intervertebral discs, and from the back by the vertebral arches. Spinal stenosis is usually a narrowing of this space as a result of degenerative changes in the spine, e.g.
bone outgrowths located on the back surface of the vertebral bodies,
herniated intervertebral discs,
degenerative changes in the intervertebral joints,
thickening of the yellow ligament covering the vertebral arches.
Within the lumbar spine canal is the lower section of the spinal cord and the spinal roots surrounded by the meningeal sac. These roots contain fibers that innervate the lower limbs and the sphincter muscles of the urethra and anus. Pressure on the nervous structures can lead to symptoms such as:
pain radiating to the lower limb,
muscle weakness (paresis in the limb) - inability to climb on your toes or walk on your heels,
involuntary passing of urine or faeces when you sneeze or exercise.
Indications for laminectomy / hemilaminectomy
Urgent indications for the procedure are paresis or urinary and fecal incontinence. The elective procedure is performed in the case of persistent pain despite the implementation of rehabilitation, analgesic and anti-inflammatory treatment. The indication for the procedure is pain that reduces the patient's quality of life, for example, making it difficult to perform daily activities or work.
How is laminectomy / hemilaminectomy performed?
The operation is performed under general anesthesia. The patient is lying on his stomach during the procedure. During the operation, it may be necessary to use X-ray viewing (fluoroscopy). The surgeon makes a longitudinal incision in the lumbar region, the length of which depends on the number of vertebrae that need to be plasticized. To reach the spine, the surgeon separates the muscles from the spinous processes and pulls them to the side. To widen the spinal canal, a procedure is performed:
Laminectomy - removal of the vertebrae along with the spinous process,
Hemilaminectomy - removal of the vertebral arch on one side only (right or left).
Additionally, the surgeon can release the nerve roots from pressure by widening the intervertebral openings (foraminotomy), cutting out bone spurs or removing the herniated disc (discectomy). After making sure that all nerve structures are free from pressure, the wound is closed with sutures. Sutures are removed approximately 7 days after surgery, unless absorbable sutures are used. Within the surgical field, a drain may be placed to carry blood to the outside. As a result, the wound heals faster and the pain after the procedure is reduced. The drain is usually removed 1-2 days after the operation.
Procedure after surgery
On the day of surgery and for a few days after the surgery, antibiotics are given to prevent wound infection, painkillers and anticoagulants to protect against thromboembolism. Getting up and walking is only possible with the surgeon's express consent. Discharge from hospital usually takes place 5-7 days after the surgery. The patient should participate in the rehabilitation process, thanks to which he will be able to safely return to everyday activities. For 6-8 weeks after the procedure, avoid lifting heavy things, making sudden movements, bends and twists of the torso. In some cases, it may be necessary to wear a corset that stabilizes the spine. The attending physician decides about the type of corset and the period of its use.
Ważne informacje
| Duration of the procedure (depending on the method) | |
| Tests required for surgery | morphology, coagulation, electrolytes, blood group |
| Anesthesia | |
| Hospital stay | |
| A period of significant dysfunction | |
| A period of limited dysfunction | |
| Removal of stitches - first visit | |
| Change of dressings | |
| Contraindications to the procedure |
Frequently asked questions about spinal stenosis surgery?
One method of widening a narrowed spinal canal is through laminectomy. This procedure consists in cutting out the vertebral arch plates together with the spinous process limiting the canal space from the back side. In a hemilaminectomy, the surgeon cuts the arch lamina on one side of the spinous process (right or left). If necessary, bone growths are removed and the intervertebral holes are deepened. The treatment allows you to decompress the pressed nerve roots or the spinal cord and relieve pain.
After a laminectomy (excision of the vertebral arches), getting up and walking is possible within a few days of the operation. The doctor makes the decision about the possibility of standing upright. Sometimes it is necessary to use a corset that stabilizes the operated section of the spine. Getting up and walking is done under the supervision of a physiotherapist.
